What is the relevance of occupational therapy (OT) and physical therapy (PT) for patients with conditions such as dementia, stroke, or chronic diseases like arthritis?

Occupational and Physical Therapy Are Essential First-Line Treatments for Dementia, Stroke, and Arthritis

Occupational therapy and physical therapy should be the primary non-pharmacological interventions for patients with dementia, stroke, and rheumatoid arthritis, with strong evidence demonstrating improvements in functional ability, activities of daily living, and quality of life. 1, 2

Evidence-Based Benefits by Condition

Stroke Patients

• Comprehensive occupational therapy significantly improves functional abilities and social participation in stroke patients, with systematic reviews showing consistent positive effects across multiple high-quality studies 2
• Physical and occupational therapy interventions should focus on retraining normal movement within functional activities rather than isolated impairment-based exercises 1, 3
• Treatment intensity matters—several sessions per week may be more successful in helping patients recover normal function 3

Dementia Patients

• Occupational therapy demonstrates moderate-level evidence for improving activities of daily living (ADL), quality of life, and reducing problem behaviors in dementia patients 1
• The person-environment-occupation model should guide treatment, optimizing the relationship between patient capabilities, their physical/social environment, and target activities 1
• Key challenges include determining optimal treatment dose, methods of service delivery, and identifying which patient subgroups benefit most 1

Rheumatoid Arthritis and Chronic Musculoskeletal Conditions

• There is strong evidence (100% relative benefit) that instruction on joint protection improves functional ability in rheumatoid arthritis patients, with absolute benefits of 17.5 to 22.5 points 4
• Comprehensive occupational therapy shows limited but positive evidence for improving functional ability, with an absolute benefit of 8.7 points (20% relative benefit) 4
• Provision of splints demonstrates indicative evidence for decreasing pain, with an absolute benefit of 1.0 (19% relative benefit) 4
• Occupational therapy is most effective for people with moderate-to-severe arthritis, though patients are increasingly being referred earlier after diagnosis to prevent progression of functional, physical, and psychological problems 5

Core Treatment Principles Across All Conditions

Focus on Function, Not Impairment

• Always prioritize activity-based (functional) goals over impairment-based goals—integrate specific treatment techniques into actual daily function rather than isolated skill training 1, 3, 6
• Avoid compensatory aids and techniques during acute phases or active rehabilitation, as these can reinforce disability patterns 1, 3, 6
• Never use splints or devices that immobilize joints unnecessarily 1, 6

Self-Management as Central Component

• Teaching self-management strategies must be integrated from initial assessment, including establishment of structure and routine through written daily plans 1, 3, 6
• Complete a relapse prevention and ongoing self-management plan as part of treatment discharge 1, 3
• Involve significant others in education and treatment to facilitate support and improve outcomes 1, 6

Therapeutic Relationship and Education

• Take time to listen to the patient's story and build therapeutic rapport before implementing interventions 1, 6
• Provide education about the diagnosis and symptoms, emphasizing that symptoms are real and potentially reversible 1, 3
• Use understandable analogies to explain conditions (e.g., "a software problem, not a hardware problem") 3

Critical Pitfalls to Avoid

• Do not treat these conditions like purely structural neurological diseases by focusing on passive modalities or pharmacological approaches as first-line treatment 3, 7
• Avoid providing wheelchairs, walkers, or other compensatory devices prematurely, as this reinforces disability and prevents functional recovery 3, 7
• Do not pursue impairment-based goals (e.g., "increase range of motion") when functional goals (e.g., "independently dress upper body") are more appropriate 1, 3
• Recognize and sensitively challenge unhelpful thoughts, beliefs, and behaviors that perpetuate disability 1, 6

Expected Outcomes and Timing

• Elderly people and people with stroke or rheumatoid arthritis can expect to benefit from comprehensive occupational therapy, with improvements in functional abilities demonstrated in systematic reviews 2
• For functional neurological symptoms, 60-96% of patients report improvement after intervention, with benefits maintained at 12-25 month follow-up 3, 7
• Early referral after diagnosis is increasingly recommended to prevent progression of functional, physical, and psychological problems, though evidence for effectiveness at this early stage remains limited 5

Multidisciplinary Team Approach

• A multidisciplinary team involving occupational therapists, physical therapists, neurologists, and other specialists is necessary for comprehensive management, with open and consistent communication between all providers 3
• Treatment should be delivered across the continuum of care: hospital settings for acute presentations, rehabilitation wards for intensive therapy, and community settings for ongoing management 3