Occupational therapy for rheumatoid arthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 26 JAN 2004
Assessed as up-to-date: 17 NOV 2003
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Steultjens EEMJ, Dekker JJ, Bouter LM, Schaardenburg DD, Kuyk MAMAH, Van den Ende ECHM. Occupational therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003114. DOI: 10.1002/14651858.CD003114.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 26 JAN 2004
For persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive. Occupational therapy (OT), with the aim to facilitate task performance and to decrease the consequences of rheumatoid arthritis for daily life activities, is considered to be a cornerstone in the management of rheumatoid arthritis. Till now the efficacy of occupational therapy for patients with rheumatoid arthritis on functional performance and social participation has not been systematically reviewed.
To determine whether OT interventions (classified as comprehensive therapy, training of motor function, training of skills, instruction on joint protection and energy conservation, counseling, instruction about assistive devices and provision of splints) for rheumatoid arthritis patients improve outcome on functional ability, social participation and/or health related quality of life.
Relevant full length articles were identified by electronic searches in Medline, Cinahl, Embase, Amed, Scisearch and the Cochrane Musculoskeletal group Specialised Register. The reference list of identified studies and reviews were examined for additional references. Date of last search: December 2002.
Controlled (randomized and non-randomized) and other than controlled studies (OD) addressing OT for RA patients were eligible for inclusion.
Data collection and analysis
The methodological quality of the included trials was independently assessed by two reviewers. Disagreements were resolved by discussion. A list proposed by Van Tulder et al. () was used to assess the methodological quality. For outcome measures, standardized mean differences were calculated. The results were analysed using a best evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures.
Thirty-eight out of 58 identified occupational therapy studies fulfilled all inclusion criteria. Six controlled studies had a high methodological quality. Given the methodological constraints of uncontrolled studies, nine of these studies were judged to be of sufficient methodological quality. The results of the best evidence synthesis shows that there is strong evidence for the efficacy of "instruction on joint protection" (an absolute benefit of 17.5 to 22.5, relative benefit of 100%) and that limited evidence exists for comprehensive occupational therapy in improving functional ability (an absolute benefit of 8.7, relative benefit of 20%). Indicative findings for evidence that "provision of splints" decreases pain are found (absolute benefit of 1.0, relative benefit of 19%).
There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis.
Plain language summary
Occupational therapy for rheumatoid arthritis
Does occupational therapy help people with rheumatoid arthritis?
To answer this question, scientists analysed 38 studies. The studies tested over 1700 people who had rheumatoid arthritis. People were either counseled, trained in skills or trained to move or do daily chores with less pain, taught to protect their joints, given splints, taught to use assistive devices, or had no therapy. Not all studies were high quality but this Cochrane Review provides the best evidence about occupational therapy that we have today.
What is occupational therapy and how could it help rheumatoid arthritis?
Rheumatoid arthritis is a disease in which the body's immune system attacks its own healthy tissues. The attack happens mostly in the joints of the feet and hands and causes redness, pain, swelling and heat around the joint. People with rheumatoid arthritis can find it difficult to do daily chores such as dressing, cooking, cleaning and working. Occupational therapists can give advice on how to do every day activities with less pain or advice on how to use splints and assistive devices.
How well does it work?
A high quality study showed that people could do daily chores better after having occupational therapy with training, advice and counseling. Two high quality studies showed that people given advice about how to protect their joints could do daily chores better than people with no advice or another type of occupational therapy. But both therapies did not help overall well-being or pain.
Another high quality study showed that people trained to move or do daily activities could move just as well as and with the same amount of pain as people who did not have occupational therapy. The strength of their grip was also improved immediately after wearing a splint. But hand movement was less after wearing a splint
There was not enough information to say whether advice about using assistive devices is helpful.
What is the bottom line?
There is "gold" level evidence that occupational therapy can help people with rheumatoid arthritis to do daily chores such as dressing, cooking and cleaning and with less pain. Benefits are seen with occupational therapy that includes training, advice and counseling and also with advice on joint protection.
Splints can decrease pain and improve the strength of one's grip, but it may decrease hand movement.
類風濕性關節炎影響患者身體、個人、家庭、社會、及職業方面甚巨。職能治療(Occupational therapy, OT)目標是幫助執行工作及減少類風濕性關節炎對日常生活影響，被認為是治療類風濕性關節炎重要角色之一。至今職能治療用於治療影響類風濕性關節炎之功能及社會參與未曾被系統性回顧。
搜尋包括Medline, Cinahl, Embase, Amed, Scisearch and the Cochrane Musculoskeletal group Specialised Register相關全文，同時搜尋所選文章之參考文獻 (直到2002年12月)。
研究的方法品質由兩位作者獨立進行評估，如果有歧異則經由討論解決，由Van Tulder所提出的列表來當評估的工具以標準化平均差異(standardized mean difference, SMD)計算其研究結果，並以試驗種類、方法的品質、及有意義的結果或過程等方向來分析以得到最佳證據力。
找到了58個試驗但只有38個臨床試驗符合標準被納入此篇回顧，其中6篇對照試驗研究為高品質，在非對照試驗研究中9篇試驗研究被認為夠品質。分析顯示強烈證據指出“指導關節保護”(絕對效益17. o 22.5，相對效益100%)及有限證據指出完整職能治療對功能能力改善有助益(絕對效益8.7，相對效益20%)。提供副木輔具可減少疼痛(絕對效益1.0，相對效益19%)
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
請問職能治療可以幫助類風濕關節炎患者嘛？要回答這個問題，科學家分析了38個研究。該研究測試了超過 1700位類風濕關節炎患者。患者被輔導，培訓技能，訓練運動或較不疼痛地做日常瑣事，教導他們保護關節，給予護木，教導使用輔助器具，或者沒有治療。並非所有的研究都有高品質，Cochrane 回顧提供了有關今日我們所擁有的職能治療最好的證據。 什麼是職能治療和它如何幫助治療類風濕關節炎？類風濕關節炎是一種疾病指人體的免疫系統攻擊其自身的健康組織。這種攻擊發生大多在腳和手的關節，造成紅腫，疼痛，腫脹和關節周圍發熱。類風濕關節炎的人很難做日常家務，如穿衣，做飯，打掃衛生和工作。職能治療師可以提供意見如何較不疼痛地做日常活動或諮詢有關如何使用護木和輔助設備。 它是如何發揮效果？高品質的研究顯示，做完職能治療與訓練，諮詢和輔導後，人們可以做日常家務做得更好。兩個高品質的研究表明，比起沒有接受諮詢或用其他職能治療，提供意見及教導病患如何保護關節，可以使病患得做日常家務做得更好。但兩者的治療對整體的幸福或痛苦沒有幫助。另一項高品質研究表明，訓練如何移動或做日常活動的患者可移動的與沒有接受職能治療的患者一樣 ，且疼痛程度相當。配戴護木後，他們的握力也立即改善。但手運動能力下降。沒有足夠的資訊來說明是否使用輔助器具的建議是有益的。 什麼是底線？有“金”級的證明，職能治療可以幫助類風濕關節炎患者的從事日常雜務，例如較不疼痛地穿衣，做飯，清潔。職能治療在下列都有益處，包括訓練，諮詢和輔導，並提供保護關節的意見。護木可以減少疼痛，加強握力，但它可能會降低手的運動度。