Advertisement
Full Length Article| Volume 35, ISSUE 3, P339-345, July 2022

Download started.

Ok

Beyond the hand and upper extremity: The role of hand therapists in care of people with rheumatic diseases

Published:August 16, 2022DOI:https://doi.org/10.1016/j.jht.2022.07.008

      Highlights

      • Functional and work disability in people with rheumatic diseases remain high despite advances in medical and pharmacological management
      • Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities.
      • Patients, primary care, and rheumatology providers need to be educated about the scope of services occupational and physical therapy provide beyond the hand impairments.

      Abstract

      Study design

      Invited Clinical Commentary

      Background

      Arthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists.

      Purpose of study

      This paper reviews concepts of self-management, and symptoms that contribute to limitations and restrictions to participation in daily life in people with rheumatic diseases and suggests roles for hand therapists beyond the immediate hand impairments.

      Methods

      The impact of selected rheumatic diseases on functional and work disability are reviewed along with strategies for symptom management and self-management. Upper extremity impairments of selected rheumatic diseases are also discussed.

      Results

      The role for hand therapists in evaluating and addressing the complex needs of persons with rheumatic diseases, including less common diseases, is discussed. Outcome measures for fatigue, muscle involvement, ergonomics and computer use, and work disability are introduced. Finally, strategies for self-management and prevention of work and functional disability, along with symptom management for fatigue and pain are presented.

      Conclusion

      Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. Patients, primary care and rheumatology providers need to be educated about the scope of services occupational and physical therapists provide beyond the hand impairments.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Therapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Theis KA
        • Murphy LB
        • Guglielmo D
        • et al.
        Prevalence of arthritis and arthritis-attributable activity limitation—United States, 2016–2018.
        Morb Mortal Wkly Rep. 2021; 70: 1401-1407https://doi.org/10.15585/mmwr.mm7040a2
        • Hootman JM
        • Helmick CG
        • Barbour KE
        • Theis KA
        • Boring MA.
        Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040.
        Arthritis Rheumatol. 2016; 68: 1582-1587https://doi.org/10.1002/art.39692
        • Theis KA
        • Brady TJ
        • Helmick CG
        • Murphy LB
        • Barbour KE.
        Associations of arthritis-Attributable interference with routine life activities: A modifiable source of compromised quality-of-life.
        ACR Open Rheumatol. 2019; 1: 412-423https://doi.org/10.1002/acr2.11050
        • Allaire SJ
        • Keysor JJ
        • Alheresh R.
        Effect of arthritis and other rheumatic conditions on employment.
        Work. 2013; 45: 417-420https://doi.org/10.3233/WOR-131629
        • Theis KA
        • Roblin DW
        • Helmick CG
        • Luo R.
        Prevalence and causes of work disability among working-age US adults, 2011–2013, NHIS.
        Disabil Health J. 2018; 11: 108-115https://doi.org/10.1016/j.dhjo.2017.04.010
        • Elfving P
        • Puolakka K
        • Rantalaiho V
        • Kautiainen H
        • Virta LJ
        • Kaipiainen-Seppänen O.
        Impact of early systemic lupus erythematosus on work disability—results from the Finnish nationwide register 2000–2007.
        Clin Rheumatol. 2018; 37: 1413-1416https://doi.org/10.1007/s10067-018-4066-6
        • Sokka T.
        Work disability in early rheumatoid arthritis.
        Clin Exp Rheumatol. 2003; 21: S71-S74
        • Hudson M
        • Steele R
        • Lu Y
        • Thombs BD
        • Baron M.
        Work disability in systemic sclerosis.
        J Rheumatol. 2009; 36: 2481-2486https://doi.org/10.3899/jrheum.081237
        • Backman C
        • Poole JL
        Enabling performance and participation for persons with rheumatic diseases.
        in: Christiansen C Matuska K Ways of Living. 5th ed. American Occupational Therapy Association, Rockville, MD2020: 187-209
        • Keramiotou K
        • Anagnostou C
        • Konstantonis G
        • et al.
        Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving lupus low disease activity state (LLDAS).
        Rheumatol Adv Pract. 2021; 5: rkab029https://doi.org/10.1093/rap/rkab029
        • Johnsson PM
        • Sandqvist G
        • Bengtsson A
        • et al.
        Hand function and performance of daily activities in systemic lupus erythematosus.
        Arthritis Care Res. 2008; 59: 1432-1438https://doi.org/10.1002/art.24108
        • Poole JL
        • Dodge C.
        • Skirven T
        • Osterman AL
        • Fedorczyk J
        • Amadio P
        • Feldscher S
        • Shin EK
        Scleroderma: Therapy.
        7th ed. Rehabilitation of the hand and upper extremity. 2020. Elsevier Inc, 2020: 1308-1322
        • Balint Z
        • Farkas H
        • Farkas N
        • et al.
        A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis.
        Clin Exp Rheumatol. 2014; 32: S68-S74
        • Candiri B
        • Talu B
        • Demirtas Karaoba D
        • et al.
        Effect of psoriatic arthritis on the strength, proprioception, skill, coordination, and functional condition of the hand.
        Int J Rheum Dis. 2022; 25: 47-55https://doi.org/10.1111/1756-185X.14241
        • Regardt M
        • Welin Henriksson E
        • Alexanderson H
        • et al.
        Patients with polymyositis or dermatomyositis have reduced grip force and health-related quality of life in comparison with reference values: an observational study.
        Rheumatology. 2011; 50: 578-585https://doi.org/10.1093/rheumatology/keq356
        • Accreditation Council for Occupational Therapy Education
        2018 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide (effective July 31, 2020).
        Am J Occup Ther. 2018; 727212410005https://doi.org/10.5014/ajot.2018.72S217
        • Lorig KR
        • Holman HR.
        Self-management education: history, definition, outcomes, and mechanisms.
        Ann Behav Med. 2003; 26: 1-7
        • Nikiphorou E
        • Santos EJ
        • Marques A
        • et al.
        2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis.
        Ann Rheum Dis. 2021; 80: 1278-1285https://doi.org/10.1136/annrheumdis-2021-220249
        • van Houtum L
        • Rijken M
        • Heijmans M
        • Groenewegen P.
        Self-management support needs of patients with chronic illness: do needs for support differ according to the course of illness?.
        Patient Educ Couns. 2013; 93: 626-632https://doi.org/10.1016/j.pec.2013.08.021
        • Diffin JG
        • Lunt M
        • Marshall T
        • Chipping JR
        • Symmons DP
        • Verstappen SM.
        Has the severity of rheumatoid arthritis at presentation diminished over time?.
        J Rheumatol. 2014; 41: 1590-1599https://doi.org/10.3899/jrheum.131136
        • Benka J
        • Nagyova I
        • Rosenberger J
        • et al.
        Social participation in early and established rheumatoid arthritis patients.
        Disabil Rehabil. 2016; 38: 1172-1179https://doi.org/10.3109/09638288.2015.1076071
        • Bertin P
        • Fagnani F
        • Duburcq A
        • et al.
        Impact of rheumatoid arthritis on career progression, productivity, and employability: the PRET study.
        Joint Bone Spine. 2016; 83: 47-52https://doi.org/10.1016/j.jbspin.2015.05.001
        • Küçükdeveci AA.
        Nonpharmacological treatment in established rheumatoid arthritis.
        Best Pract Res Clin Rheumatol. 2019; 33101482https://doi.org/10.1016/j.berh.2019.101482
        • Dures E
        • Almeida C
        • Caesley J
        • et al.
        Patient preferences for psychological support in inflammatory arthritis: a multicentre survey.
        Ann Rheum Dis. 2016; 75: 142-147https://doi.org/10.1136/annrheumdis-2014-205636
        • Bergstra SA
        • Murgia A
        • Te Velde AF
        • Caljouw SR
        A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis.
        Clin Rheumatol. 2014; 33: 1539-1548https://doi.org/10.1007/s10067-014-2691-2
        • Hammond A
        • Prior Y.
        The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review.
        Br Med Bull. 2016; 119: 49-62https://doi.org/10.1093/bmb/ldw024
        • Egan M
        • Brosseau L
        • Farmer M
        • et al.
        Splints and Orthosis for treating rheumatoid arthritis.
        Cochrane Database Syst Rev. 2001; (IssueArt)CD004018https://doi.org/10.1002/14651858.CD004018
        • Adams J
        • Burridge J
        • Mullee M
        • Hammond A
        • Cooper C.
        The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial.
        Rheumatol. 2008; 47: 1548-1553https://doi.org/10.1093/rheumatology/ken292
        • Veehof MM
        • Taal E
        • Heijnsdijk-Rouwenhorst VD
        • van de Laar MA.
        Efficacy of wrist working splints in patients with rheumatoid arthritis: a randomized controlled study.
        Arthritis Car Res. 2008; 59: 1698-1704https://doi.org/10.1002/art.24078
        • Cramp F
        • Hewlett S
        • Almeida C
        • et al.
        Non-pharmacological interventions for fatigue in rheumatoid arthritis.
        Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD008322.pub2
        • Geenen R
        • Overman CL
        • Christensen R
        • et al.
        EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis.
        Ann Rheum Dis. 2018; 77: 797-807https://doi.org/10.1136/annrheumdis-2017-212662
        • Beasley J
        • Ward L
        • Knipper-Fisher K
        • et al.
        Conservative therapeutic interventions for osteoarthritic finger joints: A systematic review.
        J Hand Ther. 2019; 32: 153-164https://doi.org/10.1016/j.jht.2018.01.001
        • Bobos P
        • Nazari G
        • Szekeres M
        • et al.
        The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: a systematic review and meta-analysis.
        J Hand Ther. 2019; 32: 194-211https://doi.org/10.1016/j.jht.2018.09.012
        • Kjeken I
        • Smedslund G
        • Moe RH
        • et al.
        Systematic review of design and effects of splints and exercise programs in hand osteoarthritis.
        Arthritis Care Res. 2011; 63: 834-848https://doi.org/10.1002/acr.20427
        • Hamasaki T
        • Laprise S
        • Harris PG
        • et al.
        Efficacy of nonsurgical interventions for trapeziometacarpal (thumb base) osteoarthritis: a systematic review.
        Arthritis Care Res. 2020; 72: 1719-1735https://doi.org/10.1002/acr.24084
        • Marotta N
        • Demeco A
        • Marinaro C
        • et al.
        Comparative effectiveness of orthoses for thumb osteoarthritis: a systematic review and network meta-analysis.
        Arch Phys Med Rehabil. 2021; 102: 502-509https://doi.org/10.1016/j.apmr.2020.06.012
        • Kloppenburg M
        • Kroon FP
        • Blanco FJ
        • et al.
        2018 update of the EULAR recommendations for the management of hand osteoarthritis.
        Ann Rheum Dis. 2019; 78: 16-24https://doi.org/10.1136/annrheumdis-2018-213826
        • Hill S
        • Dziedzic KS
        • Ong BN.
        The functional and psychological impact of hand osteoarthritis.
        Chronic illness. 2010; 6: 101-110https://doi.org/10.1177/1742395309345614
        • Liu R
        • Damman W
        • Kaptein AA
        • et al.
        Coping styles and disability in patients with hand osteoarthritis.
        Rheumatology. 2016; 55: 411-418https://doi.org/10.1093/rheumatology/kev295
        • Bühler M
        • Chapple CM
        • Stebbings S
        • et al.
        Impact of thumb carpometacarpal joint osteoarthritis: a pragmatic qualitative study.
        Arthritis Care Res. 2021; 73: 336-346https://doi.org/10.1002/acr.24124
        • Gignac MA
        • Davis AM
        • Hawker G
        • et al.
        What do you expect? You're just getting older”: a comparison of perceived osteoarthritis-related and aging-related health experiences in middle-and older-age adults.
        Arthritis Care Res. 2006; 55: 905-912https://doi.org/10.1002/art.22338
        • Harris ML
        • Byles JE
        • Sibbritt D
        • et al.
        Just get on with it”: qualitative insights of coming to terms with a deteriorating body for older women with osteoarthritis.
        PloS One. 2015; 10e0120507https://doi.org/10.1371/journal.pone.0120507
        • Poole JL
        • Santhanam DD
        • Latham AL.
        Hand impairment and activity limitations in four chronic diseases.
        J Hand Ther. 2013; 26: 232-237https://doi.org/10.1016/j.jht.2013.03.002
        • Becetti K
        • Kwakkenbos L
        • Carrier ME
        • et al.
        Physical or occupational therapy use in systemic sclerosis: a scleroderma patient-centered intervention network cohort study.
        J Rheumatol. 2019; 46: 1605-1613https://doi.org/10.3899/jrheum.181130
        • Kwakkenbos L
        • Delisle VC
        • Fox RS
        • et al.
        Psychosocial aspects of scleroderma.
        Rheum Dis Clin North Am. 2015; 41: 519-528https://doi.org/10.1016/j.rdc.2015.04.010
        • Murphy SL
        • Poole JL
        • Chen YT
        • et al.
        Rehabilitation interventions in systemic sclerosis: a systematic review and future directions.
        Arthritis Care Res. 2022; 74: 59-69https://doi.org/10.1002/acr.24737
        • Petri M
        • Orbai AM
        • Alarcón GS
        • et al.
        Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.
        Arthritis Rheum. 2012; 64: 2677-2686https://doi.org/10.1002/art.34473
        • Connolly D
        • McNally A
        • Moran D
        • Ryan M.
        Fatigue in systemic lupus erythematosus: impact on occupational participation and reported management strategies.
        Br J Occup Ther. 2014; 77: 373-380https://doi.org/10.4276/030802214X14044755581862
        • Sutanto B
        • Singh-Grewal D
        • McNeil HP
        • et al.
        Experiences and perspectives of adults living with systemic lupus erythematosus: thematic synthesis of qualitative studies.
        Arthritis Care Res. 2013; 65: 1752-1765https://doi.org/10.1002/acr.22032
        • Agarwal N
        • Kumar V.
        Burden of lupus on work: issues in the employment of individuals with lupus.
        Work. 2016; 55: 429-439https://doi.org/10.3233/WOR-162398
        • O'Riordan R
        • Doran M
        • Connolly D.
        Fatigue and activity management education for individuals with systemic lupus erythematosus.
        Occup Ther Int. 2017; 2017https://doi.org/10.1155/2017/4530104
        • Keramiotou K
        • Anagnostou C
        • Kataxaki E
        • et al.
        The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial.
        RMD Open. 2020 Jan 1; 6e001141https://doi.org/10.1136/rmdopen-2019-001141
        • Poole JL
        • Bradford JD
        • Siegel P.
        Effectiveness of occupational therapy interventions for adults with systemic lupus erythematosus: a systematic review.
        Am J Occup Ther. 2019; 73 (-21)7304205020p1https://doi.org/10.5014/ajot.2019.030619
        • Fangtham M
        • Kasturi S
        • Bannuru RR
        • et al.
        Non-pharmacologic therapies for systemic lupus erythematosus.
        Lupus. 2019; 28: 703-712https://doi.org/10.1177/0961203319841435
        • del Pino-Sedeño T
        • Trujillo-Martín MM
        • Ruiz-Irastorza G
        • et al.
        Effectiveness of nonpharmacologic interventions for decreasing fatigue in adults with systemic lupus erythematosus: a systematic review.
        Arthritis Care Res. 2016; 68: 141-148https://doi.org/10.1002/acr.22675
        • Ogdie A
        • Weiss P.
        The epidemiology of psoriatic arthritis.
        Rheum Dis Clin North Am. 2015; 41: 545-568https://doi.org/10.1016/j.rdc.2015.07.001
        • Krajewska-Włodarczyk M
        • Owczarczyk-Saczonek A
        • Placek W.
        Prevalence and severity of fatigue in psoriasis and psoriatic arthritis.
        Postepy Dermatol Alergo. 2020; 37: 46https://doi.org/10.5114/ada.2019.83629
        • Gudu T
        • Etcheto A
        • de Wit M
        • et al.
        Fatigue in psoriatic arthritis–a cross-sectional study of 246 patients from 13 countries.
        Joint Bone Spine. 2016; 83: 439-443https://doi.org/10.1016/j.jbspin.2015.07.017
        • Singh JA
        • Guyatt G
        • Ogdie A
        • et al.
        2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.
        Arthritis Rheumatol. 2019; 71: 5-32https://doi.org/10.1002/art.40726
        • Lundberg IE
        • Miller FW
        • Tjärnlund A
        • et al.
        Diagnosis and classification of idiopathic inflammatory myopathies.
        J Intern Med. 2016; 280: 39-51https://doi.org/10.1111/joim.12524
        • Alexanderson H
        • Lundberg IE
        • Stenström CH.
        Development of the myositis activities profile–validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis.
        J Rheumatol. 2002; 29: 2386-2392
        • Alexanderson H
        • Regardt M.
        Role of Exercise in the Management of Myositis.
        Managing Myositis 2020. Springer, Cham2020: 323-334
        • Regardt M
        • Schult ML
        • Axelsson Y
        • et al.
        Hand exercise intervention in patients with polymyositis and dermatomyositis: a pilot study.
        Musculoskeletal Care. 2014; 12: 160-172https://doi.org/10.1002/msc.1069
        • Gignac MA
        • Cao X
        • Tang K
        • Beaton DE.
        Examination of arthritis-related work place activity limitations and intermittent disability over four-and-a-half years and its relationship to job modifications and outcomes.
        Arthritis Care Res. 2011; 63: 953-962https://doi.org/10.1002/acr.20456
        • McCormick N
        • Marra CA
        • Aviña-Zubieta JA.
        Productivity losses and costs in the less-common systemic autoimmune rheumatic diseases.
        Curr Rheumatol Rep. 2017; 19: 1-20https://doi.org/10.1007/s11926-017-0698-9
        • Beaton DE
        • Dyer S
        • Boonen A
        • et al.
        OMERACT filter evidence supporting the measurement of at-work productivity loss as an outcome measure in rheumatology research.
        J Rheumatol. 2016; 43: 214-222https://doi.org/10.3899/jrheum.141077
        • Allaire SJ
        • Backman CL
        • AlHeresh R
        • Baker NA.
        Ergonomic intervention for employed persons with rheumatic conditions.
        Work. 2013; 46: 355-361https://doi.org/10.3233/WOR-131761
        • Baldwin D
        • Johnstone B
        • Ge B
        • et al.
        Randomized prospective study of a work place ergonomic intervention for individuals with rheumatoid arthritis and osteoarthritis.
        Arthritis Care Res. 2012; 64: 1527-1535https://doi.org/10.1002/acr.21699
        • McCormack RC
        • O'Shea F
        • Doran M
        • Connolly D
        Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: a pilot study.
        Musculoskeletal Care. 2018; 16: 398-404https://doi.org/10.1002/msc.1237
        • Lacaille D
        • Sheps S
        • Spinelli JJ
        • et al.
        Identification of modifiable work-related factors that influence the risk of work disability in rheumatoid arthritis.
        Arthritis Care Res. 2004; 51: 843-852https://doi.org/10.1002/art.20690
        • Carruthers EC
        • Rogers P
        • Backman CL
        • et al.
        Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).
        BMC Med Inform Decis Mak. 2014; 14: 1-7https://doi.org/10.1186/1472-6947-14-59
        • Backman CL
        • Village J
        • Lacaille D.
        The ergonomic assessment tool for arthritis: development and pilot testing.
        Arthritis Care Res. 2008; 59: 1495-1503https://doi.org/10.1186/1472-6947-14-59
        • Baker NA
        • Rogers JC
        • Rubinstein EN
        • et al.
        Problems experienced by people with arthritis when using a computer.
        Arthritis Care Res. 2009; 61: 614-622https://doi.org/10.1002/art.24465
        • Tang K
        • Beaton DE
        • Boonen A
        • et al.
        Measures of work disability and productivity: rheumatoid arthritis specific work productivity survey (WPS-RA), workplace activity limitations scale (WALS), work instability scale for rheumatoid arthritis (RA-WIS), work limitations questionnaire (WLQ), and work productivity and activity impairment questionnaire (WPAI).
        Arthritis Care Res. 2011; 63: S337-S349https://doi.org/10.1002/acr.20633
        • Pope JE.
        Management of fatigue in rheumatoid arthritis.
        RMD Open. 2020 May 1; 6e001084https://doi.org/10.1136/rmdopen-2019-001084
        • Basta F
        • Afeltra A
        • Margiotta DP.
        Fatigue in systemic sclerosis: a systematic review.
        Clin Exp Rheumatol. 2018; 36: 150-160
        • Power JD
        • Badley EM
        • French MR
        • et al.
        Fatigue in osteoarthritis: a qualitative study.
        BMC Musculoskelet Disord. 2008; 9: 1-8https://doi.org/10.1186/1471-2474-9-63
        • Ahn GE
        • Ramsey-Goldman R.
        Fatigue in systemic lupus erythematosus.
        Int J Clinical Rheumatol. 2012; 7: 217https://doi.org/10.2217/IJR.12.4
        • Overman CL
        • Kool MB
        • Da Silva JA
        • et al.
        The prevalence of severe fatigue in rheumatic diseases: an international study.
        Clin Rheumatol. 2016; 35: 409-415https://doi.org/10.1007/s10067-015-3035-6
        • Elera-Fitzcarrald C
        • Rocha J
        • Burgos PI
        • et al.
        Measures of fatigue in patients with rheumatic diseases: a critical review.
        Arthritis Care Res. 2020; 72: 369-409https://doi.org/10.1002/acr.24246
        • Carandang K
        • Poole J
        • Connolly D.
        Fatigue and activity management education for individuals with systemic sclerosis: Adaptation and feasibility study of an intervention for a rare disease.
        Musculoskeletal Care. 2022; https://doi.org/10.1002/msc.1617
        • Guglielmo D
        • Hootman JM
        • Boring MA
        • et al.
        Symptoms of anxiety and depression among adults with arthritis—United States, 2015–2017.
        Morb Mortal Wkly Rep. 2018; 67 (5): 1081-1087https://doi.org/10.15585/mmwr.mm6739a2
        • Jetha A
        • Theis KA
        • Boring MA
        • et al.
        Depressive Symptoms and the Arthritis–Employment Interface: A Population-Level Study.
        Arthritis Care Res. 2021; 73: 65-77https://doi.org/10.1002/acr.24381
        • Murphy LB
        • Sacks JJ
        • Brady TJ
        • et al.
        Anxiety and depression among US adults with arthritis: prevalence and correlates.
        Arthritis Care Res. 2012; 64: 968-976https://doi.org/10.1002/acr.21685
        • Prothero L
        • Barley E
        • Galloway J
        • et al.
        The evidence base for psychological interventions for rheumatoid arthritis: a systematic review of reviews.
        Int J Nurs Stud. 2018; 82: 20-29https://doi.org/10.1016/j.ijnurstu.2018.03.008
        • Roll SC
        • Hardison ME
        • Vigen C
        • et al.
        Mindful body scans and sonographic biofeedback as preparatory activities to address patient psychological states in hand therapy: A pilot study.
        Hand Ther. 2020; 25: 98-106https://doi.org/10.1177/1758998320930752
        • Takata SC
        • Hardison ME
        • Roll SC.
        Fostering holistic hand therapy: Emergent themes of client experiences of mind–body interventions.
        OTJR. 2020; 40: 122-130https://doi.org/10.1177/1539449219888835
        • Gloag D.
        Rehabilitation in rheumatic diseases.
        Brit Med J. 1985; 290: 132-136https://doi.org/10.1136/bmj.290.6462.132

      JHT Read for Credit

      Quiz: # 870

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
      • # 1.
        The authors emphasize the role of
        • a.
          NSAIDs
        • b.
          caretaker efficiency
        • c.
          self-management
        • d.
          proper use of orthotic devices
      • # 2.
        A National Health Survey found that approximately
        • a.
          2/3 of patients were women
        • b.
          2/3 of patients were male
        • c.
          50% were female and 50% were male
        • d.
          70% were left handed
      • # 3.
        Well recognized is the existence of ______________ along with the rheumatoid disease
        • a.
          depression
        • b.
          fatigue
        • c.
          anxiety
        • d.
          all of the above
      • # 4.
        The typical hand deformity accompanying scleroderma is
        • a.
          claw hand
        • b.
          swan neck
        • c.
          reduced PIP extension and reduced MP flexion
        • d.
          mallet finger
      • # 5.
        The authors emphasize the need for therapists to be more aware and concerned about the far-reaching effects of rheumatoid disease beyond the obvious effects on hands
        • a.
          not true
        • b.
          true
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.