Physical therapy in rheumatoid arthritis.

I N SPITE of new discoveries and advances in the treatment of rheumatoid arthritis, the most important part of the management of patients with this disease today is the prevention or minimizing of deformity and the maintenance or improvement of function. The numerous remedies that have been promoted for use in arthritis tend to detract from the appreciation of the value of physical treatment in preventing crippling and disability. Hill and Holbrook’ have estimated that not one patient in 100 is following a proper schedule to protect his joints and maintain function. This is a serious indictment of our medical care programs for patients with rheumatoid arthritis. Whether one agrees with these figures or not, all will agree that a high percentage of patients fail to carry out any program, or go at it halfheartedly, or eventually tend to lose interest in even a carefully planned and effective schedule of treatment. A review of the literature from 1940 to the present offers little information as to the best way to motivate ‘a patient with a chronic ailment to treat himself over a long period of time. In 1943, a report from the Mayo Clinic? gave the results of a survey of arthritis patients chosen at random from several thousand clinic patients who had been instructed in home physical therapy. Of the 346 patients to whom the investigators sent a questionnaire, 216 responded, and the results showed that 92.7 per cent had started the treatment program and 64.7 per cent had continued treatment for three months or more. There were 96 patients with rheumatoid arthritis in this group; 63.5 per cent of these were continuing home treatment or else had stopped because their condition had improved. A survey of arthritis patients at University Hospital was recently conducted to help evaluate our program of instruction in home treatment and shed some light on why patients continue or stop their home treatment schedules. Fiftysix patients who had previously been instructed in adequate home programs were personally interviewed. At the time of the interview, 5 patients had stopped their home treatment because of improvement in their condition. Of the remaining 51 patients, 27 were still continuing adequate home treatment programs, but 24 patients who needed physical therapy were not treating themselves adequately.