If PT is the heart of rehabilitation, OT is the soul.
Leisure activities, particularly those involving mobility and physical activity, are relinquished by patients as their disease process takes hold.6 This loss contributes to an overall decrease in quality of life, and can be addressed by PTs. As movement experts, PTs help patients find ways to participate in activities and capture some semblance of their predisease lifestyle.
As PTs move into primary care for neuromusculoskeletal conditions, the importance of an annual PT checkup for some patient populations, such as those with rheumatic disease, becomes clear.7,8
Patients benefit the most when referred to an OT for early intervention. OTs support patients with learning strategies to preserve engagement in valued occupations. As the name suggests, OTs can dive into patients’ lives and walk beside them as they figure out how to adapt their occupations or life roles and activities to accommodate their new diagnosis and/or changes in symptoms or disease processes.
Activities and roles OTs can assist with include work and school, household management, leisure activity, parenthood, social roles and civic responsibilities.9 Interventions include, but are not limited to, energy conservation; management of fatigue, cognitive deficits and psychosocial health; activity and environmental modifications; and orthoses to protect painful or unstable joints, especially in the hands.
OTs work closely with PTs, as each focus complements, but does not repeat, the work of the other. If PT is the heart of rehabilitation, OT is the soul.
A Pharmacist Assist
Embedding a clinical pharmacist within the rheumatology clinic can have a positive impact on patient care. Pharmacists in this role typically complete one or two years of post-graduate residency training after completing a Doctor of Pharmacy degree program.
Clinical pharmacists can counsel patients on new medications and have extensive discussions on risks vs. benefits. This frees up the rheumatologist’s time to focus on diagnosis, disease progression and prognosis.
Pharmacist appointments are typically completed after the initial discussion with the rheumatologist, allowing for an extended conversation focused on appropriate prescreening, medication management, infection risk prevention through vaccine, etc.
Clinical pharmacists can practice under a collaborative practice agreement with physicians that authorizes them to order and titrate medications, order laboratory testing and co-manage patients’ chronic diseases. For example, a newly diagnosed patient with RA starting on methotrexate may have monthly follow-up appointments with the clinical pharmacist, who can assess medication safety and make titrations as needed for efficacy and side-effect management. This collaboration can reduce physician burden, providing an opportunity for the rheumatologist to see additional patients, and improve patient access and quality of care. Clinical pharmacists can serve as medication experts, providing education and assistance with complex medication questions, conducting literature reviews and assisting with barriers to medication access.