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Recreational Therapy Evidence Based Practice Day ConferenceTemple University, Department of Rehabilitation Sciences, Recreational Therapy ProgramApril 24, 2019 Clinical Practice Guidelines for Recreational Therapy Treatment of Rheumatoid ArthritisJulia Olek, BSRT Student, juliaolek@temple.eduChristina Rennie, BSRT Student; c.rennie@temple.eduHeather R. Porter, PhD, CTRS; Associate Professor; hporter@temple.eduCitation of Guideline Reviewed: Brosseau, L., Rahman, P., Poitras, S., Toupin-April, K., Paterson, G., Smith, C.,…McEwan, J., (2014). A systematic critical appraisal of non-pharmacological management of rheumatoid arthritis with appraisal of guidelines for research and evaluation III. PLOS One, 9(5), 1-8. KeyACRAmerican College Rheumatology BSRBritish Society for RheumatologyBHPBritish Health ProfessionalsNICENational Institute for Health and Clinical ExcellenceRACGPThe Royal Australian College of General Practitioners SIGNScottish Intercollegiate Guidelines Network*=Citation number within article++ = strongly recommended; ??= recommended; - = weak evidence; 0 = insufficient evidenceOther InterventionsIntervention ACR BSR BSR & BHPEularForrestier et al. Gossec et al.Hurkmans et al. NICEOttawa Panel RACGP SIGN [29]*[30]*[31]*[32]*[33]*[34]*[35]*[36]*[37-41]*[42]*[43]*Assistive devicesNA--0-NANANA0-NAEnergy Conservation?NANANANANANANA0NANAJoint Protection?-??0NA???0Patient Education/self-management?????0????-0Authors strongly recommend the use of joint protection as an intervention for the treatment of rheumatoid arthritis. It is recommended to use patient education and self-management as a treatment option. There is insufficient to no evidence supporting the use of assistive devices. ACR recommends using energy conservation techniques in the treatment of rheumatoid arthritis. Team ApproachIntervention ACR BSR BSR & BHPEularForrestier et al. Gossec et al.Hurkmans et al. NICEOttawa Panel RACGP SIGN [29]*[30]*[31]*[32]*[33]*[34]*[35]*[36]*[37-41]*[42]*[43]*Multidisciplinary Team Approach??NA??NANA?NANA?It is recommended to use a multidisciplinary approach in the treatment of rheumatoid arthritis. Therapeutic ExercisesIntervention ACR BSR BSR & BHPEularForrestier et al. Gossec et al.Hurkmans et al. NICEOttawa Panel RACGP SIGN [29]*[30]*[31]*[32]*[33]*[34]*[35]*[36]*[37-41]*[42]*[43]*AquaticsNANANANANA?0NA?NANAAerobic Exercise (AE)???????????-??Low Intensity ExercisesNANANANANANANANA??NA??Dynamic Exercises???????????????????StretchingNANANANANANANA?NANANAStrengthening & Exercise (SE)??????????-??Whole body exercise (Tai Chi and Yoga)????NA?NA??-??Aquatics as a therapeutic exercise in the treatment of rheumatoid arthritis is recommended by Gossec et al as well as Ottawa Panel. Aerobic exercise is strongly recommended by Hurkmans et al as well as SIGN. RACGP found weak evidence supporting aerobic exercise and it is recommended by all other authors. Low intensity exercises were strongly recommended by Ottawa Panel and SIGN. Dynamic exercise is both strongly recommended and recommended by all authors. Stretching is recommended by NICE. Strengthening & exercise is strongly recommended by Hurkmans et al and SIGN, recommended by ACR, BSR, BSR & BHP, Eular, Forrestier et al, Gossec et al, NICE, and Ottawa Panel, and there is weak evidence supporting strengthening and exercising by RACGP. Whole body exercise, including tai chi and yoga, is recommended by ACR, BSR, BSR & BHP, Eular, Gossec et al, NICE, and Ottawa Panel, with strong recommendation from SIGN and weak evidence supporting from RACGP. More research is needed for More research needed regarding disease activity, joint symptoms, level of fatigue and quality of life to determine optimal management of RA. Weight ManagementIntervention ACR BSR BSR & BHPEularForrestier et al. Gossec et al.Hurkmans et al. NICEOttawa Panel RACGP SIGN [29]*[30]*[31]*[32]*[33]*[34]*[35]*[36]*[37-41]*[42]*[43]*Control of WeightNANANA0NANANANANA-?DietNANANA00NANA-NA???Diet and Physical ActivityNANANA0NANANANANA?NAControl of weight is recommended by SIGN and weak evidence supports control of weight from RACGP. Diet is strongly recommended by RACGP, recommended by SIGN, with weak evidence supporting diet from NICE. Diet and physical activity is recommended by RACGP. ReferencesAmerican Academy of Physical Medicine and Rehabilitation (2019). Clinical practice guidelines. Retrieved from Arthritis Research UK (2011). Looking after your joints when you have arthritis. Retrieved from , L., Rahman, P., Poitras, S., Toupin-April, K., Paterson, G., Smith, C.,…McEwan, J., (2014). HYPERLINK "" A systematic critical appraisal of non-pharmacological management of rheumatoid arthritis with appraisal of guidelines for research and evaluation III. PLOS One, 9(5), 1-8. Guo, L. ?(2015). Rheumatoid Arthritis. In Porter, H. (Ed.), Recreational therapy for specific diagnoses and conditions (327-334). Enumclaw, WA: Idyll Arbor Inc.Porter, H. R. (2015). Energy conservation techniques. In Porter, H. (Ed.), Recreational therapy basics, techniques, and interventions (317-321). Enumclaw, WA: Idyll Arbor Inc.Porter, H. R. (2015). Consequences of inactivity. In Porter, H. (Ed.), Recreational therapy basics, techniques, and interventions (317-321). Enumclaw, WA: Idyll Arbor Inc.Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71-72. ................
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