“They are especially helpful with patients who have issues that include reduced range of motion in the hands and in patients who are unable to do activities of daily living,” Dr. Rubenstein says.
Because visits might be limited by what insurance will cover or how often patients can come for appointments, Perniciaro likes to ask patients about the two or three activities that are most important to them, and she will focus on those. “If it’s not meaningful to the patient, then they won’t do it,” she says.
Occupational therapists will consider patient goals along with treatment orders from rheumatologists, which are sometimes as vague as “evaluate and treat,” says occupational therapist Lenore Frost, PhD, OTR/L, CHT, clinical associate professor, Department of Occupational Therapy and Health Sciences, Sacred Heart University, Fairfield, Conn. Other times, the orders are more focused, with requests for specific splints or patient education.
Here’s some of what goes on during OT sessions for patients with rheumatologic conditions. The therapist will:
- Review activities of daily living that are difficult for the patient and suggest ways to make those tasks easier (see below). “If the hands and upper extremities are largely affected, fine motor ability, such as picking up small objects, giving change to a cashier, putting on earrings, buttoning, pulling the tab on a baby diaper or turning a car key can be more difficult,” says Frost. Gross activities that may be difficult could include drinking from a coffee mug with one hand, washing one’s hair, bathing a child or participating in such activities as golf or tennis.
The therapist provides concrete solutions to approach activities in a different but easier way, says ARHP member Carole Dodge, OT, CHT, allied health supervisor/clinical specialist, physical medicine and rehabilitation, Occupational Therapy Division, University of Michigan Hospital and Health Systems, Ann Arbor, Mich. Although patients may need some time to get accustomed to those new approaches, “by the third or fourth time, it’s habitual,” she says. - Use heat to help loosen joints. Rheumatologist Arlene Tieng, MD, Bronx-Lebanon Hospital, and instructor, Department of Medicine, Albert Einstein College of Medicine, New York, had an occupational therapist tell her that she likens the heated paraffin wax treatments some patients receive to that used at nail salons—a description that many patients immediately understand. That description helped Tieng better describe at least one type of therapy patients might get in OT.
Fluidotherapy, which involves dry heat provided by cellulose particles in a special machine, can provide relief to the hands and forearms in certain patients, says occupational therapist John Indalecio, OT, Hand Therapy Center, Hospital for Special Surgery, New York.
Design splints to help patients reduce their joint swelling, pain and use. - Discuss ways to conserve energy throughout the day or even long time periods. By carefully planning daily, weekly or even monthly activities, patients can help reduce joint stress and not overextend their energy on a particular task, says Indalecio. “When patients are overfatigued, a rush of symptoms can occur,” he says.
- Educate the patient on how to use walkers and canes, something the patient may be resistant to do.
An analysis of six reviews published on the efficacy of RA-related interventions used by occupational therapists found sufficient evidence to support the profession’s therapeutic exercise, patient education on joint protection and splinting for pain, inflammation and joint strength, according to a study published this year in Occupational Therapy in Health Care.1