The role of occupational therapy for the self-management of rheumatoid arthritis: a mixed methods systematic review

Abstract Background/Aims Occupational therapy (OT) can support people with rheumatoid arthritis (RA) to self-manage their symptoms and engage in meaningful daily activities. Previous evidence reviews are dated, limited to quantitative research designs, and lack a focus on self-management. The effectiveness of OT in supporting RA self-management is unclear when accounting for both measurable outcomes (e.g., function) and lived experience. This review aimed to assess the impact of OT on the self-management of RA by reviewing quantitative (pain, function and fatigue) outcomes and qualitative (narrative experience) evidence. Methods PROSPERO registration CRD42022302205. We systematically searched for studies involving adults with RA participating in self-management programmes incorporating OT. Searches were conducted via MEDLINE, CINAHL, AMED, PsycINFO, Web of Science (Core Collection) databases, and grey literature sources up to 1 April 2022, with a refresher search conducted on 30 June 2022. Three reviewers screened titles and abstracts. Two reviewers independently extracted and assessed full texts of eligible studies, using the Cochrane risk of bias (quantitative and mixed methods) and Critical Appraisal Skills Programme (CASP) (qualitative) tools to assess study quality. Studies were categorised as: educational-behavioural, comprehensive OT, community (home-based) OT, splints and assistive devices, and other programmes, including workplace interventions. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE-CERQual (qualitative) were used to assess the quality of evidence for each intervention category. Patients and occupational therapists (OTs) were consulted via online workshops to inform the search strategy (n = 4 patients) and interpret review findings (n = 6 patients; n = 4 OTs). Results Of the 36 papers meeting eligibility criteria, 27 were quantitative studies (n = 1802 participants), three qualitative (n = 31), and six mixed methods (n = 844). Strong evidence supports the use of educational-behavioural programmes for pain and function, particularly group sessions on joint protection education. Qualitative evidence was limited to three papers exploring personal transformations experienced during community-based (home) OT. Weak evidence supports the use of splints and assistive devices, whereas comprehensive OT intervention had mixed effectiveness. Across all intervention types, there was little evidence to support OT for self-managing fatigue. Conclusion Educational-behavioural programmes offer improvements in pain and function, but behaviour changes in self-management do not translate to improved long-term health benefits. For fatigue, the evidence to support OT self-management programmes is inconclusive, with the few qualitative insights on lived experience relating to illness, independence, (occupational) activity and altruism specific to home-based OT. Our findings extend current research that OT programmes targeting RA self-management behaviours are effective for short-term behaviour change and improving pain and function, but cannot demonstrate prevention of further physical deterioration for progressive RA. Timing programmes to match the individual’s disease stage (i.e. early or established RA) appeared to impact therapy outcomes and patient experience. Evidence on the patient experience and long-term effectiveness are lacking. Disclosure J.P. Gavin: None. L. Rossiter: None. J. Adams: None. V. Fenerty: None. J. Leese: None. A. Hammond: None. E. Davidson: None. C. Backman: None.