| Note on research and authorship Rheumatoid arthritis is a progressive, chronic, systemic disease that may involve numerous joints in the body. The focus of rehabilitation is to preserve function and to control pain. Rehabilitation will be based upon the stage of the disease, such as an instance of acute flare-up or of ongoing symptoms.
During an acute flare-up, rehabilitation must, in conjunction with pharmacological treatment (Vliet Vlieland), address pain control through the use of modalities such as heat (Robinson). Gentle motion may be initiated with care to avoid an increase of inflammatory symptoms. Attempts should be made to prevent the loss of range of motion and to maintain as much independent function as possible.
Once the acute stage has passed, the therapist begins addressing mobility and strength. The object of all exercise is to maximize independence in all functional activities. Gentle range of motion exercises are taught and progressed to strengthening exercises. These exercises may be performed as part of an aquatic program or in conjunction with another form of heat. Because steroids are commonly used to treat rheumatoid arthritis, and osteoporosis may result from long-term steroid use, a general aerobic conditioning program, including weight bearing exercises, should be incorporated into the rehabilitation program. All exercise progression is gradual with consideration of the individual's tolerance and the underlying disease.
Occupational therapy may also be necessary to address activities of daily living. A home assessment might be indicated to ascertain that the environment is optimal for the individual's needs. The occupational therapist may recommend assistive devices for common daily tasks and may also assess the need for devices for joint protection such as splints or other supportive equipment (Egan; Steultjens).
An ergonomic evaluation may be beneficial to modify the workstation so that the individual may be able to maintain his or her employment status.
Because individuals may experience depression if their activities become restricted as a result of exacerbations of this disease, counseling or a support group might be needed. Individuals may also benefit from the experience of other individuals with similar needs (Riemsma).
Additional information may provide insight into the rehabilitation needs of these individuals (Oh). |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical ‡ | |
| Physical or Occupational Therapist | | Up to 24 visits within 12 weeks | |
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| ‡ Note on Nonsurgical Guidelines: It is quite difficult to pinpoint the rehabilitation needs of individuals with rheumatoid arthritis. Some contributing factors include the point of diagnosis, number of involved joints, acuteness of illness, recurrence, response to medication, joint integrity, anatomical involvement and progression of disease. |
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor