SP0121 Occupational therapy in patients with rheumatic diseases
Authors: U Nordenskiöld
Journal: Annals of the Rheumatic Diseases (2001)

<h3></h3> Action for health is a central concept in occupational therapy and assuming that the individual is an active person with his or her own resources. Activity encompasses all such situations as personal care, living conditions, work, leisure, and relations to other people, referred to as activities of daily living (ADLs). Individuals with arthritis have problems conducting their daily lives because of pain, muscle weakness, stiffness, fatigue, reduced grip force and hand deformities. They are often unable to perform daily activities in what is considered a normal manner. When analysing the situation of patients, the occupational therapist may find the ICIDH, 2000 helpful, since it clarifies the different levels in the disablements process as; Body Functions Structure -Impairments, Activity – Activity Limitations, Participation – Restrictions analysing the problems an individual may experience in life situation and Environmental Factors. Most patients experience chronic pain. The frustration over the inability to perform tasks, dependence upon others and difficulties in adjusting routines, have been identified. The benefit of using assistive devices has been described as decreased pain and increased ability in performing daily activities. Research has shown that costs of these interventions related to their effectiveness have been considered rather low. Pain and reduced strength in the wrist and fingers, has a strong impact on the person´s daily activity. It has been shown that hand exercise reduce pain and have a positive effect on the finger joints. Research has also shown that an elastic wrist orthosis used in ADL situations decrease pain and stabilise the inflamed joints. ADL assessments are used by the occupational therapist to describe patients' problems, identify suitable intervention measures, establish goals, follow changes in ADL and evaluate treatment. The ADL instruments can also be used to measure whether the individual can perform the activity in a way that is satisfactory to the individual with assistance, or after special interventions. Research has revealed a significant reduction of patients' difficulties when they use assistive devices and altered working methods. The policy regarding assistive technology is based on two concepts: integration and normalisation. In recent years, the development of devices with good function and aesthetic design has become an area of increasing interest. Patient education such as the Joint Protection Programme have been developed to influence the patient's knowledge, emotion and behaviour and the patient's own activity is in focus. In occupational therapy for individuals with arthritis a combination of assessments and treatments of grip force, pain, hand function and the subjects' perceived ability/difficulty and needs in performing daily activities is to be recommended. The use of adaptive occupation, introducing alternative strategies, or modifying social environments are other aspects of the occupational therapists intervention process. Both the benefit of assistive technology in relation to the individual's goals and their own solutions should be identified and described. In order to understand why a person is more, or less, able to do the activities, it is important to consider both the person's physical capacity and the person's mental ability to perform in relevant situations. The role of an occupational therapist entails the ability to switch between the role of "efficient professional" and that of a caring fellow human being and have the ability to see the person/patient with arthritis as both healthy and sick. The most important goal is to build a basis for the individual's creative thinking that will enable them to find their own solutions to their problems. <h3>References</h3> WHO. <i>International classification of functioning, disability and health</i>. Geneva, 2000 Dellhag B. Handfuction in rheumatoid arthritis, (dissertation) Goteborg, Sweden, 2000 Nordenskiold U. Daily activities in women with rheumatoid arthritis. Scand J Rehab Med Suppl 1997;37:1–72