Rheumatoid arthritis (RA) commonly affects hand function, causing pain, disability, and reduced quality of life (QoL)—particularly among women in resource‐limited settings. While aquatic therapy is often promoted for its joint‐protective properties, its accessibility and long‐term feasibility remain limited. This randomized controlled trial compared the effects of land‐based versus aquatic dynamic hand exercises on pain, hand function, and health‐related quality of life (HRQoL) in 40 adults with RA recruited from Assiut University Hospitals, Egypt. Participants were randomly assigned to 12 weeks of supervised, dynamic hand exercises performed either on land or in water, with outcomes assessed at baseline, post‐intervention, and 3‐month follow‐up. Both groups showed significant improvements; however, the land‐based group demonstrated superior and sustained benefits in pain reduction (VAS: 1.80 vs. 2.90, p = 0.036), hand function (DHI total: 21.05 vs. 28.25, p = 0.048), and HRQoL (QOL‐RA: 5.10 vs. 10.80, p = 0.02; lower scores indicate better QoL) at follow‐up. Notably, 80% of the land‐based group achieved low disease activity or remission (CDAI ≤ 10) compared to 40% in the aquatic group ( p = 0.046). Adherence remained high in the land‐based group (EARS: 38.75) but dropped sharply in the aquatic group (21.45, p < 0.001) post‐intervention. These findings underscore that culturally adapted, land‐based hand exercises offer a feasible, effective, and equitable strategy for RA self‐management—particularly where hydrotherapy access is constrained. For nursing practice, this supports integrating low‐cost, home‐based functional exercise into routine chronic care to enhance autonomy, adherence, and long‐term outcomes in underserved populations.
Ahmed et al. (2026) studied this question.