Functional and work outcomes improve in patients with Rheumatoid Arthritis (RA) who receive targeted comprehensive occupational therapy

INTERVENTION: Occupational therapy versus usual care. Comprehensive occupational therapy alongside usual rheumatology care. Typical OT interventions included the following: 1. Provision of education on RA 2. Medications, compliance and management within the IAC 3. Self‐advocacy 4. Work place rights and responsibilities 5. Ergonomic reviews 6. Discussions with employers regarding reasonable accommodations 7. Posture and positioning advice 8. Pacing 9. Activities of daily living 10. Stress management 11. Assertiveness 12. Sleep posture and hygiene 13. Exercises 14. Footwear 15. Splinting 16. Assertive communication Patients were referred to multidisciplinary team members and community services as required. Duration of intervention: 6 months CONDITION: Rheumatoid Arthritis (RA) ; Musculoskeletal Diseases ; Rheumatoid Arthritis (RA) PRIMARY OUTCOME: The following outcomes were measured at baseline and 6 months: ; 1. The Canadian Occupational Performance Measure (COPM). The COPM is a well known standardised semi‐structured interview tool designed for use by OTs to detect change in a patient's self perception of occupational performance. ; ; 2. The Health Assessment Questionnaire ? Disability Index (HAQ‐DI) is a standardised, self‐administered, written questionnaire developed to assess the extent of the patient's functional ability. SECONDARY OUTCOME: The following outcomes were measured at baseline and 6 months: ; 1. The RA‐Work Instability Scale (RA‐WIS) is a self administered written validated questionnaire used to screen for WD. The questionnaire takes less than 5 minutes to complete by checking 'yes' or 'no' boxes in a series of 23 questions. ; ; 2. The Modified Health Economics Questionnaire combined measures of presenteeism and absenteeism. This is a written self‐report questionnaire which includes the following:; a. Number of days/hours at work per week; b. Number of days missed from work in the past month due to RA; c. A 100 mm Visual Analogue Scale (VAS) for work performance and work satisfaction affected by RA, in the past week INCLUSION CRITERIA: Employed RA patients were recruited at the Inflammatory Arthritis Centres (IACs), Guy's and St. Thomas' NHS Foundation Trust, to ensure standardised medical management. Within the IACs the focus of medical treatment is on early, aggressive management with a goal of achievement of remission (the Disease Activity Score 28‐joint assessment [DAS28] <2.6). Participants were eligible if they: 1. Had a confirmed diagnosis of RA 2. Were involved in full time/part‐time work or were self employed 3. Were fluent in English 4. Lived locally 5. Had medium or high Work Disability (WD) risk on the RA‐Work Instability Scale (RA‐WIS)