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
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