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Meta-Analysis
. 2004;2004(1):CD003114.
doi: 10.1002/14651858.CD003114.pub2.

Occupational therapy for rheumatoid arthritis

E M J Steultjens  1 , J Dekker, L M Bouter, D van Schaardenburg, M A H van Kuyk, C H M van den Ende
Affiliations
Meta-Analysis

Occupational therapy for rheumatoid arthritis

E M J Steultjens et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: For persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive. Occupational therapy (OT), with the aim to facilitate task performance and to decrease the consequences of rheumatoid arthritis for daily life activities, is considered to be a cornerstone in the management of rheumatoid arthritis. Till now the efficacy of occupational therapy for patients with rheumatoid arthritis on functional performance and social participation has not been systematically reviewed.

Objectives: To determine whether OT interventions (classified as comprehensive therapy, training of motor function, training of skills, instruction on joint protection and energy conservation, counseling, instruction about assistive devices and provision of splints) for rheumatoid arthritis patients improve outcome on functional ability, social participation and/or health related quality of life.

Search strategy: Relevant full length articles were identified by electronic searches in Medline, Cinahl, Embase, Amed, Scisearch and the Cochrane Musculoskeletal group Specialised Register. The reference list of identified studies and reviews were examined for additional references. Date of last search: December 2002.

Selection criteria: Controlled (randomized and non-randomized) and other than controlled studies (OD) addressing OT for RA patients were eligible for inclusion.

Data collection and analysis: The methodological quality of the included trials was independently assessed by two reviewers. Disagreements were resolved by discussion. A list proposed by Van Tulder et al. (Van Tulder 1997) was used to assess the methodological quality. For outcome measures, standardized mean differences were calculated. The results were analysed using a best evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures.

Main results: Thirty-eight out of 58 identified occupational therapy studies fulfilled all inclusion criteria. Six controlled studies had a high methodological quality. Given the methodological constraints of uncontrolled studies, nine of these studies were judged to be of sufficient methodological quality. The results of the best evidence synthesis shows that there is strong evidence for the efficacy of "instruction on joint protection" (an absolute benefit of 17.5 to 22.5, relative benefit of 100%) and that limited evidence exists for comprehensive occupational therapy in improving functional ability (an absolute benefit of 8.7, relative benefit of 20%). Indicative findings for evidence that "provision of splints" decreases pain are found (absolute benefit of 1.0, relative benefit of 19%).

Reviewer's conclusions: There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis.

PubMed Disclaimer

Conflict of interest statement

No potential conflicts of interest are known to the authors.

Figures

1.1
1.1. Analysis
Comparison 1 Comprehensive Occupational therapy vs control, Outcome 1 Pain.
1.2
1.2. Analysis
Comparison 1 Comprehensive Occupational therapy vs control, Outcome 2 Functional ability.
1.3
1.3. Analysis
Comparison 1 Comprehensive Occupational therapy vs control, Outcome 3 Depression.
2.1
2.1. Analysis
Comparison 2 Training of motor functions vs control, Outcome 1 Grip strength.
3.1
3.1. Analysis
Comparison 3 Joint protection vs control, Outcome 1 Pain.
3.2
3.2. Analysis
Comparison 3 Joint protection vs control, Outcome 2 Functional ability.
3.3
3.3. Analysis
Comparison 3 Joint protection vs control, Outcome 3 Knowledge.
4.1
4.1. Analysis
Comparison 4 Provision of splints vs control, Outcome 1 Pain, long term effect.
4.2
4.2. Analysis
Comparison 4 Provision of splints vs control, Outcome 2 Dexterity.
4.3
4.3. Analysis
Comparison 4 Provision of splints vs control, Outcome 3 Grip strength long term effect.
4.4
4.4. Analysis
Comparison 4 Provision of splints vs control, Outcome 4 Range of motion.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003114

References

References to studies included in this review

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References to other published versions of this review

Steultjens 2002
    1. Steultjens EMJ, Dekker J, Bouter LM, Schaardenburg D, Duyk MAH, Ende CHM. Occupational therapy for Rheumatoid Arthritis. Arthritis and Rheumatism 2002;47:672‐685. - PubMed

MeSH terms