Rheumatoid Arthritis: Impact & Management

This assignment delves into the multifaceted effects of rheumatoid arthritis on individuals. It examines the disease's influence on physical function, psychological well-being, and overall quality of life. The assignment further explores various management strategies, including education, self-management techniques, exercise programs, assistive devices, and pharmacological interventions. A comprehensive understanding of rheumatoid arthritis and its implications is crucial for effective patient care and support.

Running head: OCCUPATIONAL THERAPY
Occupational therapy
Name of the Student
Name of the University
Author note
COMMENTENTS FROM THE TUTOR
Pease let the introduction be short and straight to the approach used ? focus on that approach
only.
why have you chosen that approach in regards to the case study. The strength and limitations.
why this approach is good for Josef?
what are the s assessment used ? why would this assessment goog for Josef?
What are interventions for biomechanical? please use biomechanical only. because there is a
mixture of compensatory and education. (see comments on interventions)
what are treatments of biomechanical? eg improving concentration, reducing anxiety, reducing
fatigue,

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How effective is the treatment eg consider statistics?
where does it say that biomechanical approach is good for RA ? reference?
put as many references as you can
Don't waste words keep refereeing to the questions.
#sorry i cannot comment on the quality but read through again and follow the guidelines
Part a (2000)

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Occupational therapists provide special assistance so that people lead a productive,
independent and satisfying life due to developmental, physical, emotional or social problems
(Schell et al. 2013). In a similar way, in the given case study, Mr JozefJurik because of his
rheumatoid arthritis is unable to complete his daily activities due to morning stiffness and joint
pain. As a result, he is dwelling in negative thoughts considering him incompetent to take care
of his family and complete manual tasks at work. In such cases, biomechanical approach and
behavioural approach are required for him so that he can lead quality life and overcome his
depressive episodes. Therefore, the following discussion deals with the occupational approach
techniques required for Mr JozefJurik so that he gain confidence and enhance his ability to be
engaged in occupations of his daily living.
In the given case study of Mr Jozef, it is evident that he is suffering from long-term
sickness due to his rheumatoid arthritis that causes joint pain in ankle and wrist joints, morning
sickness and fatigue. As he is unable to perform his activities and cannot drive to his wife in
Derby, he is feeling lonely and depressed. He is dwelling in negative thoughts, as he is incapable
to help his wife and complete manual tasks, operate technology at work. These situations are
taking a heavy toll on his life and health affecting his quality of life and ability to do
occupations. Keeping this in mind, biomechanical approach is the main occupational approach
that can be employed for Jozef to make him engaging in occupations and lead a good quality life
(Roussouly and Pinheiro-Franco 2011)
Biomechanical approach is the best occupational approach for Jozef as its designing can
provide him structural stability, movement and posture so that he can accomplish activities of
daily living (ADL) (Fern'ndez-Baena, Susín and Lligadas 2012). The rationale for choosing this
approach is that it would assist Jozef to get engaged in tasks of daily life like heavy manual tasks

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at work, operate digital technology induct new team members and junior staffs and teach
apprentices. Biomechanical occupational therapists employ different principles of movement like
strength, range of motion (ROM), ergonomics, endurance that reduces the arthritic pain and
assist in client movement (Iacoangeli et al. 2013). Employing biomechanical approach would
assist movement so that he could drive to his wife Teresa in Devon and spend time with his
family, as he values family and agreed that his wife should look after her mother.
Biomechanical approach refers to the remediation and improvement in strength and
endurance where occupational functioning model (OFM) to make clients get engaged
satisfactorily to perform their life role and accomplish task which in their opinion is the making
up of the role (Hennessy, Woodburn and Steultjens 2012). The traditional approach addressed
the physical disabilities, however according to the new concept, occupational therapists
recognized both mental and physical features in the occupational performance. Biomechanical
therapy is a holistic approach that combines both psychosocial and physical aspects in an
individual’s life (Jones et al. 2013). In the given case scenario, it is illustrated that Jozef was
unable to perform his daily tasks and drive to his family in Devon, he was gradually feeling low
and depressed. He was advised to take sertraline for depression. He loves gardening, however,
due to his arthritic pain he was unable to enjoy gardening and gradually lost confidence
influencing his engagement in his meaningful occupations. Jozef is having wrist pain that is most
complex and pronounced in rheumatoid arthritis (RA). There is high contact pressure created in
the wrist joint as compared to non-RA. Biomechanical approach aims at improving the ADL by
the patient, adaptation to modified lifestyle changes, functional limitations prevention and
improvement or maintenance of psychosocial health (Bajuri et al. 2013).

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RA motivates multiplicity of involvements and singularity in daily activity presentation,
the first step towards the biomechanical approach is the appropriate assessment and evaluation of
the disease. RA assessment in occupational therapy is important to gather relevant information
regarding the state and impact of RA on Jozef’s ADLs. Although, this evaluation of RA is an
ongoing process, it enables to develop interventions and monitor treatment and making
modifications during exacerbation and periods of remission. As the case study depicts, he has
painful wrist and ankle joints that has restricted his occupational performance and affected his
mental and social state. The assessment methods for RA depend on the complaints and its
relevance to RA’s clinical presentation. The OT evaluates it and choice of instrument depends on
the information obtained from the patient. Jozef complains of wrist and ankle joint pain, and OT
should design standardized instruments that assess the functional ability of arm, shoulder, hand
and ankles. It is also important to assess his depression or anxiety level, as he is depressed and
limited social inclusion.
In the given case study, Jozef has characteristic joint impairment due to RA and
decreased ability due to painful conditions and associated motor constraints. This is the main
reason that is restricting his areas of performance, self-care, home maintenance and heavy tasks
at work like operating digital technology. The physical and participation constraints that are
experienced by Jozef can be resolved by biomechanical approach where the OT would engage
him in productive activities to maintain his physical and psychosocial health. OT is an integral
part of the biomechanical multidisciplinary team that is concerned with improvement in ADL
performance and inclusion of the client in meaningful activities in his or her life. Previously, he
has been a keen gardener and enjoyed driving, however, due to his RA pain; he has few leisure
pursuits and loss in confidence affecting his engagement in daily life activities.

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The main concern of biomechanical approach is physical health and musculoskeletal
system improvement. When a person is able to perform the ADL, it provides them a basic level
of endurance, strength and range of motion by addressing the impairments and improving
occupational performance (Baan et al. 2012). Despite of the pharmacological advancements
made in RA, biomechanical or rehabilitation therapy is important that is aimed at maximizing the
occupational performance, reduction of disability diminishing the impact of RA symptoms on
the functional ability of patient (Matcham et al. 2014). In the similar manner, this approach
would help Jozef to improve his activity performance so that he can undertake day-to-day tasks
at home and within the work settings. He also struggles to stand due to his ankle joint pain and
reduced energy and stamina at performing ADL. This approach emphasizes on the designing of
body and accomplishment of motion where it restores the abilities of motion of Jozef. Therefore,
this approach would assist him with his limitations, mobility and provide adequate strength with
sustainability. The subsequent section of the essay in part A will deal with the assessment in
biomechanical approach that can be helpful for Jozef.
Firstly, the assessment of pain at the wrist and ankle joint is important as the systemic
inflammation target the synovial joints. Moreover, Jozef suffer from joint stiffness and pain
along with difficulty in standing. Therefore, it is crucial to assess pain by painDETECT tool for
the multimodal pain features established in RA patients. It comprises of questionnaire that
contains multimodal pain perception and features existing in RA including sensitization and
neuropathic elements involved in pain (Ahmed et al. 2014). After the pain detection in Jozef on a
scale of 1 to 10, treatments like cold and hot therapy, moist heating pad or electric blanket can
relief pain along with pain medications. Exercises that strengthen knee can also be helpful in
relieving pain.

6OCCUPATIONAL THERAPY
In the biomechanical approach, performance is considered in maintaining and improving
the range of motion (ROM), strength and endurance. As Jozef has limited ROM and strength,
biomechanical frame of reference is based on ROM. The assessment can be done by using the
geniometer, dynamometer, volumeter and measurement of oedema of the hand. In the physical
therapy, geniometer measures the ROM joint angles of the body.
The first assessment instrument is Disabilities of Arm, Shoulder and Hand (DASH)
because it would help to measure the functional impact level resulting from upper limb
impairment. Jozef is unable to perform his ADL related to mobility, self-care, recreation and
home maintenance. In addition, this instrument has optional modules to assess the specific work
activities impairment like gardening and driving that he used to perform before RA pain. The
data collection method for this assessment is self-administered and structured questionnaires
ranging from score 0 to 100 that indicate increase in disability due to upper limb involvement
(Bilberg, Bremell and Mannerkorpi 2012).
Sequential Occupational Dexterity Assessment (SODA) is another assessment
instrument that assesses the performance of an individual based on twelve tasks. The tasks
include handling of objects, writing, hand hygiene and pieces of clothing. This instrument would
help to assess Jozef’s performance on the daily tasks that are performed bilaterally and
unilaterally. This assessment is necessary for Jozef as he unable to perform his daily activities
and take care of himself (Holtslag et al. 2013).
Health Assessment Questionnaire (HAQ) is also helpful to assess the functionality of
Jozef by measuring the level of difficulty in performing activities in eight areas like self-care,
reaching, object holding and mobility. The data collected in this assessment comprises of

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standardized questionnaire containing 20 questions scoring from zero to three that indicates
increasing disability. This assessment is important as it encompasses every aspect of daily
functioning from self-care to mobility that is important, as he cannot stand due to reduced
stamina and energy (Anderson et al. 2012). This assessment procedure helps to know about the
Jozef’s functionality in performing daily activities and develop exercises and interventions based
on his disability level measured on the scale.
Handgrip dynamometry aids in the assessment of handgrip strength through the
measurement of maximum force exerted by client when pressing hydraulic dynamometer. It is
important to measure the strength of grip of Jozef as he suffers from wrist pain that make it
difficult to perform activities involving hand movement. It is considered a standardized test that
requites grip and posture standardisation forms that are utilized during the process of evaluation.
It is an appropriate assessment instrument for Jozef as grip and posture is associated with wrist
and ankle joint pain (Cima et al. 2013). Motor skills in Jozef can be improved by using adaptive
and assistive equipments like long-handled reachers, built-up handles that compensate deficits in
self-care. Upper extremity orthotics, thera-putty exercises can also help to protect and stabilize
weak or painful joints for the holding facilitation and in using utensils.
Geniometer is a clinical tool the help to measure the accurate track progress of a patient.
It measures the angle and helps to allow the object to be rotated at the angular position. This is
used for the measurement of total amount of motion at the specified point. It is used to measure
the passive and active ROM.
Dynamometer is used to measure the arm, grip leg or back strength for the evaluation of
physical performance, task demands and status. It is used for determining the power and torque

8OCCUPATIONAL THERAPY
for the operation of driven machine like pump. It is designed in such a way called passive or
absorption dynamometer. It measures the torque, measuring force or power.
Theraband endurance measurement is a non-standardized procedure to test the strength
and endurance of Jozef. The assessment tool is used to measure the muscle resistance and to
work on the ROM. It also assesses the general conditioning of the muscles and improvement in
the muscle group cooperation.
Although, these assessments help to assess the ROM and endurance of Jozef, it is unable
to assess the psychological aspects of his condition. The cause of his depression or mental health
status cannot be assessed by the biomechanical assessments and this is the major limitation of
these approaches.
For the given case study on Jozef, occupational therapy interventions are vital that
involves principles of energy conservation and joint protection. Modification of activities and
work environment along with patient education and guidance are important occupational therapy
interventions suitable for Jozef. The above discussion explains the assessment in biomechanical
therapy, however, it has certain limitations.
Although, biomechanical approach has strengths, it has certain limitations. It focuses on
strength, ROM, endurance of the patient with RA; however, it does not address the psychological
aspect of Jozef. It looks at the physical health of the patient and does not address his depression
due to which he is losing his contact with the outside world. The main limitations of
biomechanical approach are the compliance, stigma, safety, failure experience. There might be
reduced choice of patient to participate in the program, environmental issues that need to be
fixed like over-prescribing of the equipment. The approach only addresses the physical problems

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and ignores the psychological aspects of the patient with RA. As he is suffering from depression,
he may feel unmotivated to participate in the occupational program as he is suffering from
depression.
Compensatory approach encompasses assistive technologies, Upper Extremity Orthotics
and Modification of activities and environment. It includes devices that aim to enhance, maintain
or facilitate self-care, educational, instrumental, social activities or employment performance.
Neoprene or elastic strips favour handling, writing, and hygiene materials like hair comb or
toothbrushes. Orthoses or splints are helpful for Jozef as it would help provide support to joint,
optimize functionality and reduction of pain. Traction forces can also be helpful for Jozef to treat
morning stiffness, joint motion improvement and functionality (Põlluste et al. 2012).
Modification of activities and environment is also a vital intervention for performing
self-care, work and mobility activities. Changing of shifts, fair division of work, ergonomic
modifications like change in furniture, joint positioning during work and replacement of fixtures
by lighter weight objects for better handgrip. These interventions are useful for Jozef to assist
him in ADL and activity performance (Ahlstrand et al. 2012).
Upper extremity orthotics also compensate for the strength of upper limb like the one
mobile arm support attached to flexor hinge splints and wheelchairs. This intervention
compensates the activities of grooming, feeding and writing.
As it is evident from the above discussion that biomechanical, approach failed to address
the psychosocial problems and only focused on the pain and physical mobility of Jozef.
Therefore, the second section of the essay deals with the behavioural approach that addresses the
psychosocial problems of Jozef.

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Part B (1000)
Different approach that is suitable for Jozef is behavioural approach. This approach is
not only related to pain management but also reconceptualise individual to live despite of
ongoing pain. This also reinforces acknowledgement of achievements and reinforce progress. In
this, a person acquires skills to cope with their physical and mental health conditions as well as
make changes for better understanding of pain, strategies and re-engage themselves in activities
(Dures et al. 2012).
In the similar way, the behavioural approach would help Jozef to understand and accept that
chronic pain (RA) would not change itself; however, he can consider himself well and lead a
normal life (Hofmann et al. 2012). Self-acceptance is important for him, as he is depressed
because of his inability to perform tasks and engage in leisure activities like driving and
gardening. The reason for choosing this approach is that apart from pharmacotherapy, patient
education, psychological coping with RA is important as a part of comprehensive disease
management. Behavioural approach helps in improving resilience among RA patients based on
principles of therapeutic concepts and mindfulness. It encompasses stress reduction that manages
pain and enhances quality of life along with sustenance of resilience imparting overall well-being
of patient (Dures and Hewlett 2012).Also treating depression can improve
quality of life, and maybe even ease joint pain and inflammation
associated with RA. This approach would be helpful in treating
depression in Jozef as his mood is directly related to his thought
pattern. When his thinking becomes positive and functional, it
would help to restore his behaviour, sense of self, physical state
like joint pain and stiffness (Davis et al. 2015).

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Behavioural approach is a structured, semi-sensitive and client oriented that is directed to
solve symptoms of anxiety and depression associated with disease and teach skills that modifies
the dysfunctional behaviour and thinking (Davis and Matteson 2012). RA brings about
depression in people as the sense of living with pain poses potential disability making the patient
feels hopeless and helpless (Matcham et al. 2013). Pain in RA is associated with psychological
symptoms like depression and feeling of helplessness. In the given case study, Jozef is highly
depressed as he unable to perform his daily activities and spend time in gardening. His wife stays
in Devon to look after his mother and due to flare up RA symptoms; he is unable to drive to join
her in Devon after he finishes work on Friday evening. He finds this upsetting and there is
limited public transport and no Catholic Church that makes him feel depressed. Because of RA,
he is off from work from last two months making him feel lonely, depressed and fatigued. He
cannot carry out his hobbies, as he is incapable of performing them due to grappling RA pain.
This clearly shows that individuals who experience depression have a limited quality of life and
diminished level of occupational performance as suggested in literature (Lim, Jin and Ng 2012).
Behavioural approach in occupational therapy helps individuals to get through the
everyday activities and improve quality of life. The intervention that is important for Jozef is
psycho-education that is a part of behavioural approach in occupational therapy. It would be
helpful for him to make better choices and lead a normal life despite of the illness (Hewlett et al.
2011). This can be achieved when he knows about his clinical condition and treatment. The
autonomy of patient is valued and respected throughout the treatment where the client and

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therapist are active partners and responsible for the conduct of behavioural therapeutic approach.
This is an appropriate intervention for Jozef experiencing health problems and issues associated
with medical treatments. Psychosocial interventions are important for him as he is experiencing
depressive mood due to functional disability, joint pain, fatigue and feeling of helplessness as he
is away from his family and work. There is sufficient evidence in literature that behavioural
therapy is an effective and adjunctive treatment for RA that help in improving the
psychopathology, disability, levels of pain, joint function and biological indicators associated
with RA (Manning et al. 2014).
The assessment of depression in RA is important for Jozef that evaluate the level of
depression and its impact on his daily functioning and occupational performance. Health
assessment questionnaire (HAQ) is helpful in the assessment of depression in patients with RA
and so, it is helpful in addressing the depression and its root causes. In addition, Hospital
Anxiety and Depression Scale (HADS) also helps to evaluate the occurrence of depressive
symptoms in Jozef. It consists of standardized questionnaire that would be helpful in suggesting
the level of depression in Jozef based on score ranging from zero to three. As mentioned above,
RA also causes depression in patients, so HADS scale assessment would be helpful in knowing
his thought pattern, and depression level and interventions would be developed accordingly.
Pharmacological interventions work better with psychological approach in the proper
treatment and management of disease. Jozef feel hopeless as he cannot help his wife and
extremely worried that he is being marked as a bad employee. He is dwelling on negative
thoughts and pre-occupied with it. He is very particular about his appearance and lack of self-
care made him quiet and tearful gradually making him unmotivated and feeling of hopelessness
about his future. The aim of this intervention is to help him learn coping mechanisms and to live

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with RA. He needs to be motivated so that he can perform his daily activities and develop an
adaptive attitude towards the disease.
The strategies include illness education, relaxation training, attention diversion training, and
assertiveness, cognitive restructuring that foster positive attitudes towards the illness (Benka et
al. 2014). It would also be helpful for Jozef to manage flare-up RA symptoms and life-risking
situations and reduce levels of depression.
From the above discussion, it can be concluded that biomechanical and behavioural
approach are the two best approaches that would be helpful for Jozef. He suffers from
excruciating pain due to flare-up symptoms of RA that is restricting his ability to perform daily
tasks and be socially engaged. He lost his occupational performance and ability to carry out
activities of self-care, home management and perform heavy tasks at office. His wrist and ankle
joints are painful and lost stamina to even stand and walk. As a result, he is having negative
thoughts considering him an irresponsible husband and incapable employee. Therefore, as an
occupational therapist, the employment of these two approaches can be helpful in the treatment
and management of RA in Jozef. However, there are certain limitations of the approaches that
fail to meet the needs of Jozef so that he leads a quality life.

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