Few gains seen from occupational therapy in early RA

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Rheumawire

Jan 5, 2004

Few gains seen from occupational therapy in early RA

Derby, UK - Early, aggressive pharmaceutical treatment provides clear

benefits to most patients with rheumatoid arthritis (RA), but

occupational therapy (OT) during the first year of RA has little effect

on health status, British researchers report.

Writing in the January 2004 issue of ls of the Rheumatic Diseases,

Dr Alison Hammond (Derbyshire Royal Infirmary, Derby, UK) says,

" Self-management significantly increased in the OT group. Otherwise,

there were no significant differences in any outcome measures, or

between groups, by American College of Rheumatology functional class,

Arthritis Impact Scale 2 (AIMS2) physical function, pain visual analog

scale (VAS), or total Arthritis Self-Efficacy Scale (ASES) score. "

Hammond adds, " This study suggests that rheumatology departments should

think twice before providing early secondary preventive intervention to

everyone with RA using current 'typical' methods. "

This randomized, controlled, assessor-blinded trial included 162

patients randomized to OT plus usual rheumatology care and 164

randomized to usual care without OT. All patients had been diagnosed

with RA by a consultant rheumatologist within the previous 2.5 years,

(median disease duration 9 months). Patients were assessed at baseline

and at 6 and 12 months.

The OT intervention was 4 1-hour individual treatments and 1 2-hour

group education program, delivered over 6 to 8 weeks and lasting a total

of 8 hours. The OT intervention included information about RA treatment

and management, activities of daily living (ADL) training, joint

protection and energy conservation, posture and positioning, and a

range-of-movement hand-exercise home program. " A supportive approach of

listening and counseling was integral, " the researchers note.

Outcome measures included the health assessment questionnaire (HAQ), the

AIMS-2, the disease activity scale 28 (DAS28) tender and swollen joint

count, ACR functional grade, duration of early-morning stiffness, and

100-mm pain VAS in the preceding week. Hand status was evaluated using

grip strength and Jebsen hand function test. Psychosocial outcomes were

measured using the ASES, the Rheumatoid Attitudes Index, and 2 scales of

the AIMS2 that form the Affect Scale (level of tension and of mood,

which are measures of anxiety and depression).

" The intensive program of OT aimed to be a secondary preventive

intervention, facilitating adjustments in lifestyle and preventing

losses of function in the long term. It was successful in leading to

greater use of self-management. However, over the 2-year follow-up

period it did not make a significant difference to the health status of

people with early RA, " Hammond reports.

The investigators suggest that 2 factors might have contributed to this

lack of effect. First, a qualitative study with a subgroup of the

patients found that one third did not consider the program appropriate,

since they did not feel that their disease was advanced enough for it to

be relevant. Second, the program was largely a didactic, informational

one rather than built around possibly more effective behavioral

approaches.

Janis

Source

1. Hammond A, Young A, Kidao R. A randomised controlled trial of

occupational therapy for people with early rheumatoid arthritis. Ann

Rheum Dis 2004 Jan; 63(1):23-30.