Table 2.

Recommendations on patient education and treatments for systemic sclerosis patients with hand function loss

			Level of evidence	Reference	Level of Agreement (0–10) Mean (s.d.); Median (range)
PATIENT EDUCATION
Provide patient education and advice to all SSc patients with hand function loss to enhance their knowledge about treatment options and promote self-management. The patient education and advice should be tailored to the individual patient but should contain the following aspects.
	13.	Independently and regularly doing hand exercises to maintain hand mobility and strength.	II	[19, 44–47]	9.1 (0.9) 9.0 (7–10)
	14.	A continuous use of hands in activities of daily living to maintain hand functionality.	V	n/a	8.7 (1.3) 9 (5–10)
	15.	Avoiding cold and keeping the hands warm.	IV	[48]	9.0 (0.8) 9 (8–10)
	16.	Good hand care, for example by moisturizing the skin (especially with lanolin-based products) and wearing protective gloves.	IV	[48]	8.3 (1.2) 8 (5–10)
TREATMENTS
a) Treatments for SSc patients whose activities of daily living are restricted due to limitations in hand function
	17.	Passive and active hand function exercises to promote hand mobility, functionality and strength, under the guidance of a skilled health professional (e.g. a hand therapist), should be offered to SSc patients who experience restrictions in the performance of daily activities due to hand function loss.	II	[19, 44–47]	8.5 (0.9) 8.0 (7–10)
	18.	Learning ergonomic measures under the guidance of a health professional such as an occupational therapist should be offered to SSc patients who experience restrictions in the performance of daily activities due to hand function loss.	I	[45, 49]	8.4 (1.1) 8 (7–10)
	19.	The adaption of hobbies and work (including volunteer work) to enable participation in meaningful activities of daily living, under the guidance of a health professional, e.g. a social worker or occupational therapist, should be offered to SSc patients who experience hand function loss.	II	[47]	7.9 (1.2) 8 (5–10)
b) Multidisciplinary treatments:
	20.	A multidisciplinary rehabilitation should be offered to SSc patients with hand disabilities that lead to problems in multiple domains of activities of daily living.	II	[19, 47]	8.0 (1.4) 8 (3–10)

Level of evidence (according to the standards of the Oxford Centre for Evidence Based Medicine), Level of Agreement for the recommendations, Numeric Rating Scale from 0 (total disagreement) to 10 (total agreement) reported as mean (range), n/a not applicable.