New Zealand Rehabilitation Association, Inc.

Steultjens EMJ, Dekker J, Bouter LM, van Schaardenburg D, van Kuyk MAH, van den Ende CHM. Occupational therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2004, Issue 1.

The question explored in this systematic review was: does occupational therapy (OT) help people with rheumatoid arthritis?  Here the authors described OT interventions as including ‘comprehensive therapy, training of motor function, training of skills, instruction on joint protection and energy conservation, counselling, instruction about assistive devices and provision of splints’ (p1).  For outcome evaluation Steultjens et al. (2004) included measures of pain, fatigue, functional abilities, physical independence and quality of life.  Impressively, the authors found 38 studies that met the complete inclusion criteria for the review (with a total of 1700 people involved as participants in these studies).  Of these 38 studies, six were randomised controlled trials with what was considered high quality methodological design.  As far as rigorous systematic reviews for allied health interventions go, this was a fairly decent-sized data set from which to draw results.

• Strong evidence that advice regarding ‘protection of joints’ resulted in improvements in the performance of functional activities. 
• Some evidence that OT-directed training, advice and counselling resulted in improvements in the ability of people with rheumatoid arthritis to undertake daily chores (such as dressing, cooking and cleaning).
• Some evidence that the use of splints by people with rheumatoid arthritis resulted in improved grip strength and a reduction in pain – but interestingly splint use was also associated with a ‘cost’ in terms of a loss of range of movement on the hand.
• There was insufficient high quality research however to draw conclusions regarding the place of assistive technology for people with rheumatoid arthritis.

All considered, this systematic review provides considerable endorsement of occupational therapy for the management of rheumatoid arthritis.  Go the OTs!