ANN ARBOR, Michigan—Occupational therapy (OT) may help get patients with knee and hip osteoarthritis (OA) lead more active lives, according to a pilot study in the October issue of Arthritis Care & Research.¹

“The wave of future will be where occupational therapists get referrals before people are at the point that they need joint replacement,” predicted lead researcher Susan L. Murphy, ScD, OTR, assistant professor in the department of physical medicine and rehabilitation at the University of Michigan Medical School in Ann Arbor and a research health science specialist at the Veteran’s Affairs Ann Arbor Healthcare System. “It’s important for rheumatologists to know that there is a role for OT among people with knee and hip OA. We need to think about lifestyle as much as we do exercise,” she told MSK report.com.

“Strategy training” enters the picture

Enter an occupational therapist-led approach called activity strategy training.

This structured rehabilitation program is designed to educate patients about joint protection, proper body mechanics, activity pacing, and environmental barriers.

The pilot trial included 54 adults with hip or knee OA from three senior housing facilities and one senior center. Patients were randomly assigned to an exercise with activity strategy training (OT group) or to exercise with health education. The latter was based on educational materials from the Arthritis Foundation. Patients participated in eight sessions during a 4-week period, and then two follow-up sessions during a 6-month period. Researchers measured pain, total physical activity, and physical activity intensity. Objective physical activity was measured by a wrist-worn accelerometer.

OT patients had significantly higher levels of objective peak physical activity compared with their counterparts in the exercise and education group. OT patients also trended toward larger pain decreases, increased total objective and subjective physical activity, and increased physical function, but these were not statistically significant. In addition, there were no effects seen for arthritis self-efficacy among patients who received OT.

The study authors caution that longer follow-up is needed to see if any of these improvements last >6 months.

Meet the patients where they live

“We try to address barriers in the context of where [OA patients] live,” she said. Patients learned how and where to walk in their neighborhoods and where they could participate in local classes. They also learned techniques to help painlessly navigate stairwells or walkways in their living facilities.

“We know exercise makes people with OA feel better and we taught them how to pepper physical activity into their day…like walking to their mailbox.”

What’s more, patients learned how to plan out their days by looking at the things they want to do. “Instead of a 3-hour shopping trip, they can break it up so they are not laid up for the rest of the day. The key is to balance activity and rest,” she said.

“Physical activity is so important. It can be short walks through the day that add up over time. Things that don’t feel like they hurt can be just as good for you. The ultimate goal is to build activity in to [patients’] lives so that it becomes habitual.”

Reference

1. Murphy SL, Strasburg DM, Lyden AK, et al. Effects of activity strategy training in pain and physical activity in older adults with knee or hip osteoarthriotis: a pilot. Arthritis Care Res. 2008;58:2845-2853.