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| Division of Occupational Therapy - OT Connect Arthritis - Osteoarthritis
Diagnosis Name: Osteoarthritis (OA) Common symptoms/Course of the disease: Osteoarthritis (OA), or degenerative joint disease, is one of the most common types of arthritis. It is characterized by the breakdown of the joint's cartilage. Cartilage is the part of the joint that cushions the ends of bones. Cartilage breakdown causes bones to rub against each other, causing pain and loss of movement. The joints that are commonly affected include the joints of the spine, elbows, hips, knees, and ankles (Neistadt & Crepeau, 1998). Joints in the body usually contain synovial fluid and cartilage. OA causes the breakdown of cartilage in joints. OA does not affect the entire system of the body, but only affects individual joints that wear down with age and overuse making this disease commonly known as the “wear and tear” disease (Pedretti, 2001). Some common symptoms include:
Usual age of presentation: Most commonly affecting middle-aged and older people, OA can range from very mild to very severe. It affects hands and weight-bearing joints such as: knees, hips, feet and the back. OA can occur as early as the 3rd decade of life (20s), but most people will not experience OA until their 40s or 50s (Time South Pacific, 2002). Cultural bias: Caucasian individuals have a higher incidence of OA of the hip than Chinese, Jamaican blacks, South African blacks, and Asian Indians. Japanese individuals have a higher prevalence of OA of the hip than Caucasians. Black American women have a higher incidence of knee OA than Caucasian women, but a lower prevalence of DIP joints of the hand (joint right below fingernails) (Goldman, 2000). Current medical treatment: medications, surgeries and testing Medications: Many different medications are used to control pain, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAID). Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDS. For mild pain without inflammation, acetaminophen may be used. Surgeries: Joint reconstruction (arthroplasty) http://www.jointreconstruction.com and joint fusion (arthrodesis) http://home.inreach.com may be done when joint restoration is not possible. These may be performed to relieve pain, correct deformity, provide stability to the affected joint, and improve function. Occupational Therapy Involvement The pain caused by arthritis can affect how a person functions in the home and workplace. Occupational therapists can suggest modifications to help people with arthritis to work and live independently while avoiding stress to the joints. What can an occupational therapist do?
References
How OT Makes a Difference: Evidence-Based Practice Berggren, M., Joost-Davidsson, A., Lindstrand, J., Nylander, G., and Povlsen, B. (2001). Reduction in the need for operation after conservative treatment of osteoarthritis of the first carpometcarpal joint: A seven year prospective study. Scandinavian journal of plastic and reconstructive hand surgery. 35: 415-417. This article examines the effect of occupational therapy for individuals suffering from osteoarthritis of the carpometalcarpal of the thumb who are planning to receive joint replacement surgery for the inflicted joint. Thirty-three subjects consisting entirely of women with a mean age of 63 were included and split into three groups following three initial sessions with a hand therapist. The first group was treated in a compensatory fashion with “technical accessories” including these specially fitted accessories: bread saw3, grabber stick, scissors, potato peeler, tap handle, pen handle, cheese cutter and book support. The other groups were given the same accessories as well as splints; one group received a semistable textile splint, while the other group was given non-stabilizing leather splint. After seven months the same hand surgeon and the client re-evaluated the need for the joint replacement operation. The results indicated that after the seven months of occupational therapy as depicted above, only 10 out of the 33 subjects opted to receive the operation. In the next seven years, only two more subjects chose to have the operation. “P” is a middle-aged woman riddled with osteoarthritis in her knees, neck, thumb, and back. She has received 15 different operations on her knees, and throughout these operations she has received occupational therapy while she was staying in the hospital. She feels that occupational therapy considered her needs and wants by teaching her everyday things that were important to her. She felt that occupational therapy went beyond just the physical aspect of her injuries by focusing on more than just strengthening her weakened knees. She explained that the treating occupational therapist taught her how to complete activities that she would use daily, such as “getting up from a chair” or “putting on shoes and socks”. She stated that she had been really concerned about activities such as these before she received occupational therapy because all she was told previously was “not to bend at the waist”. Statements like this made her unsure of how she was going to complete activities independently once she was discharged from the hospital. However, she felt that occupational therapy really helped her with such as activities by not only teaching her new techniques, but also by looking her home environment to point out any risks or obstacles that she may face because of the layout of her home. “P” stated that when you get hurt, “you don’t realize the importance of how your body moves and works, you take things like this for granted so it [occupational therapy] helps you realize how to do things again…and how to handle things at home”. She felt that all of her occupational therapy treatment was very useful and relevant to life. The only recommendation that she had to make about occupational therapy is that there should be more of it! She did not receive home health or any follow up treatment following her stay in the hospital and she felt that she could have benefited from more occupational therapy.
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