Physical and Occupational Therapy Nenette Dusal, RN
Physical and occupational therapy• Provide a multimodal program to help reduce pain and to improve joint function• Many other measures can be taught to patients for home practice.
Components of the Program• Joint conservation.• Energy conservation.• Splinting.• ROM exercises.• Application of heat and cold.• Endurance or aerobic conditioning.• Modification of home and work environment.
• Teach or reinforce the following practices: – Perform activities using good body mechanics. – Maintain ideal body weight—extra weight places undue stress on weight-bearing joints. – Use large joints to perform activities—spread the load over as many joints as possible. – Perform activities in smooth movements to avoid trauma induced by abrupt movements.
• Teach or reinforce the following practices: – Organize materials, utensils, and tools. – Perform lengthy activities in a seated position. – Work at an even pace—avoid rushing. – Delegate work to others when possible.
• Frequently used for wrists and hands.• Ensure proper application.• Periodically inspect for skin irritation, neurovascular compromise, or improper fit.• Usually worn during acute stage of inflammation to protect joint.
• Instruct and reinforce correct method of exercise: – Avoid exercising inflamed joints—putting these joints through ROM exercises one to two times per day when inflamed is sufficient. – Perform exercises daily as prescribed. – Aerobic conditioning exercises may be indicated when disease activity permits.
– Walking, biking, swimming, and water walking for 30 minutes, three times per week– Regular exercise three times per week for at least 20 minutes for 6 months has been shown to reduce fatigue and disability in patients with RA compared to those who didnt exercise.
• Reinforce correct use and application of heat and cold.• Obtain and teach correct use of assistive devices.• Reinforce use of behavior modification and relaxation techniques as adjuncts to therapy.
• Suggest discussion with health care provider about complementary and alternative therapies• A wide variety of herbal and nutraceutical products have been used and studied, but data remain inconclusive about efficacy. – Many herbal and supplemental products are marketed for pain, inflammation, repair of cartilage, and boosting the immune system
– Reflexology, Tai Chi, and acupressure or acupuncture have benefited some patients with arthritis and connective tissue disorders.– Assist the patient in finding certified providers in these disciplines if desired.– Use of magnets to relieve pain has not shown effectiveness in numerous studies since the concept was introduced.
• Advise patient to modify home and work environments, as needed, to install safety devices, and to maintain a safe environment.• Advise patient to seek counseling regarding sexuality, if joint pain and inflammation are barriers to performance.• Reinforce the chronic waxing and waning nature of the illness to lessen susceptibility to quackery.