RESEARCH - Functional and work outcomes improve in patients with RA who receive targeted, comprehensive occupational therapy

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Arthritis Rheum. 2009 Oct 29;61(11):1522-1530.

Functional and work outcomes improve in patients with rheumatoid

arthritis who receive targeted, comprehensive occupational therapy.

Macedo AM, Oakley SP, Panayi GS, Kirkham BW.

Guy's & St. ' National Health Service Foundation Trust, London, UK.

OBJECTIVE: Work disability is a serious consequence of rheumatoid

arthritis (RA). We conducted a 6-month, prospective randomized

controlled trial comparing assessments of function, work, coping, and

disease activity in employed patients with RA receiving occupational

therapy intervention versus usual care.

METHODS: Employed patients with RA with increased perceived work

disability risk were identified by the RA Work Instability Scale (WIS;

score >/=10). Patients were stratified into medium- (score >/=10 and

<17) and high-risk (>/=17) groups, then randomized into occupational

therapy or usual care groups. Assessments were conducted at baseline

and 6 months. The primary outcome was the Canadian Occupational

Performance Measure (COPM), a standardized patient self-report of

function. Other outcomes included the disability index (DI) of the

Health Assessment Questionnaire (HAQ); Disease Activity Score in 28

joints (DAS28); RA WIS; EuroQol Index; visual analog scales (VAS) for

pain, work satisfaction, and work performance; and days missed/month.

Independent sample t-tests and Mann-Whitney U tests were used.

RESULTS: We recruited 32 employed patients with RA. At baseline the

groups were well matched. At 6 months the improvement in the

occupational therapy group was significantly greater than that in the

usual care group for all functional outcomes (COPM performance P <

0.001, COPM satisfaction P < 0.001, HAQ DI P = 0.02) and most work

outcomes (RA WIS [P = 0.04], VAS work satisfaction [P < 0.001], VAS

work performance [P = 0.01]). Additionally, Arthritis Helplessness

Index (P = 0.02), Arthritis Impact Measurement Scales II pain subscale

(P = 0.03), VAS pain (P = 0.007), EuroQol Index (P = 0.02), EuroQol

global (P = 0.02), and DAS28 (P = 0.03) scores significantly improved.

CONCLUSION: Targeted, comprehensive occupational therapy intervention

improves functional and work-related outcomes in employed RA patients

at risk of work disability.

PMID: 19877106

http://www.ncbi.nlm.nih.gov/pubmed/19877106

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