ILOTA Communique 2019 Second Quarter | Página 3

April / May / June • Issue 2 • 2019 Holistically Treating Patients Who Internalize Osteoarthritis, Continued from Page 1 This article highlights a clinical case scenario in which a patient was referred to occupational therapy services because of a distal radius fracture; however, this patient also had a secondary diagnosis of OA. Typical treatment for an individual with a distal radius fracture might include wrist and finger active and passive range of motion, strengthening, and home exercise programs (Ikpeze, Smith, Lee, & Elfar, 2016). However, after completing a thorough occupational profile, it was revealed that this patient had a history of disengaging in a number of meaningful activities due to a variety of deficits related to her OA and not her primary diagnosis (i.e., distal radius fracture). For instance, the patient reported that her joint pain and stiffness from her OA led to the discontinuation of her valued occupations such as knitting, cooking, and gardening. The patient stated, “...but I can’t do anything about that; it’s just my arthritis and old age.” The patient went on to describe how discontinuation in these daily and leisure activities (knitting, cooking, and gardening) affected her social participation and roles. For example, she enjoyed knitting gifts for her grandchildren and knitting blankets for donation to local organizations for the homeless. As best practice in occupational therapy should unfold, this patient’s decreased participation in meaningful occupations related to both her primary and secondary diagnoses were addressed. For instance, this patient was educated on: methods to manage her pain and decreased range of motion (e.g., contrast baths and compression gloves); activity and task modifications (e.g., built-up handles, strategic placement of knitting projects to avoid strain on hand/wrist, taking short breaks, and pacing self during long activities) to enable her to remain engaged in her meaningful occupations; as well as the benefits of low-impact exercise (e.g., swimming). Furthermore, the primary occupational therapy practitioner incorporated client centered practice and considered the current evidence to guide intervention with this patient. For example, the current literature suggests that knitting has the capacity to increase hand dexterity and decrease arthritis morning stiffness (Arthritis Foundation, 2019; Brosseau & Léonard, 2017). Therefore, this patient was educated on many ways to facilitate her participation in a variety of her meaningful occupations and daily activities via adapting the environment and modifying the activity. Additionally, since the literature provides evidence that activities such as swimming, tai chi, yoga, and low impact dance programs are beneficial for the improvement of arthritis symptoms (Radomski & Trombly, 2014), this patient was also introduced and encouraged to consider participating in some of these activities, especially the ones of interest to her. The intervention approach discussed above was viewed as successful, as the patient reported increased satisfaction and ability to participate in numerous meaningful activities, several of which she had completely disengaged from since being diagnosed with OA. Likewise, this patient demonstrated improved scores on standardized outcome measures such as the Quick Dash. Some degree of acceptance of OA can be advantageous for older adults (Butler & Ciarrochi, 2007). However, as this case illustrates, there are times when patients are too accepting of this diagnosis and too willing to cease participation in meaningful activities. Although OA is common in older adults, it does not have to be a contributor to the cessation of meaningful occupations. Recent literature indicates that many individuals with arthritis internalize the perspective that arthritis is a condition that should be tolerated, instead of a condition that can be managed (Hootman, Helmick, & Brady, 2012). Therefore, it seems imperative that older adults with OA are educated on ways that they can not only manage their current symptoms, but also proactively find ways to maximize their ability to remain engaged in their meaningful occupations and continue to live their lives to the fullest (Frost & Harmeyer, 2011; Zimmer, Hickey, Searle, 1995). In summary, patients’ reduced performance in meaningful activities due to symptoms of OA should be addressed with client-centered and evidence-informed occupation-based and occupation-focused solutions. References Arthritis Foundation. (2019, n.m, n.d). Smart tricks to make needlework with arthritis finger-friendly. Retrieved from: http://blog.arthritis.org/living-with-arthritis/needle- work-with-arthritis/ Brosseau, L., & Léonard, G. (2017). Knitting as a promising pain self-management strategy for older women with osteoarthritis of the hand. Journal of Clinical Rheumatology: Practical Reports On Rheumatic & Musculoskeletal Diseases, 23(3), 179–180. https://doi-org.mwu.idm.oclc.org/10.1097/ RHU.0000000000000503 Butler, J. & Ciarrochi, J. (2007). Psychological acceptance and quality of life in the elderly. Quality of life Research, 16(4) 607-615. https://doi.org/10.1007/s11136-006-9149-1 Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population. (2018, July 18). Arthritis-Related Statistics. Retrieved from: https://www.cdc. gov/arthritis/data_statistics/arthritis-related-stats.htm Doherty, M., Arden, N., Bijlsma, N., & Hunter, D. (Eds.). (2016). Oxford textbook of osteoarthritis and crystal Continued on Page 4 Page