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Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy
Macedo AM, Oakley SP, Panayi GS, Kirkham BW
Arthritis and Rheumatism 2009 Nov;61(11):1522-1530
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Work disability is a serious consequence of rheumatoid arthritis (RA). We conducted a 6-month, prospective randomized controlled trial comparing assessments of function, work, coping, and disease activity in employed patients with RA receiving occupational therapy intervention versus usual care. METHODS: Employed patients with RA with increased perceived work disability risk were identified by the RA Work Instability Scale (WIS; score >= 10). Patients were stratified into medium- (score >= 10 and < 17) and high-risk (>= 17) groups, then randomized into occupational therapy or usual care groups. Assessments were conducted at baseline and 6 months. The primary outcome was the Canadian Occupational Performance Measure (COPM), a standardized patient self-report of function. Other outcomes included the disability index (DI) of the Health Assessment Questionnaire (HAQ); Disease Activity Score in 28 joints (DAS28); RA WIS; EuroQol Index; visual analog scales (VAS) for pain, work satisfaction, and work performance; and days missed/month. Independent sample t-tests and Mann-Whitney U tests were used. RESULTS: We recruited 32 employed patients with RA. At baseline the groups were well matched. At 6 months the improvement in the occupational therapy group was significantly greater than that in the usual care group for all functional outcomes (COPM performance p < 0.001, COPM satisfaction p < 0.001, HAQ DI p = 0.02) and most work outcomes (RA WIS (p = 0.04), VAS work satisfaction (p < 0.001), VAS work performance (p = 0.01)). Additionally, Arthritis Helplessness Index (p = 0.02), Arthritis Impact Measurement Scales II pain subscale (p = 0.03), VAS pain (p = 0.007), EuroQol Index (p = 0.02), EuroQol global (p = 0.02), and DAS28 (p = 0.03) scores significantly improved. CONCLUSION: Targeted, comprehensive occupational therapy intervention improves functional and work-related outcomes in employed RA patients at risk of work disability.
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