Physical and Occupational Therapy
Rheumatoid arthritis (RA) is a chronic, progressive condition that can affect all aspects of life, from normal functioning and daily activities to maintaining independence. Specialists in rehabilitation medicine are trained to promote musculoskeletal health, address symptoms, and help to develop strategies to handle special challenges. The goals of physical therapy and occupational therapy are to preserve physical functioning, promote bone and joint health, and find solutions to more easily carry out the tasks of daily living, both at home and at work.1
The role of physical therapy in RA depends on a patient’s disease severity and level of disability. For example, patients who function well and have minimal disability might consult a physical therapist (PT) to develop a tailored exercise program designed to support general health. For patients with greater disability, the PT can offer non-drug interventions and exercise techniques designed to improve RA symptoms and daily functioning.2
Regardless of the level of disability, goals of physical therapy in RA remain the same: to help you maintain or improve physical function, prevent disability, and reduce pain. To fit your needs, the PT will: 2
- Develop an individualized exercise program to address symptoms and maximize health and functioning
- Introduce aids and adaptive equipment to improve physical functioning
- Use specific tools (eg. application of heat and cold, ultrasound) to provide symptom relief
What can I expect in working with a PT?
During your first appointment, the PT will ask about your medical history, conduct a complete assessment of your physical functioning and limitations, and ask you the reason(s) for your visit. You may want to develop an exercise program or address specific RA symptoms, including the function of certain joints.
Your PT will ask you in detail about your medical history (including other conditions you may have), how RA affects you, what medications you take, and what physical problems affect your quality of life. This initial assessment will provide your PT with a detailed picture of your baseline, where you are at the present.
He or she may have you complete some standard physical tests to determine your level of functioning. This baseline information will be useful when it comes to developing a treatment program, whether it includes exercise, use of assistive devices, or other interventions, such as water therapy and ultrasound, or a combination of each of these. Baseline information will be useful in monitoring your progress and in making adjustments to your treatment program over time.
After a thorough assessment, your physical therapist will work with you to develop a treatment plan, including a home exercise program tailored to specific symptoms and challenges. Your PT may recommend the use of assistive devices, such as mobility aids and splints. If custom orthotics or supportive shoes are recommended, your PT can make a referral to a podiatrist.
The primary goal of occupational therapy is to help you maintain everyday skills needed to remain independent and productive at home and at work. Guidance provided by an OT may overlap somewhat with that of a PT, but the OT focuses more on developing practical solutions to help you carry out the basic activities of daily living so you can maintain a high quality of life.1
The focus of occupational therapy is occupation or any activity that requires time and energy and gives meaning to life, at home, at work, or in the community. The OT is specially trained to offer instruction on making environmental and behavioral adaptations to maintain and improve functioning.1
Occupational therapy interventions
Occupational therapy focuses on removing or reducing barriers that prevent you from enjoying leisure activities, staying productive, and being fully involved in self-care. Your OT will use several tools to help you achieve your goals, focusing on three major areas key to one’s ability to function independently:1,3
- Physical functioning (strength, mobility, and coordination)
- Engagement in activities of daily living which may involve use of adaptive equipment and assistive technologies to function safely and efficiently at home, office, and in the community
- Development of strategies to manage energy in daily activities and minimize fatigue
What can I expect in working with an OT?
Your doctor may suggest working with an OT when you notice that you are having difficulty engaging in common daily activities, such as getting around the house, preparing meals, taking care of personal hygiene, and engaging fully and productively at work. If your doctor notices these types of problems or if you mention them during an office visit, he or she may recommend an OT experienced in working with individuals with RA.
During your initial meeting, the OT will conduct a thorough evaluation of your needs, focusing on specific activities or tasks that you want to be able to do or continue to do. The next step will be to identify what factors are restricting or limiting you from a certain task or activity. These factors generally fall into one of three categories: personal factors (RA-related symptoms that pose a barrier to functioning), environmental factors (elements of your physical or social environment, such as home and work accessibility, that pose a barrier to functioning), and occupational factors (the physical demands of an activity).
Once your OT has identified the factors that affect your ability to carry out a task or activity, he or she will work with you to develop an intervention to help you achieve your goals. For instance, if you are having problems getting around the house or accomplishing activities of daily living, such as bathing, grooming, preparing meals, or cleaning, your OT may suggest you reorganize your living space and/or use adaptive equipment to make basic tasks easier. Analysis of work and home activities can provide useful information about how to modify desired activities.
- Smith HR. Rheumatoid arthritis treatment & management. Medscape. Available at https://emedicine.medscape.com/article/331715-clinical. Accessed 6/13/18.
- Kavuncu V, Evcik D. Physiotherapy in Rheumatoid Arthritis. Medscape General Medicine. 2004;6(2):3.
- de Almeida PHTQ, Pontes TB, et al. Occupational therapy in rheumatoid arthritis: what rheumatologists need to know? Revista Brasileira de Reumatologia. 2015;55(3):272-280. http://dx.doi.org/10.1016/j.rbre.2014.07.008.