APPENDIX A
Principles of Joint Protection, Work Simplification, and Fatigue Management
● If activities that cause pain must be completed, attempt them only if pain lasts less than one hour following the activity. ● Develop a light touch to decrease static pressure on thumb joints during activities such as writing. ● Use tools, adaptive implements and handles, and modified lifting techniques to decrease pain and stress during activities. ● Stop prolonged activities for at least 10 minutes per hour for rest or stretching exercises. ● Maintain muscle strength and range of motion through a pro- gram suggested by a healthcare provider. ● Avoid positions that put undue stress on arthritic joints and that could create deformities. ● Apply cold before, during, or after activity, depending on which method is most effective in reducing pain and inflam- mation. ● Use orthosis as recommended. ● Use the strongest joints available. For example, try to substi- tute the elbow for carrying a purse when hands show signs of arthritic changes. ● Avoid staying in one position for too long. ● Avoid starting an activity that cannot be stopped. Regular rest breaks take stress off delicate or painful joints. Adapted from Cooper (2020) Cleaning your Orthosis The plastic portion of your orthosis can be cleaned using soap and warm water. DO NOT wash orthosis in hot water, as it will melt. Stains can be removed from the orthosis with a scouring cleanser containing chlorine. Rinse and dry the orthosis, and be sure to dry the padding if needed. The straps and orthotic liners can be washed gently and line dried. These components need to be replaced for long-term orthosis usage. Orthosis with Attachments If your orthosis was fabricated with rubber bands or hardware to improve motion, be sure to follow the recommendations below: ● A light, steady pull is better than a hard or forceful pull. ● To achieve optimum comfort and benefit from your orthosis, the tension can be adjusted according to your therapist’s in- structions. Please sign your name below to confirm your understanding of these instructions. Please retain this portion for your records. _________________________________________________________ I have been instructed in the care and use of my orthosis as de- scribed above and have been provided a copy of this information. Client __________________________________ Date __________ ● National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov ● National Institute on Aging http://www.nia.nih.gov Telephone: 1-800-222-2225 ● The American Occupational Therapy Association http://www.aota.org Telephone: 1-800-377-8555 ● The American Physical Therapy Association http://www.apta.org Telephone: 1-800-999-APTA ● The American Society of Hand Therapists http://www.asht.org Amoako, A. O., & Pujalte, G. G. A. (2014). Osteoarthritis in young, active, and athletic individuals. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 7 , 27-32. doi: 10.4137/CMAMD.S14386 Arthritis Foundation. (n.d.). Osteoarthritis. https://www.arthritis.org/diseases/osteoarthritis Badia, A. (2011). Management of the osteoarthritic thumb carpometacarpal joint. In T. Skirven, A. L., Osterman, J. Fedorczyk, & P. C. Amadio (Eds.), Rehabilitation of the hand and upper extremity (6th ed.; pp. 1356-1365). Elsevier. Beasley, J. (2011). Therapist’s examination and conservative management of arthritis of the upper extremity. In T. Skirven, A. L. Osterman, J. Fedorczyk, & P. C. Amadio (Eds.), Rehabilitation of the hand and upper extremity (6th ed.; pp. 1330-1343). Elsevier. Beasley, J. (2012). Osteoarthritis and rheumatoid arthritis: Conservative therapeutic management. Journal of Hand Therapy, 25 (2), 163-172.
● Pack handbags, briefcases, or luggage as light as possible. Use ergonomically designed carrying handles when carrying grocery or trash bags. ● For prolonged telephone use, use a headset that lessens pres- sure on the neck, shoulder, or elbow while talking. Consider a speakerphone for hands-free conversations. ● When cooking, use ergonomically friendly tools such as an electric can/jar opener, utensils with cushioned grips, and spring-activated scissors. ● When purchasing clothing, buy shirts with larger buttons that are easier to work. Buttonhooks with special grips are also available to make buttoning simpler, or try loose-fitting, pull- on clothing to avoid buttons and zippers. ● Reduce force and effort. Whenever possible, consider aids such as lamp switch enlargers, special doorknob/key turners, gas cap turning aids, zipper pulls, dressing sticks, long shoe- horns, and sock pulls to make daily tasks easier or to change the position of the hand. ● Respect pain. Do not engage in activities that cause pain and swelling of the joints of the hand.
APPENDIX B SAMPLE ORTHOSIS CARE AND USE SHEET
Name _________________________________________________ Therapist _______________________________ Date __________ Type and purpose of orthosis: _____________________________ ________________________________________________________ ________________________________________________________ Wearing schedule: ______________________________________ Special considerations for application: ____________________ Precautions: ● Keep your orthosis away from open flames, as it will burn. ● Avoid exposing the orthosis to temperatures above 135 de- grees Fahrenheit. ● Do not leave the orthosis in a car or near a heat vent. ● Do not adjust the orthosis. ● Contact your therapist (XXX-XXX-XXXX) for adjustments or if any of the following occur: ○ Reddened areas on your skin lasting longer than 20 min- utes. ○ Additional swelling, pain, or stiffness. ○ Numbness. Resources ● American College of Rheumatology http://www.rheumatology.org ● American Society for Surgery of the Hand: Goniometry/ Range of Motion Norm Values http://www.eatonhand.com/cht/cht044.htm ● Arthritis Foundation http://www.arthritis.org ● E-hand.com: The electronic textbook of hand surgery http://www.eatonhand.com/ References Agency for Healthcare Research and Quality (AHRQ). (2020). Self-management support. https://www.ahrq.gov/ncepcr/tools/self- mgmt/self.html Akaltun, M. S., Altindag, O., Turan, N., Gursoy, S., & Gur, A. (2021). Efficacy of high intensity laser therapy in knee osteoarthritis: A double-blind controlled randomized study. Clinical Rheumatology, 40 , 1989-1995 Altman, R., Alarcon, G., Appelrouth, D., Bloch, D., Borenstein, D., Brandt, K., Brown, C., Cooke, T. D., Daniel, W., & Gray, R. (1990). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis & Rheumatism, 33 (11), 1601-1610. American Occupational Therapy Association (AOTA). (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001 American Physical Therapy Association (APTA). (n.d.). Becoming a PT. https://www.apta.org/your-career/careers- in-physical- therapy/becoming-a-pt
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