Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory condition that primarily affects the joints of the body. The best management of RA is a holistic approach - including both medical and therapeutic interventions.
The primary goal of occupational therapy is to enable people to participate in activities of everyday life. As occupational therapists, we achieve this through assisting our clients to engage in valued occupations by modifying the occupation, the environment or both. Key roles in the management of clients with RA include; thorough assessment of the effect of RA on the bones, muscles, tendons and ligaments of the hand; specific function of the hand; and the overall engagement in valued occupations of our clients.
Following a thorough assessment, a treatment plan will be created in collaboration with our client that is aimed at preventing further joint deformity, minimising pain, minimising swelling, and further destruction of the joint surfaces, whilst maintaining strength and joint movement. These goals are achieved through lots of education on ways to protect joints and conserve energy – making valued activities easier. The fabrication and provision of orthoses (splints) is also a key role of the occupational therapist in allowing our clients to continue to do what they want to do, for example; cooking, making sushi or playing cards with the kids.
Joint protection and energy conservation strategies are one of the best ways to help reduce the overall impact that RA has on joints. Altering the way a task is completed (by using specific techniques) has been clinically proven to reduce pain during activity, reduce forces on joints, reduce inflammation and subsequent strain on soft tissue, reduce fatigue and help preserve the joint surface - all of which improve or maintain function.
Some of these strategies include breaking down the activities that worsen symptoms into smaller tasks. These smaller tasks are then spread out over a longer period of time, to allow the body to rest and recoup between each smaller task. As a result, less energy is used at once and the level of stress on joints is reduced as the body has a chance to recover. This strategy often requires pre-planning to accommodate the increased time it will take to complete a task - however the overall benefit for your body is well worth taking it slow and steady!
Using equipment that can help place less stress on joints is also really useful in managing RA. There are plenty of products available for purchase for a small cost that can make a huge difference in the day-to-day tasks at home. Arthritis Queensland has a small range of aids to assist with daily living available online at www.arthritis.org.au/our-services/arthritis-shop. Another provider of information and advice on assistive technology is Life Tec. Visit their website or call 1300 885 886.
Orthoses (splints) for the hand and wrist are another great option for helping manage the pain and swelling resulting in increased function.
They also have the benefit of maintaining the correct alignment of joints and help in the prevention of joint deformity by counteracting
destructive forces, and providing support. Orthoses are either custom-made by specially trained therapists for individual fit and comfort or
prefabricated based on generic sizes.
It is always recommended to see a qualified occupational therapist with specialist training in hand and upper limb rehabilitation to get advice on which is the best orthosis option for you. There are a number of factors that impact the decision and the occupational therapist will conduct a thorough assessment and provide recommendations on the best choice based on your individual needs and occupational limitations. If it is required, they will be able to make you a custom-fit splint and provide specialist advice tailored to your needs. You do not require a referral from your GP to make an appointment, however they may be able to point you in the right direction to find the closest one. Appointment costs from registered occupational therapists are eligible for Private Health Insurance rebates, depending on the level of cover.
Living with RA can be challenging. There is however a few small things that can be done that can significantly improve the quality of life for those living with RA. Breaking down tasks and spreading them out over the day, using the bigger joints in the hand instead of small joints to complete tasks and employing orthoses where appropriate, can help make the day to day a little easier. If you are living with RA and you would like further information about how an occupational therapist can help, speak with your GP or Rheumatologist.
By Dave Parsons
BSc. (Occupational Therapy)
Unit Coordinator (Orthoses and Rehabilitation Science)
Lecturer School of Occupational Therapy and Social Work, Curtin University
Dave Parsons lectures in hand therapy and orthoses fabrication at Curtin University in the School of Occupational Therapy and Social Work. He has extensive experience working in both the public and private sectors in the area of hand and upper limb rehabilitation, prior to moving into a teaching position. He is both a Full Member as well as Treasurer of the Australian Hand Therapy Association (AHTA), the peak professional body representing Hand Therapists in Australia.
Note: Joint protection and energy conservation techniques are not only useful for the treatment of rheumatoid arthritis, but for many types of arthritis. People with osteoarthritis of the hands (for example, at the base of the thumb) can also find that splints relieve pain and improve function.
Reproduced with the permission of: Arthritis Western Australia