Sometimes, the physician's role on minimizing work limitations is direct, perhaps by prescribing traditional therapy regimens and even biologic therapy.
Other times, a physician may refer a patient to physical or occupational therapy, or to a hand surgeon for a customized thumb or wrist splint that permits normal workplace activities, said Diana Baldwin, an occupational therapist at the Missouri Arthritis Rehabilitation and Training Center.
“We've found that it isn't enough to tell people, 'Cut back on your hours,' or 'Be more flexible,' or 'Don't do things that hurt,'” she said. “For the average working person with arthritis, that is not useful.”
What is useful is when physicians explain to patients that their joints are vulnerable, and provide a rationale to implement protective strategies, she said.
The Missouri Training Center in Columbia is currently completing a federally funded study that has randomized 84 adults with arthritis to receive either written materials about arthritis in the workplace or interventions conducted by Ms. Baldwin in the work setting, be it a manufacturing workshop, business office, or classroom. She has spent 1.5–2 hours interviewing these workers with arthritis and then has studied them as they work, taking pictures that she will later diagram to show movements that stress the joints including twisting, grabbing, reaching, and bending.
She has investigated ergonomic surgical tools to aid an anesthesiologist, adapted the car of a traveling salesman, and added a step stool to ease a manufacturing specialist's reach to a drill press.
Making such changes early on appears to keep people working longer, more effectively, and with less pain, she said.
But economic realities have proved to be a barrier to early workplace interventions. No janitors have agreed to allow Ms. Baldwin to come to their workplaces to identify practices that might be exacerbating their arthritis, for example. “They're not going to expose the fact that they have arthritis on the job,” she said.
Before modification, the low cart height required the worker to bend forward.
The modification of a raised handle decreased painful bending posture.
Unmodified task required static overreaching and bending of the trunk.
Before modification, leaning forward created greater tension on back muscles. PHOTOS COURTESY DIANA BALDWIN