Effective Conservative Intervention Strategies for Arthritis of the

Hand: Increasing Overall Functional Ability

ASOT 2015 Vision in Action Conference

Jordan Towery, OTSJanuary 23, 2015

Research Question

Is joint protection demonstration/education the most effective treatment, to reduce

pain and increase hand function in patients with rheumatoid arthritis/osteoarthritis of

the hand?

Prevalence

Approximately 13.9% of adults <25 and 33.6% of adults <65 in the US have Osteoarthritis (CDC).

Approximately 1% of the US has been diagnosed with Rheumatoid Arthritis (CDC).

Patients typically are not seen in the clinic until in late stages of OA or RA presenting with severe deformities

Cause

Osteoarthritis◦Total joint breakdown including the cartilage, joint lining, ligaments, and contacting bone normally from overuse of specific joints.

◦Normally affects the body unilaterallyRheumatoid Arthritis

◦Auto-immune disease that affects the synovial fluid of a joint causing significant inflammation. This leads to erosion of the bone and cartilage making up the joint causing significant pain, swelling, and redness.

◦Normally affects the body bilaterally.

Joints Effected in the Hand

Osteoarthritis◦IPs◦DIPs◦CMC

Rheumatoid arthritis◦IPs◦MPs◦Inter-Carpal joints (wrist)

Treatments- Joint Protection

Educational-Behavioral Training

Psycho-educational training supporting behavior change

Occupational Based vs Cookie Cutter

Individualized and Client Centered

Treatments- Splinting

Custom vs Pre-fabricated

Functional day time splint

Night time splint

Patient education

Daily wearing journal

Treatments - Exercises

Simple easy to follow directions

Do not overwhelm the client with an hour a day

Begin with P/AROM exercises

Begin strengthening when max perceived AROM for that client has been reached

Again keep daily journal to hold client accountable

Functional Outcomes

Exercise

SplintingJoint

Protection

Decreased perceived pain, Decreased perceived stiffness, Increased grip strength, Increased

functional ability, Increased AROM

Questions

Email: JTowery@spalding.edu