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Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy
Arthritis Care and Research , 11/05/09

Macedo AM et al. – Targeted, comprehensive occupational therapy intervention improves functional and work-related outcomes in employed RA patients at risk of work disability.

Methods

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
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
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

Results

At 6 months the improvement in the occupational therapy group was significantly greater than that in the usual care group for all functional outcomes and most work outcomes
Arthritis Helplessness Index, Arthritis Impact Measurement Scales II pain subscale, VAS pain, EuroQol Index, EuroQol global, and DAS28 scores significantly improved

Exclusive Author Commentary
Dr Bruce Kirkham, 11/16/09

This small (16 patients per arm), randomised study of occupational therapy(OT), targetted patients with rheumatoid arthritis who had evdience of work-related problems identified by the Work Instability Score. Patients who received the comprehensive OT intervention had significant clinically meaningful improvements in all of the work and functional outcomes measured. In addition pain scores improved in contrast to the untreated group. This small study strongly supports further studies of this strategy.