Abstract
This paper is intended to give the reader an insight of what difficulties a person diagnosed with rheumatoid arthritis can face whether its pain inflammation, swelling. This research holds various ways on how OT can help with treating, decreasing pain so that the patient can return to their daily function or close to what they use to be able to accomplish.
INTRODUCTION
Occupational therapy is a vital part of care for clients with RA, because occupational therapy practitioners work with the clients and teach individuals skills to remain independent in everyday occupations through coping strategies, joint protection, education, physical activity, adaptive devices, environmental modifications and how to use splints and restore joint function, range of motion, and mobility. Studies have shown that after a few sessions with an occupational therapist, patients are more mobile and able to regain their normal daily chores they could not do before for example cooking, cleaning, dressing, etc. There are several different approaches on educating a client to plan, simplify, and pace tasks as a way of protecting joints; reducing strain, fatigue, and pain; and avoiding joint and tissue overuse while participating in everyday activities (ADL). They observe the patient’s lifestyle and determine the areas where the quality of life can be improved by performing activities differently. Modification and adaptability go hand in hand with energy conservation and joint protection. Easy-grip handles, adjustable shelves, grab bars, a raised toilet seat, a chair with arms, and removal of clutter are examples of adaptive equipment and approaches that can be used to positively influence a client’s independence in their environment. These combined strategies address the clients' functional needs and maintain or increase their participation in home, work, leisure, and community activities by accommodating for decreased joint motion, strength, and endurance. Occupational Therapy will not cure this disease, it will only help make it manageable to live with.
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WHAT ARE JOINT PROTECTIONS AND ENERGY CONSERVATION TECHNIQUES?
The term ‘joint protection’ is used to describe ways to reduce stress and pain in your joints. This can help reduce inflammation and preserve your joints. Conserving your energy also helps to protect your joints and improve endurance. One study (Hammond, Jefferson, Jones, Gallagher, & Jones, 2002), which included two 2-hr face-to-face sessions and a home program, resulted in a significant increase in the use of joint protection behaviors after 3 months. Immediately after intervention, increases in grip strength, overall knowledge, and self-efficacy were seen. A 4-year follow-up of these same participants found that even though function decreased in both groups over time, the decline was steeper in the control group (Hammond & Freeman, 2004).
ENERGY CONSERVATION/JOINT PROTECTION TECHNIQUE BENEFITS TO PATIENT
Energy conservation and joint protection go hand in hand, they are treatment techniques used by occupational therapist to teach the clients on proper proactive ways to conserve energy and protect the joints. The client should Use the strongest/largest joints Available for the activity at hand, Large joints are stronger than smaller ones. The patient should Save their smaller, weaker joints for the specific jobs that only they can accomplish and favor large joints when possible. Carrying objects with the palm open, distributing the weight equally over your forearm will transfer excess weight throughout the whole arm. Such as carrying a purse or satchel over the shoulder instead of grasping it with their hands. If their shoulder is in pain, the client should use a backpack. Clients should spare their fingers as much work as possible. The client should try to avoid prolonged pinching or gripping motions. The client should Use less force to hold tools or equipment. The client should Rest their hands flat and open rather in a tight fist. The client should Push heavy objects using the weight of the body, rather than pulling or lifting. OT will educate the client on reducing the effort needed to complete an activity by adding leverage to items, such as reducing the force needed to operate a levered faucet, or door handles. Planning such as gathering all items needed before starting an activity or job, by managing workloads from heavy to light tasks throughout the day and week will lessen the load for the patient and promote energy conservation. The Clients should pace themselves to avoid Fatigue by Planning the day to allow for a balance of rest and activities, clients shouldn’t wait until they are tired before taking a rest period. Client should Sit when Possible, by Sitting and taking rest periods this eliminates considerable fatigue on the individual, if the client is having difficulty standing for a long period of time, they should use a seat in the shower, when dressing or whenever completing a task that requires long period of time standing. While sitting the client must Make sure they have good back and foot support. Their forearms and upper legs should be well-supported, resting level with the floor. The patient should Select an activity to improve; one that takes too long, one that increases fatigue or pain to work on simplification strategies. The Occupational therapist Determine if the activity is necessary and if the client is the best person suited to do it, by breaking down the activity into steps, getting ready, performing the activity, clean up after completion will help ease the patient in doing the task given. What is the best way to perform an activity using the energy conservation? Using Good Posture by Sitting and standing straight, Proper body alignment will balance the muscles out and decrease stress. Using Good Body Mechanics such as Pushing or pulling, rather than lifting will help alleviate the pressure on the joints. Sliding objects along the counter-top (pots and pans, gallon of milk, and other heaving items). Stand close to the object to be moved. Carry items close to the body, keeping your back straight. Avoid bending, reaching, twisting. If you must lift, you should do so with your leg muscles rather than your back
As occupational therapist we are thought to respect pain, no matter the level that it may be. If an activity causes joint pain, the OT will change the way that activity is being done or change the activity to a more tolerated one. Continuing the activity despite pain can damage the clients joint. Forging the activity altogether can lead to joint stiffness through lack of use. As a general guideline, if pain persists for one hour after doing an activity, consider changing the way its being done. For example: Taking frequent rest breaks. Using adaptive tools or furniture such as (Reacher, grab bars, chairs with handles, higher chairs) and alternate between sitting and stretching, and light and moderate activities, throughout the day. If the client has pain in their feet, they should wear proper shoes. The patient should Ask their doctor or occupational therapist for specific recommendations. The client should never give their joints the chance to become stiff by keeping them in a constant motion. When writing or doing handwork, the client should release their grip every 10 to 15 minutes, or when their hand feels tired. If the client works at a computer, they should do hand and thumb stretches for 10 seconds every hour, to relieve those joints. On long car trips, take breaks every hour or two so you can get out and stretch. If client travels a lot on the airplanes, they should choose aisle seats, so they can shift their legs more easily. When doing repetitive tasks, the client must change their body position every 20 to 40 minutes. The client should Reduce excess body weight, Excessive weight puts a strain on the patient’s body, especially the lower back, hips, knees and ankles. Losing weight is ideal when diagnosed with RA, this will help decrease their pain and increase their energy level throughout the day.
CONCLUDING SUMMARY
When managing Rheumatoid Arthritis there are several techniques and treatment intervention, that’ll help our patients manage pain and decrease inflammation and swelling in their joints. Educating the patient on energy conservation and joint protection precautions are two beneficial ways to help a patient in pain, by educating them on the proper ways to take frequent rest brake, use larger joints unless smaller joints are required, how to organize their daily activity in a manner where it lightens their workload, how to use proper body mechanics, proper body alignment, how to use adaptive devices to facilitate their everyday activities such as bathing, walking, sitting and many other activities, teaching the patient how to use step by step sequencing activities. A patient pain level should always be regarded and respected by OT practitioner, if pain is identified the task being completed should be modified or changed to an easier task that help alleviate the patients pain level. These techniques are key when it comes to a patient diagnosed with RA, they are great tools to help manage a patients pain and decrease there swelling and discomfort. With these methods a patient will be able to return to their daily activities such as work, school, leisure or any activities their lacking in because of their pain level.
REFERENCES
- Gecht-Silver MR, et al. Overview of joint protection. http://www.uptodate.com/home. Accessed Jan. 28, 2015.
- Hochberg MC, et al. Rheumatology: 2-volume set. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Jan. 28, 2015.
- Kucukdeveci AA, et al. Inflammatory arthritis. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM section professional practice committee. European Journal of Physical and Rehabilitation Medicine. 2013;49:551.
- This work is based on the evidence-based literature review completed by Janet Poole, Ph.D., OTR/L, FAOTA, Patricia Siegel, OTD, OTR/L, CHT, Marian C. Arbesman, PhD, OTR/L, FAOTA, Melissa J, Tencza, B.S., MOTR/L, and Beverly Apodaca, MOTR/L.
- Centers for Disease Control and Prevention. (2010). Arthritis: Meeting the challenge: At a glance 2010. Retrieved December 27, 2010, from
- http://www.cdc.gov/chronicdisease/resources/publications/aag/arthritis.htm 2. Boutaugh, M. L. (2003). Arthritis Foundation community-based physical activity programs: Effectiveness and implementation issues. Arthritis Care and Research, 49(3), 463–470
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