2. Physical and occupational therapy
• Provide a multimodal program to help
reduce pain and to improve joint function
• Many other measures can be taught to
patients for home practice.
3. Components of the Program
• Joint conservation.
• Energy conservation.
• Splinting.
• ROM exercises.
• Application of heat and cold.
• Endurance or aerobic conditioning.
• Modification of home and work environment.
5. • Teach or reinforce the following practices:
– Perform activities using good body
mechanics.
– Maintain ideal body weight—extra weight
places undue stress on weight-bearing joints.
– Use large joints to perform activities—spread
the load over as many joints as possible.
– Perform activities in smooth movements to
avoid trauma induced by abrupt movements.
7. • Teach or reinforce the following practices:
– Organize materials, utensils, and tools.
– Perform lengthy activities in a seated position.
– Work at an even pace—avoid rushing.
– Delegate work to others when possible.
9. • Frequently used for wrists and hands.
• Ensure proper application.
• Periodically inspect for skin
irritation, neurovascular compromise, or
improper fit.
• Usually worn during acute stage of
inflammation to protect joint.
11. • Instruct and reinforce correct method of
exercise:
– Avoid exercising inflamed joints—putting
these joints through ROM exercises one to
two times per day when inflamed is sufficient.
– Perform exercises daily as prescribed.
– Aerobic conditioning exercises may be
indicated when disease activity permits.
12. – Walking, biking, swimming, and water walking
for 30 minutes, three times per week
– Regular exercise three times per week for at
least 20 minutes for 6 months has been
shown to reduce fatigue and disability in
patients with RA compared to those who
didn't exercise.
14. • Reinforce correct use and application of
heat and cold.
• Obtain and teach correct use of assistive
devices.
• Reinforce use of behavior modification and
relaxation techniques as adjuncts to
therapy.
15. • Suggest discussion with health care
provider about complementary and
alternative therapies
• A wide variety of herbal and nutraceutical
products have been used and studied, but
data remain inconclusive about efficacy.
– Many herbal and supplemental products are
marketed for pain, inflammation, repair of
cartilage, and boosting the immune system
16. – Reflexology, Tai Chi, and acupressure or
acupuncture have benefited some patients
with arthritis and connective tissue disorders.
– Assist the patient in finding certified providers
in these disciplines if desired.
– Use of magnets to relieve pain has not shown
effectiveness in numerous studies since the
concept was introduced.
17. • Advise patient to modify home and work
environments, as needed, to install safety
devices, and to maintain a safe
environment.
• Advise patient to seek counseling
regarding sexuality, if joint pain and
inflammation are barriers to performance.
• Reinforce the chronic waxing and waning
nature of the illness to lessen susceptibility
to quackery.
