The Role of the Occupational Therapist

Paula Jeffreson DipCOT SROT, Head Occupational Therapist, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, NHS Trust, Oswestry
Original article: 28/10/2003
Reviewed: 09/12/2011
Next review due: 09/12/2014

The other day I was reading through some comments made by patients attending one of our education programmes. It had been a practical programme aimed at helping a small group of men and women with rheumatoid arthritis (RA) adopt new ways of doing everyday activities in order to take the strain off painful joints and feel less tired. One participant had written, “I just wish I had done this earlier, everyone should be given the chance to learn about this.”

The issues of providing information for people early on and ensuring they continue to have access to expert advice when they require it is very topical. ARMA (Arthritis and Musculoskeletal Alliance) state in their Standards of Care document that people with inflammatory arthritis should be provided with advice that promotes self-management and have on-going access to the multi-disciplinary healthcare team.

The role of the occupational therapist (OT) in the treatment of people with RA is to improve their ability to perform daily tasks and valued life rolesand assist in the successful adaptation to disruptions in lifestyle caused by RA. There is strong evidence that a full OT treatment programme can help people with RA to improve in this way. For people with early RA the research evidence is less clear and timing of OT intervention is important. Those most likely to benefit will have problems managing daily activities at home or at work, have wrist/hand pain, or may be struggling emotionally to come to terms with the impact RA has had on their lives.

As therapists, we tailor our treatment to suit an individual’s requirements and goals. It is therefore important that people have access to an OT when they feel they need help. For someone whose arthritis is stable and causing few problems, learning self-management techniques will not be a priority. If they start to get problems with their hands and grip weakens, they may wish to learn how to look after their joints and manage their flare up. So it is worth finding out early on who your OT is and how she/he can help you. At our rheumatology unit, we give a pack (containing various arthritis information leaflets and our Helpline number) to people when they are newly diagnosed and invite them to an Information day where they can meet the team. We believe this encourages people to call us when they need help later on, but patient's experiences and access to services will vary between hospitals.

OTs work in a variety of locations and can be based in hospitals, community (PCT), social services, Disability Living Centres and in private practice. Many will be able to visit you at home if this is the most appropriate place. To see an OT for the first time, you may need a referral from your rheumatologist or GP. Social services OTs who specialise in home adaptations, will accept a self-referral. Disability Living Centres offer impartial advice on assistive equipment and usually have comprehensive display and demonstration facilities. A specialist rheumatology OT will be able to offer a comprehensive treatment programme.

The occupational therapist is someone who can help you think outside the box. If you want to continue doing a hobby or working and are concerned about protecting your joints she can help you think creatively around a problem. Of course not all problems have a solution but it is worth exploring the options. They might be able to put you in contact with REMAP if you need specialist equipment for baby care, work or a hobby.

The following mini case histories illustrate some of the ways OT can help.

Cast History 1 (Sophie):

Sophie attended a joint protection programme run by the rheumatology OT about three years after she developed RA. Learning how to modify the way she gripped and carried things helped improve painful hands, and wrist splints provided support when she vacuumed and shopped. Sophie called the OT again when she was considering refurbishing her kitchen and bathroom. She had been having difficulties getting out of the bath and reaching into kitchen cupboards. She lives alone and wanted advice to ensure that the new fittings would still enable her to manage independently, even if her arthritis worsened. Following an assessment in her home by the OT, modifications were planned which would reduce her need to reach (raise dish washer, lower wall units and re-arrange storage), give better grips (lever taps and door handles, knobs on cupboards), and change the bath for a shower. Sophie visited a Disability Living Centre to get more ideas on helpful equipment and adaptations. The social services OT was also consulted and was able to advise on access to funding for some of the modifications.

Case History 2 (Megan):

Megan was referred to OT by the rheumatologist shortly after she was diagnosed. She was struggling to manage her job as a primary school teacher and was considering giving up work. She found it painful to stand for long periods, bend to attend to the children’s work and help them with fastening coats and shoe laces at break. Her grip was weak and she felt too tired in the evenings to go out and enjoy herself. During a workplace assessment by the OT, she tried out more comfortable working postures and modifying tasks. Of particular help to Megan were a chunky grip pen, perching stool and self opening scissors. Following discussions with the head teacher, a class room assistant was made available for some sessions. Joint protection advice showed Megan how to alter the way she gripped some things so she had less pain and taught her how to protect her joints from damage so that in the future she could continue to do the things that were important to her. Setting goals and taking time to rest in her breaks helped Megan to manage her energy and gain a better work/leisure balance.

Case History 3 (Thomas):

The surgeon referred Thomas to OT for a hand function assessment to advise whether knuckle joint replacements would help his grip. Following the assessment and Thomas’ decision to go ahead with surgery, the OT visited him at home to help him plan how he would manage after the operation. He found some gadgets helpful, such as moulded grip cutlery, non-slip matting to stabilize utensils on the work surface and his chair and toilet seat were raised so that he would not need to push down on his hands to rise. Following surgery, he attended the OT department for hand splints, exercise and joint care advice.

Case History 4 (Emma):

Emma has RA and is a professional artist. She has a problem called swan necking as a result of her RA and this caused pain and problems with bending her fingers. The occupational therapist trialled some splints made in plastic, but though they were very effective, they were ugly and broke easily. Therefore Emma decided to get something stronger made. Once the most effective design had been decided, Emma went to the local jeweller who made the splints in silver. The occupational therapist supervised the final fitting to ensure that the splints were doing the job they were designed to do. When the OT contacted Emma 10 years later when conducting research, Emma was still using the silver swan neck splints and requested a review of them. The splints needed to be altered for a better fit but were still doing the job of helping her fingers bend. Her hand wasn’t badly deformed as she wore the splints when needed. With these splints she could still bend her fingers without pain.

Further Reading

How can an Occupational Therapist help?

Practical help in links section of NRAS website

NRAS inormation on silver ring splints

Link to British Association of Occupational Therapies & College of Occupational therapists

References available on request

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