Other healthcare professionals

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Other healthcare professionals
The lecture on other healthcare professionals
looks at
Who they are
Their importance in the overall treatment plan
Their specific role in the various
musculoskeletal disorders
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Other healthcare professionals
   Social workers        
Dietitians         Chiropractors        
Podiatrists         Massage therapists
        Physiotherapists         Occupational
therapists         Nurses        
Pharmacists         Psychologists  
It is important for the clinician to have an
understanding of the services provided by
alternative healthcare professionals. The
healthcare professional used will depend upon the
type of rheumatic disease.Patients may also
consult other healthcare professionals, e.g.
podiatrists. The clinician should keep in mind
that the number of patients using alternative or
complementary therapies is very high. (1)Other
healthcare professionals should not be relied
upon to make a diagnosis. Patients not benefiting
from these services may be a reflection of a poor
diagnosis or the prescribing of a therapy not
tolerated by the patient.
1. Eisenberg D. Alternative medical therapies for
rheumatologic disorders. Arth Care Res
199691-4.
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Other healthcare professionals
All rheumatic conditions
Provincial arthritis centres
Education is important for all rheumatic
conditions. For chronic conditions, group
programs can be accessed through provincial
arthritis centres. Such programs can often be
arranged for outlying communities and can be run
by nurses, physiotherapists, occupational
therapists and social workers.
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Other healthcare professionals
The Arthritis Society
Patient leader
General knowledge
Provincial divisions of The Arthritis Society
organize the Arthritis Self-Management Program
(ASMP). It consists of six sessions using a
trained patient leader and is good for general
information on arthritis and for developing new
behavioural skills.
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Other healthcare professionals
Fibromyalgia, regional pain syndromes
Compensation/disability issues
Avoidance of medical interventions
Role of physiotherapist and education programs
Interdisciplinary clinic
With fibromyalgia and regional pain syndromes
there may be compensation and disability issues.
Patients should be directed to group education
and exercise programs rather than specialized
medical therapy. If there is evidence of chronic
pain syndrome with depression and disability,
then an interdisciplinary clinic may be of
benefit.
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Other healthcare professionals
Prevention through community education program
Management
Weight-bearing exercise
Fall prevention
Calcium, vitamin D
Avoid manipulation
Community education programs are key in the
prevention of osteoporosis. Physiotherapists can
help with weight-bearing exercises, occupational
therapists teach fall prevention, and dietitians
provide advice on how to increase calcium and
vitamin D intake through diet or supplementation.
Manipulation should be avoided.
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Other healthcare professionals
Muscle strengthening, education, ROM
The Arthritis Society
Surgery
The goal in degenerative arthritis is muscle
strengthening, education and increasing range of
motion (ROM). Physiotherapists, occupational
therapists and the local arthritis treatment
centre can meet these needs. The patient may
graduate to community-based programs. The
Arthritis Society can be contacted for exercise
programs that are safe for those with
arthritis.Inpatient rehabilitation care with an
interdisciplinary team may be useful particularly
for post-operative patients.
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Other healthcare professionals
Gout
Diet
Medication and compliance
Gout is a common condition. A dietitian can help
educate patients about a low purine diet and the
avoidance of alcohol. Pharmacists are useful for
medication education, particularly the importance
of complying with uric acid lowering drugs and
potential drug interactions. Physiotherapists
are helpful in the treatment of acute and chronic
arthropathies and an occupational therapist or a
podiatrist may be useful for chronic foot and
ankle arthropathy.
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Other healthcare professionals
Early intervention of other healthcare
professionals
Occupational therapy
Extensive education
Social workers
The Arthritis Society
Specialized nurses
Systemic inflammatory conditions are usually
complex and an interdisciplinary team approach is
often necessary. This can be done as an acute
care inpatient, a rehab inpatient or as an
outpatient. These conditions also need extensive
education regarding organ involvement, prognosis,
medication and activity.   Therapists with
rheumatology training will have a good
understanding of the issues of joint
inflammation, muscle weakness, rapid joint
destruction and danger signals requiring the
immediate attention of the attending
physician.   Occupational therapy is necessary
both early in the course of the disease and when
joint damage makes function more difficult later
in the disease.   There may be a significant
change in the quality and length of life and
depression may be a secondary phenomenon that may
necessitate psychological counselling.   Social
workers can be helpful in accessing disability
programs, financial aid and support groups.
Financial problems often occur due to loss of
employment and the expense of medical equipment.
Social workers can also arrange vocational
counselling.   Specialized nurses can direct drug
monitoring, screen for drug side effects and
educate the patient. Such nurses often run
clinics at arthritis centres that administer
immunosuppressive agents and second-line
therapies.
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Other healthcare professionals
Team approach
Provincial arthritis centres
Disease complexity and severity
The use of other healthcare professionals is
important in the treatment of rheumatic
conditions. Services can usually be accessed
through provincial arthritis centres or
affiliated therapists.The complexity and
severity of the disease will help determine which
services to access.
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Other healthcare professionals
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with arthritis. Patient Ed Counsel
199627257-267.   Barry MA, Purser J, Hazleman R
et al. Effect of energy conservation and joint
protection education in rheumatoid arthritis. Br
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Burckhardt CS Clark SR et al. Group treatment of
fibromyalgia A 6-month outpatient program. J
Rheumatol 199623521-528.   Block JA, Schnitzer
TJ. Therapeutic approaches to osteoarthritis.
Hospital Practice (Office Edition).
199732159-164.   Creamer P, Hochberg MC.
Osteoarthritis. Lancet. 1997350503-8.   Fransen
M, Margiotta E, Crosbie J et al. A revised group
exercise program for osteoarthritis of the knee.
Physiother Res Int 1997230-41.   Keefe FJ,
Kashikar-Zuck S, Opiteck J et al. Pain in
arthritis and musculoskeletal disorders the role
of coping skills training and exercise
interventions. J Orthop Sports Phys Ther
199624279-90.   Mazes JM, van den Ende CH. How
vigorously should we exercise our rheumatoid
arthritis patients? Annals of the Rheumatic
Diseases. 199655861-862.   McCain GA Bell DA
Mai FM et al. A controlled study of the effects
of a supervised cardiovascular fitness training
program on the manifestations of primary
fibromyalgia. Arthritis Rheum 1988311135-1141.  
Rejeski WJ, Brawley LR, Ettinger W et al.
Compliance to exercise therapy in older
participants with knee osteoarthritis
implications for treating disability. Med Sci
Sports Exer 199729977-985.   Ronen R, Braun Z,
Eyal P et al. A community-oriented programme for
rehabilitation of persons with arthritis. Disab
Rehab 199618476-481.   Stenstrom CH, Arge B,
Sundbom A. Home exercise and compliance in
inflammatory rheumatic diseases a prospective
clinical trial. J Rheumatol 1997 24470-476.  
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