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Small Changes can make a Huge Difference

How occupational therapy can help those living with rheumatoid arthritis

By Dave Parsons BSc. (Occupational Therapy)

Unit Coordinator (Orthoses and Rehabilitation Science), Lecturer School of Occupational Therapy and Social Work, Curtin University

Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory condition that primarily affects the body’s joints.  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 by assisting our clients in engaging in valued occupations by modifying the job, 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 to prevent further joint deformity, minimise pain, minimise swelling, and further destruction of the joint surfaces whilst maintaining strength and joint movement.  These goals are achieved through lots of education on protecting joints and conserving energy – making valued activities easier. The fabrication and provision of orthoses (splints) are also a vital role of the occupational therapist in allowing our clients to continue doing what they want to do, such as cooking, making sushi, or playing cards with the kids.

Joint protection and energy conservation strategies are one of the best ways to help reduce RA’s overall impact on joints. Altering the way a task is completed 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 time to allow the body to rest and recoup between each more minor task. As a result, less energy is used at once, and the stress level 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 useful in managing RA. There are plenty of products available 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. at www.lifetec.org.au/or call 1300 885 886, and Indigo Solutions (Nedlands, WA) at www.indigosolutions.org.au/or call 9381 0600.

Orthoses (splints) for the hand and wrist are another great option for helping manage the pain and swelling, resulting in increased function. They also benefit from maintaining the correct alignment of joints and help prevent joint deformity by counteracting destructive forces and providing support.  Orthoses are custom-made by specially trained therapists for individual fit and comfort or prefabricated based on generic sizes.

It is always recommended you see a qualified occupational therapist with specialist training in hand and upper limb rehabilitation to get advice on the best orthosis option for you. Several factors 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 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. However, you can do a few small things 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 live with RA and you would like further information about how an occupational therapist can help, speak with your GP or Rheumatologist.

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.

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