Occupational Therapy Gets People With Osteoarthritis Moving

But an occupational therapist-led approach – called activity strategy training – could provide patients with knee and hip osteoarthritis the opportunity to lead more active lives and even improve their overall health, according to a new study led by researchers at the University of Michigan Health System.

In the pilot study, the researchers found that patients who engaged in activity strategy training along with regular exercise increased their physical activity, more so than those patients who only took part in exercise and health education sessions. Study results are now online and are set to appear in the October issue of Arthritis & Rheumatism.

"Occupational therapy is really the missing link in promoting wellness of people with hip and knee osteoarthritis," says study lead author Susan L. Murphy, Sc.D., OTR, assistant professor in the Department of Physical Medicine and Rehabilitation at the U-M Medical School and Research Health Science Specialist at the VA Ann Arbor Healthcare System.

"Most people with osteoarthritis want to be active, but often find that there are personal or physical barriers in the way. For instance, people with osteoarthritis often deal with pain and fatigue, which makes engaging in regular physical activity more difficult. In addition, there are often barriers in people's homes and communities that make physical activity difficult," she continues.

For that reason, Murphy says the pilot study used activity strategy training in groups and in places – such as senior housing facilities – where barriers could be addressed and potential solutions discovered.

Taught by occupational therapists, this structured rehabilitation program is designed to educate patients about joint protection, proper body mechanics, activity pacing, and environmental barriers. For example, patients with joint pain caused by osteoarthritis learn techniques for walking around the house or outdoors, or even getting in and out of a car. For the pilot study, the activity strategy training included education, group discussion, a home visit, and demonstration and practice of techniques to facilitate activity.

Activity strategy training, however, is not commonly prescribed to patients with hip or knee osteoarthritis, a degenerative disease that causes the breakdown of the cartilage in joints. Most physical activity programs for these patients only offer structured exercise, which has been shown to have short-term positive effects on arthritis pain and physical disability. But these effects usually fade soon after participation in the program ends.

In this study, both groups participated in the same structured exercise program. However, only participants who received the activity strategy training were found to have increased the intensity of their physical activity at the end of the study compared to those who received health education.

While the results are promising, Murphy says more research needs to be conducted to replicate with larger groups and to examine long-term effects before this technique can be applied to patient care.

Regardless, Murphy encourages patients with hip or knee osteoarthritis to seek out opportunities now to enhance and expand their daily physical activity, and improve overall health behaviors.

"People with osteoarthritis tend to know more about surgical options, and less about how they can take an active role in promoting their own health and well-being," Murphy explains. "People with osteoarthritis need to be their own agents of change. They can do so much to manage symptoms and stave off functional decline caused by osteoarthritis just by being physically active. The bottom line is to find ways to help people create and maintain these healthy habits."

Methodology: The pilot trial was conducted at three senior housing facilities and one senior center. Fifty-four older adults with hip or knee osteoarthritis participated, and were randomly assigned to take part in one of two programs: exercise with activity strategy training, or exercise with health education, which was based on education materials from the Arthritis Foundation. The groups participated in eight sessions during a four-week period, and then two follow-up sessions during a six-month period. During the trial, researchers measured patients' pain, total physical activity, and physical activity intensity. Objective physical activity was measured by a wrist-worn accelerometer.

Authors: Along with Murphy, study authors from the U-M Health System were Debra M. Strasburg, MS, PT; Angela K. Lyden, MS; Dylan M. Smith, Ph.D.; Jessica F. Koliba, BA; Dina P. Dadabhoy, M.D.; and Susan Wallis, M.D.

Funding: This research was supported by a grant from the National Center for Medical Rehabilitation Research, and the U-M Office of the Vice President for Research.

Reference: Arthritis & Rheumatism, Vol. 58, No.10.