When you have arthritis, you may struggle with everyday tasks, like getting into and out of cars, lifting gallon-sized jugs of milk, or chopping vegetables. To help make these tasks a little easier — and cut down on the pain, stress, and fatigue that comes with having an inflammatory or degenerative condition — your rheumatologist or primary care physician may suggest seeing an occupational therapist, or OT.
An occupational therapist is a professional who helps people develop, improve, or maintain skills needs for daily activities in their homes, offices, and communities. They will do a thorough assessment of the barriers that make it difficult for you to maintain your normal life, and then work with you to overcome those barriers. They may do this by creating an exercise plan that builds up muscles around damaged joints, prescribing splits to protect fragile joints, showing you how to do tasks in ways that minimize pain, or help you find products that make performing tasks easier.
The ultimate goal of working with an occupational therapist is to “have less pain throughout more of the day,” as Carole Dodge, OT, Supervisor of the Occupational therapy Hand Therapy Program at the University of Michigan, explains. “The payoff is huge.”
Though occupational therapy may seem unnecessary when you’re first diagnosed with arthritis, you may soon realize that your rheumatologist or physician may not be able to provide the detailed advice your need to help you get through all the different parts of your daily routine.
Read more about occupational therapists, including the role they play in your arthritis treatment plan and how to find a good one near you.
What Is an Occupational Therapist?
According to the American Occupational Therapy Association (AOTA), occupational therapists ask, “What matters to you?” and not “What’s the matter with you?”
In other words, OTs try to discern how any physical dysfunction may be getting in the way of achieving what you want in your daily life. In coordination with patients and possibly their families, occupational therapists come up with interventions to ease your way in the world. Then they evaluate how successful the interventions are and modify them if need be.
All U.S. states, Canadian provinces, the District of Columbia, Puerto Rico, and Guam require that OTs be licensed in order to “protect consumers in a state or jurisdiction from unqualified or unscrupulous practitioners,” the AOTA states on its website. The license is obtained by completing a two-year graduate program and a minimum six months of field work. A licensed occupational therapist will often have the letters “OTR/L” after their name.
With further experience and education, occupational therapists can become certified as specialists by the AOTA. Currently, the AOTA only offers certification exams for pediatric OTs. Next year, however, it will offer certification in physical rehabilitation, which emphasizes regaining functioning in daily pursuits after injury, illness, or declining strength.
If your arthritis is specific to your hand, you may also want to consider a hand therapist — 80 percent of whom are occupational therapists, according to Lenore Salomon, OTR/L, a Professor Emerita of OT at Sacred Heart University in Fairfield, Connecticut. To be certified by the American Society of Hand Therapists, practitioners need to pass an exam. That said, any OT can practice hand therapy without that specific certification.
What Does an Occupational Therapist Do?
Occupational therapists work with people of all ages in private practices, hospitals, outpatient clinics, nursing homes, and rehab facilities, according to the AOTA. They may come to your home or workplace, or you may go to their offices.
Occupational therapists are well-versed in ways to improve the daily functioning of adults with any type of arthritis. Strong evidence exists for the beneficial effects of OT on fibromyalgia, rheumatoid arthritis, and hand, wrist, and forearm problems, for example.
During sessions, occupational therapists will:
- Assess your pain levels and look for any muscle and/or joint limitations that may get in the way of your functioning in your daily life.
- Teach you exercises that will help you function better in everyday tasks. For example, if you have arthritis that makes it hard for you to grasp objects, they might help building up the muscles around your thumb.
- Custom-make and fit splints that help protect your joints.
- Recommend assistive equipment, such as jar openers, and teach you how to use them properly.
- Do a comprehensive evaluation of your home and office, and then make recommendations for how to adapt activities in these spaces. “An OT can teach a patient how to dress, shower, clean their home, and do their jobs, all while protecting their joints,” Richmond explains.
- Provide guidance to family members and caregivers on how to help you.
- Treat your pain with heat and ice, and continue to monitor it in each session.
In between sessions, occupational therapists continue to develop plans for patients. “The therapist may also go over logs that patients have been asked to keep to see how much the exercises and adaptations have altered their pain and mobility,” says Scott Trudeau, OTR/L, Productive Aging Practice Manager at AOTA. “The therapist may make further adjustments based on these logs.”
What Is the Difference Between an Occupational Therapist and a Physical Therapist?
Occupational therapy (OT) and physical therapy (PT) have completely different origins. Modern occupational therapy began in the early 1900s as part of a movement to treat people with mental illness more humanely. “Innovative nurses and volunteers saw the need for patients to be more engaged in their recuperation and began introducing purposeful activities such as arts and crafts,” explains Trudeau. The motto was: Doing is healing. As the occupational therapy profession evolved, it expanded into treating all forms of disabilities by helping people perform basic functions like bathing and cooking. Occupational therapy took off during the two world wars to assist wounded soldiers. While the training and equipment have changed over the years, occupational therapy has always emphasized looking at patients holistically, with a special focus on their mental well-being.
Modern physical therapy dates back to the early 1800s when a Swede developed gymnastic exercises to improve athletes’ medical conditions. By the early 1900s, various forms of equipment replaced the gymnastic training. A polio epidemic in 1916 led to the development of ways to test the strength of muscles and help repair damaged ones through massage. During World War I, the U.S. army created a special medical unit for rehabilitating injured soldiers and started “reconstruction aide” programs to train what were essentially physical therapists, according to an article in the Archives of Medicine and Health Sciences. In later decades, physical therapists became independent of the military and acquired deep technological skills, such as the use of electrical stimulation to restore muscles. Throughout its history, physical therapy has always emphasized improving patients’ ability to move.
Though they sound similar — and may both be recommended for people with arthritis — occupational therapists and physical therapists serve different purposes.
- Occupational therapists work with patients to make everyday tasks easier.
- Physical therapists work to “improve quality of life through prescribed exercise, hands-on care, and patient education,” according to the American Physical Therapy Association. “Physical therapists examine each person and then develop a treatment plan to improve their ability to move, reduce or manage pain, restore function, and prevent disability.”
OTs and PTs tend to work on different issues. A PT probably would not help you learn how to use a doorknob, while an OT probably would not work on a gait problem, says Seattle-based occupational therapist and rheumatoid arthritis patient Cheryl Crow, MOT, OTR/L, an occupational therapist in private practice in Seattle, Washington.
There may be times, however, when you might require both types of specialists. After a joint replacement surgery, for example, Salomon says an OT can help you navigate your home while you’re healing, while a PT can help you regain your muscle strength and flexibility.
Why Should People with Arthritis See an Occupational Therapist?
Arthritis pain, stiffness, and inflammation can really hinder your day-to-day activities. An occupational therapist can help you overcome those obstacles. But there are other areas in which occupational therapy may be helpful for people with arthritis:
OTs may engage in pain-reducing treatments such as wax baths and heated corn husks for painful hands, says Theodore R. Fields, a rheumatologist at Hospital for Special Surgery in New York City.
OTs may suggest assistive devices, such as jar openers, to help protect fragile joints from overuse. They may also work with you to build up muscles to take further stress off the joints, Crow explains.
“Chronic tiredness is particularly common among people with inflammatory forms of arthritis,” Crow says. OTs may prescribe daily moderate-intensity exercise, such as a 30-minute walk, to improve energy. They might also suggest taking a 10-minute nap each day.
“Mental health is always in the forefront with occupational therapy,” Salomon says. “Physical pain and mental distress affect each other — if you are anxious, that can make your pain worse.” Occupational therapists can help improve your mindset with deep breathing exercises; cognitive behavioral therapy to help change your perception of negative events; mindfulness, which research says may reduce inflammation and pain; and acceptance and commitment therapy, a form of psychotherapy that increases patients’ psychological flexibility so that they learn to accept things, such as living with chronic pain. Salomon adds, however, that an occupational therapist is not a substitute for a counselor or clinical psychologist, especially if a patient is experiencing “serious mental distress.”
“The best time to schedule an appointment with an occupational therapist is right after you’ve received a diagnosis of arthritis,” said Salomon. Therapy is useful at any time, of course, but early treatment may slow down damage to your joints. In most states, you need a referral from a nurse practitioner, physician assistant, or doctor, such as a primary care physician or a rheumatologist.
“In general, Medicare and most insurance companies do pay for occupational therapy visits, but they have restrictions on how many sessions you may receive,” notes Dodge.
What Does a Session with an Occupational Therapist Entail?
“How are you today?” That’s how most occupational therapy visits begin, says Tammy Richmond, CEO and founder of the online OT firm Go 2 Care in Los Angeles. And while you might think that the question is merely polite, your answer presents a roadmap as to how your occupational therapy session should take place that day.
“The next step is for the occupational therapist to ask, ‘What bothers you the most? Where is your pain?’” Richmond said.
Your first session with an OT will likely last longer than subsequent ones. The therapist will ask you to walk them through your day, explaining what tasks (such as doing laundry, cooking dinner, or driving) have become difficult for you because of your arthritis. This forms the basis for a highly individualized therapy plan, explains Crow. In a first visit, an OT may measure you for a joint-protecting splint. They may provide muscle-strengthening and stretching exercises to do at home, as well as recommendations for assistive devices to make some activities, like using keys, easier. In addition, the therapist will ask about your state of mental well-being.
In further sessions, the OT will continue to offer ways to modify activities (such as using two hands to lift a gallon of milk instead of one) and will track your progress.
Occupational therapy is often a short-term project, as “the goal is to teach self-management to arthritis patients,” said Dodge. As your situation changes, you may want to continue to check in with an occupational therapist from time to time.
How to Find a Good Occupational Therapist
You can find a good occupational therapist by asking for referrals from your health care provider, contacting your insurer, and going to your state government licensing website. If you live in Canada, the Canadian Association of Occupational Therapists has a search function for therapists. So does the American Society of Hand Therapists.
Here’s what to look for in an occupational therapist:
- Credentials. An occupational therapist who has passed a national exam and is licensed by a state will have the initials OTR/L after their name. Certified hand therapists, who have extensive specialized education, are identified by CHT. These credentials show that a therapist has both experience and training.
- Expertise in rheumatic conditions. “Ask if an OT has had a lot of experience with patients who suffer from arthritis,” says Dodge.
- A good questioner. “The secret to a good quality session is having a therapist who asks the right kinds of questions,” says Richmond. Look for an OT who listens and who asks about your goals and how your arthritis prevents you from achieving those goals.
- Warmth and compassion. If you are going to an OT, you are probably in some kind of pain. Your therapy will be more successful if you feel that the practitioner cares about you and is on your side.
- “You should feel that you got something out of each visit,” Dodge says. “If you don’t, go elsewhere.”
Here are some red flags to keep an eye on:
- An OT who performs therapies not related to your functioning. If you are weak in one arm, but want to do your own cooking, exercises such as using an arm bike will not be as helpful as an OT showing you ways to reach into cupboards and turning on the stove, according to AOTA.
- An OT who uses pain-relief therapies without an explicit goal. If an OT applies heat, cold, or electrotherapy to, for instance, reduce shoulder pain so you can reach into a refrigerator, that’s fine. If the therapist is using these techniques simply for pain control, they are not practicing occupational therapy.
- An OT who uses overhead pulleys. Overhead pulleys can damage shoulders and cause pain. If you are having trouble, say, setting the table, your therapist can guide your arm in the correct direction so you can safely practice the move you need to make.
Get Mental Health Support
We understand the mental health struggles that can occur when you are living with chronic illness. It is important to talk to someone who can help. You should contact your primary care physician or your insurance provider to learn about the supportive resources that are available to you. Here are other mental health resources for your reference:
- To find local support groups and services, you can call 1-800-950-NAMI (6264) or email firstname.lastname@example.org. The National Alliance on Mental Illness HelpLine can be reached Monday through Friday, 10 AM to 6 PM ET.
- For a counselor or therapist in your area, view the resources page at Mental Health America: Finding Therapy.
- Crisis Text Line (free 24/7 support via text): Text HOME to 741741
- The Friendship Line from the Institute on Aging (toll-free 24/7 support for people ages 60 or over and adults living with disabilities): 1-800-971-0016
- LGBT National Hotline (free, confidential support for the lesbian, gay, bisexual, transgender, queer, and questioning community): 1-888-843-4564
- If your mental health concern is an emergency for you or someone else, you should call 911.
- If you are having suicidal thoughts or have or are thinking of hurting yourself, you should call the National Suicide Prevention Lifeline’s 24-hour toll-free crisis hotline, 1-800-273-TALK (8255).
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About Occupational Therapy. American Occupational Therapy Association. https://www.aota.org/About-Occupational-Therapy.aspx.
AOTA’s Advanced Certification Program. American Occupational Therapy Association. https://www.aota.org/Education-Careers/Advance-Career/Board-Specialty-Certifications-Exam.aspx.
Becoming a PT. American Physical Therapy Association. https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt.
Five Occupational Therapy Treatments to Question. American Occupational Therapy Association. https://www.aota.org/About-Occupational-Therapy/Patients-Clients/choosing-wisely-five-treatments-to-question.aspx.
Hegarty RSM, et al. Acceptance and commitment therapy for people with rheumatic disease: Existing evidence and future directions. Musculoskeletal Care. April 15, 2020. doi: https://doi.org/10.1002/msc.1464.
Interview with Carole Dodge, Supervisor of Hand Therapy and Lymphedema at Michigan Medicine in Ann Arbor, Michigan
Interview with Cheryl Crow, MOT, OTR/L, an occupational therapist in private practice in Seattle, Washington
Interview with Lenore Salomon, PhD, Associate Professor Emerita, Department of Occupational Therapy, Sacred Heart University in Fairfield, Connecticut
Interview with Scott Trudeau, PhD, Productive Aging Manager at AOTA, North Bethesda, Maryland
Interview with Tammy Richmond, CEO and Founder of Go 2 Care (occupational therapy with an emphasis on telehealth), Los Angeles, CA
Interview with Theodore R. Fields, MD, rheumatologist, Hospital for Special Surgery in New York City
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