Each recommendation is followed by recommendation grades (Level I or II and A, B, C+, C and D). Definitions of the recommendation grades are presented at the end of the "Major Recommendations" field.
Shoulder functional strengthening (strengthening involving movement useful in daily activities) versus control, level II (controlled clinical trial [CCT], n = 28) (Mannerkorpi & Bjelle, 1994): Grade C for activities of daily living (ADL), pain, and range of motion (ROM) at 2 months (no benefit). Patients with chronic rheumatoid arthritis (RA), functional class I or II, and shoulder pain.
Hand functional strengthening versus control, level II (CCT, n=41)(Hoenig et al., 1993): Grade C for ROM and grip force at 3 months (no benefit). Patients with chronic RA and functional class II or III.
Knee functional strengthening versus control, level I (randomized controlled trial [RCT], n = 35) (McMeeken et al., 1999): Grade A for pain at 6 weeks (clinically important benefit); grade C for function at 6 weeks (no benefit). Patients with seropositive or seronegative inflammatory RA requiring long-term medication.
Whole-body functional strengthening versus control, level II (CCT, n = 312) (Ekblom et al., "Effect of short-term physical training: I," 1975; Ekblom et al., "Effect of short-term physical training: a six-month follow-up," 1975; Hakkinen, Hakkinen & Hannonen, 1994; Harkcom et al., 1985; Kirsteins, Dietz, & Hwang, 1991; Minor & Hewett, 1995; Nordemar et al., 1981; Noreau et al., 1995; Rintala, Kettunen, & McCubbin, 1996; Van Deusen & Harlowe, 1987): Grade B for sick leave and lower-limb muscle force at 8 years (clinically important benefit); grade C+ for swollen joints at 2 months. Grade C for the following: pain at 2 months and 8 years; function at 3 and 6 months; ROM at 3, 6, and 12 months; number of inflamed joints at 2 months and 8 years; grip force at 2, 6, and 12 months; leg muscle force at 8 weeks; and walking capacity at 6 weeks and 6 months (no clinically important benefit). Patients with diagnosis of RA and functional class I, II, or III.
Whole-body, low-intensity functional strengthening exercises (group dynamic exercises) versus instructions for home, level I (RCT, n=100) (van den Ende et al., 1996): Grade C for pain, function, swollen/tender joints, and global patient (patient's assessment of overall disease activity or improvement (Philadelphia Panel Evidence-Based Clinical Practice Guidelines, 2001) at 3 and 6 months (no benefit). Patients with RA (chronic stage).
Physical activity versus bed rest, level I (RCT, n=145) (Alexander, Hortas, & Bacon, 1983; Lee et al., 1974; Mills et al., 1971): Grade A for grip force at 3 months (clinically important benefit); grade C for pain, tender joints, function, ROM, swollen joints, and time to walk 15.24 m (50 ft) (no benefit demonstrated). Patients with RA (chronic stage).
Whole-body, low-intensity exercises (individualized) versus control (written instructions for home exercises), level I (RCT; n=100) (van den Ende et al., 1996): Grade A for change in function at 3 months (clinically important benefit); grade C+ for pain relief at 3 months (clinically but not statistically important benefit); grade C for changes in tender/swollen joints, joint mobility, and muscle force at 3 and 6 months (no benefit). Patients with RA (chronic stage).
Whole-body, high-intensity exercises (group) versus control (written instructions for home exercises), level I (RCT, n=100) (van den Ende et al., 1996): Grade C for pain, function, joint mobility, muscle force, and swollen/tender joints at 3 and 6 months (no benefit). Patients with RA (chronic stage).
Whole-body, low-intensity exercises (group) versus whole-body, high-intensity exercises (group), level I (RCT, n=100) (van den Ende et al., 1996): Grade A for pain at 6 months (clinically important benefit favoring low intensity); grade C+ for function at 3 months (clinically but not statistically important benefit); grade C for joint mobility, muscle force, and swollen/tender joints at 3 and 6 months (no benefit). Patients with RA (chronic stage).
Definitions:
The recommendations were graded by their level (I for RCTs, II for nonrandomized studies) and strength (A, B, C+, C, or D) of evidence.
Grade A: Evidence from one or more RCTs of a statistically significant, clinically important benefit (>15%)
Grade B: Statistically significant, clinically important benefit (>15%) if the evidence was from observational studies or CCTs
Grade C+: Evidence of clinical importance (>15%) but not statistical significance
Grade C: An appropriate outcome was measured in a study that met the inclusion criteria but no clinically important difference and no statistical significance were shown
Grade D: Evidence from one or more RCTs of a statistically significant benefit favoring the control group (<0%: favors controls.)
