Move and Not Move: Benefits of Integrated Approaches in Rehabilitation for Patient Living with Rheumatoid Arthritis After Combined Wrist and Tendon Reconstruction
A descriptive case study. Subject with RA underwent combined wrist and tendon reconstruction. Therapy approaches were reexamined to strive for improvement with reference to the postoperative conditions and centric needs of patient. Outcome measures were (1) pain level; (2) hand range of motion; (3) isometric grip strength; and (4) hand function in daily activities. A logic model was applied to analyze thematically the inputs, outputs, outcomes, and impacts of the therapy process.
A 63-year-old right-handed lady serving roles as wife and managing household chores underwent Darrach procedure together with side-to-side tendons repair over right hand and completed 10 occupational therapy sessions in 5 months. Notable changes were reported in (1) Numeric Pain Rating Scale-activity from 5 to 1; (2) Total Active Motion from 75° to 225° of 4th and 5th fingers; (3) Grip Strength from 2 to 12 kgf; and (4) Jebsen Hand Function Test from 98.6 to 62.3. A logic model analysis indicated the integrated approaches in therapy process, including patient-centric care and tailored splinting design featured with both mobilization and immobilization, were promising to address patient’s biopsychosocial needs.
The "move and not move" integrated approaches could accomplish two different benefits of finger mobilization and wrist immobilization were highlighted. The results indicated the impacts were not only substantial pain relief but functional regain. The featured output was the early recovery of agnostic and antagonistic muscle pairs while with the wrist resting through a unique splinting design. The outcomes of achieving optimal hand grip and manipulation were essential to safe and independent living, hence the quality of life. Clinical outcomes trusted in patient’s mastery and compliance to therapy were notably facilitated by the inputs of uncomplicated splint design and regime. Additionally, mastering the eclecticism in perioperative rehabilitation that draws on multiple orientations and techniques could equip therapists to determine the best ways to address the needs of patient. With this logic model analysis augmented with integrated mobilization and immobilization therapy approaches, the surgery for DRUJ arthritis with tendon ruptures may expand the potential benefits of typical patient population of elderly with low physical demands.
Keywords: Rheumatoid Arthritis, DRUJ, Tendon, Surgery, Rehabilitation, Occupational Therapy