WHAT IS OCCUPATIONAL THERAPY?
Occupational therapy involves assessment and intervention strategies to help people maintain, restore, or improve their ability to engage in the occupations of daily life. Daily occupations are typically grouped into three main occupational performance areas: self-care (e.g., eating, dressing, bathing. mobility), productivity (e.g., employment, household work, parenting, going to school. volunteering), and leisure (social and rear-admit activities)W.Typically. patients with rheumatoid arthritis (RA) are referred to an occupational therapist by their rheumatologist or another health care provider because they have cited specific functional problems at home, work, or school. The cited problems are often just the tip of the iceberg, because some patients are reluctant to mention problems that seem insignificant (e.g., putting on cosmetics) or too shy about others (e.g., managing personal hygiene or perineal care). An occupational therapy assessment will identify and prioritize problems in all aspects of self-care, productivity, and leisure and had to an action plan to resolve those of greatest impact for the patient.
Referrals to occupational therapy are appropriate throughout the disease process in RA and are part of a comprehensive team approach to management . Early referral helps patients learn about the disease process and apply strategies to minimize pain and fatigue while preserving function. Occupational therapists provide a thorough evaluation of functional status to monitor disease progression and make recommendations for adapting activities or the home and work environment to enable participation in activities that are at risk or may have been curtailed by RA symptoms. Later in the disease process. occupational therapists offer resistive devices and strategies to compensate for functional impairment and provide pre- and postoperative rehabilitation for patients undergoing reconstructive surgery.
FUNCTIONAL LIMITATIONS IN RHEUMATOID ARTHRITIS
Despite advances in medical therapy to control arthritis symptoms, some people with RA will experience significant impairment and disability. Recent estimates of the prevalence of work disability In RA range from 22% to 38% . Adults with RA report working fewer hours of both paid and unpaid (household) work than healthy controls . In a survey of 142 women
with RA, more than half reported limitations in household tasks (cleaning, doing laundry, and shopping), and, among those with young children, 29% reported limitations in caring for them . Lower functional status and pain are associated with both household work limitations and limitations in paid work . RA has an adverse affect on participation in a range of productivity and leisure activities . and decreased functional abilities have been associated with depression (II). Because the domain of concern for occupational therapy is to maintain, restore, or improve performance in everyday activity. the prevalence of functional limitations in RA provides a strong rationale for inclusion of occupational therapy in the comprehensive management of the disease.
ASSESSMENT AND EVALUATION
The occupational therapist works collaboratively with the patient to identify problems in self-care. productivity, and leisure; identify the underlying causes of these problems; and propose solutions to restore or improve occupational performance. A patient-centered approach (termed client-centered in occupational therapy literature) is helpful to gain insight into individual beliefs, fears, knowledge of RA, and what techniques have been successful or ineffective in the past. Understanding the patient's perspective provides the basis for a collaborative relationship that often spans many years.
The patient-centered approach respects the individual views of people racking health cam and recognizes that their choices and decisions are the ones that direct the care plan . An individualized approach helps the term past to understand the influence of culture, family, community networks, and other environmental factors, as illustrated by a qualitative case study . Although not specific to managing RA, Increasing evidence Indicates that patient-centered approaches improve communication between health care providers and patients and result in greater patient satisfaction with care . Additionally., approach's, based on individualized, collaborative goal-setting with patients result in Unproved functional outcomes .
Once occupational performance problems have been identified, the occupational therapist assesses the Performance components Include physical, affective, and cognitive abilities. The physical assessment is comprised of functional range of motion and strength, observation and palpation of joint swelling, and deformity or Instability.
