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Rehabilitation in rheumatoid arthritis: a critical review
Author(s) -
Hammond Alison
Publication year - 2004
Publication title -
musculoskeletal care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.628
H-Index - 28
eISSN - 1557-0681
pISSN - 1478-2189
DOI - 10.1002/msc.66
Subject(s) - medicine , cinahl , rehabilitation , physical therapy , rheumatoid arthritis , hydrotherapy , cochrane library , psychological intervention , randomized controlled trial , medline , systematic review , meta analysis , physical medicine and rehabilitation , alternative medicine , occupational therapy , nursing , pathology , political science , law
This article considers the evidence for effectiveness and timing of rehabilitation for people with rheumatoid arthritis (RA). The Cochrane Library, DARE, Medline, Embase, CINAHL and AMED were searched to identify systematic reviews and randomized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis. Many trials identified had methodological limitations (e.g. short follow‐up periods, small sample sizes). Evidence to date is that symptomatic relief results from thermotherapy, laser therapy, acupuncture and assistive devices. In the short‐term, comprehensive occupational therapy (in established rheumatoid arthritis), orthoses, and mind–body approaches can help maintain function. Over at least a one‐year period, the following are effective in reducing pain and maintaining function: patient education and joint protection training using behavioural approaches; dynamic exercise therapy, hand exercises and hydrotherapy; and cognitive‐behavioural therapy (in people with poorer psychological status). Many trials have recruited people with moderate to severe, established RA and relatively little is known about the long‐term effectiveness of early rehabilitation, although this is becoming much more common in practice. Despite the increased availability of guidelines and systematic reviews, most conclude there is insufficient evidence for many areas of rheumatology rehabilitation. Further well‐designed clinical trials are needed recruiting people with early disease using patient‐centred outcomes. Copyright © 2004 Whurr Publishers Ltd.