Systematic review and meta-analysis of the effectiveness of rehabilitation interventions on upper limb function in patients with systemic sclerosis

Abstract

Objective To systematically synthesize the available evidence regarding the effects of rehabilitation interventions on upper limb function, pain and activity performance in patients with systemic sclerosis (SSc), and to further evaluate the limitations of current evidence base and the comparative effectiveness of rehabilitation delivery modes. Methods Computer searches of databases such as PubMed, Embase, Web of Science, The Cochrane Library, Medline, CINAHL, the SinoMed (China Biomedical Literature Service System), CNKI, WanFang Data Knowledge Service Platform,and VIP were conducted to collect randomized controlled trials on rehabilitation interventions for upper limb function in patients with systemic sclerosis, with search time spanning from database inception (January 1, 1990) to May 2026. Considering the limited number, high clinical heterogeneity and generally moderate-to-high methodological bias risk of included trials, this study adopted a combination of meta-analysis and cautious narrative synthesis. Two researchers independently screened the literature and extracted data according to inclusion and exclusion criteria, and assessed the quality of included studies using the bias risk assessment tool recommended in the Cochrane Handbook 5.1.0. Meta-analysis was performed using RevMan 5.4 software for outcomes with acceptable heterogeneity. Results A total of 8 studies were included, with a total of 729 cases. The overall evidence base is limited, with no high-quality low-bias Grade A studies, and a single large trial dominates the pooled weight of many analyses. Meta-analysis results showed that patients with systemic sclerosis who received rehabilitation intervention demonstrated significant improvements in pain [MD = −4.41, 95% CI (−6.54, −2.29), P < 0.0001], hand mobility [MD = −2.58, 95% CI (−4.09, −1.06), P = 0.0009], and DASH score [MD = −6.91, 95% CI (−12.54, −1.27), P = 0.02] at the end of intervention compared to the control group, with statistically significant differences. For outcome indicators that could be subjected to subgroup analysis, the results showed that face-to-face rehabilitation guidance yielded a marginally significant improvement in hand function [SMD = −0.40, 95% CI (−0.77, −0.02), P = 0.04]; however, such subgroup findings should be interpreted cautiously due to small sample size and confounding factors. Meanwhile, the effect of rehabilitation exercises on improving patients' SHAQ scores was not significant [MD = −0.03, 95% CI (−0.25, 0.20), P = 0.81], with no statistically significant difference. Conclusion Rehabilitation interventions have a positive effect on the hand function, hand mobility, and local upper limb function of patients with systemic sclerosis, and can also aid in pain relief. However, rehabilitation cannot improve the multidimensional overall disease status reflected by SHAQ. Current evidence is limited by small trial quantity, high heterogeneity and suboptimal methodological quality; firm definitive conclusions and practice-changing recommendations cannot be drawn. Face-to-face rehabilitation displays only preliminary favorable signals compared with remote rehabilitation, and definite superiority cannot be verified. In clinical practice, rehabilitation programs may be selected based on individual patient circumstances with very cautious reference to the limited evidence base. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1019908, PROSPERO CRD420251019908.