‘Lifestyle redesign’ with occupational therapy

11 Nov 2014  |  Print

‘Lifestyle redesign’ with occupational therapy

Patients with chronic pain often find everyday tasks difficult and tiring. Frequently reported problems include essential functions like self-care, leisure activities, working and even sitting down.[1] Pain medications can be important in addressing these issues, but a broader approach is required to maximize patient functionality. This is where occupational therapy comes in.

Roles of occupational therapy in chronic pain

Occupational therapists examine the effect of chronic pain on a patient’s life. Although the word ‘occupation’ is in the job title, they are not concerned only with work-related issues – here the word refers to a broader sense of daily occupation. Hence, their role is to address the impact of chronic pain on all aspects of functional ability: in work, leisure and other activities of daily living.

What does this mean in practice?

Occupational therapists support patients in a number of ways. Their first role is to identify activities that trigger the patient’s pain. Through ‘activity analysis’, they can often identify actions that exacerbate pain, and suggest adaptive devices that will make the task easier.[2]

Their second role is harm reduction. For example, some activities may place strain on damaged joints. Occupational therapists can guide patients toward more ergonomically correct tools or biomechanically better ways of lifting and carrying.[2]

A third key role of occupational therapists is reducing fatigue. Chronic pain is often very tiring, either as a result of the pain itself or because of other factors such as difficulty sleeping or the side effects of medications.[2,3] Re-structuring daily routines, improved sleep position, and customized exercise programs can reduce the impact of fatigue.[2]

The fourth role is to provide emotional support through counseling and cognitive behavioral therapy. This can help patients to cope with feelings of loss or anger caused by their pain.[2]

The final role of the occupational therapist is to help patients navigate the health and welfare system. Chronic pain is often stigmatized and is frequently not well understood, even by some healthcare professionals. Hence, many patients require assistance in accessing the resources they need to manage their pain.[2]

Does occupational therapy work?

The straightforward answer to this question is ‘yes, it does work’. In a recent study, patients with rheumatoid arthritis were randomized to occupational therapy or usual care.[4] After 6 months, improvements in functional outcomes were significantly greater in the occupational therapy group than in the usual care group; pain and quality of life were also significantly improved.

Similarly, in a study of 134 patients with chronic low back pain, patients randomized to integrated care (based on occupational therapy) were able to return to work more rapidly than patients receiving usual care.[5] They also experienced improvements in functional status and pain.[5] Integrated care also had substantial economic benefits, resulting from patients’ increased productivity.[6]

Lifestyle redesign

It is clear that occupational therapy is beneficial for patients with chronic pain. But can we take it further? Is it possible to work with chronic pain patients to re-examine all relevant aspects of their lives?

This is where the concept of ‘lifestyle redesign’ comes in. As described by Barbara Kornblau, Executive Director of the Society for Participatory Medicine: “Lifestyle redesign is a process of looking at how someone lives their day, what their activities are, what they do in their life… and coming up with a redesign of how they can do the things they want to do, in a way that decreases their pain”.[7]

Lifestyle redesign integrates theories and techniques from both occupational therapy and life coaching, to help patients establish a happy and successful lifestyle that is compatible with their functional limitations. It is typically delivered through a mix of individual and group sessions over a few weeks or months.

Lifestyle redesign incorporates a variety of methods and tools, including[8]:

  • Stress and the relapse dynamic
  • Body mechanics and posture
  • Energy conservation
  • Time management
  • Optimizing the home environment

A good example of the techniques that might be applied is ‘pacing’. This aims to spread activity throughout the day, helping patients to manage their energy levels and avoid exacerbating their pain.[9] Individually tailored pacing has been shown to significantly reduce the amount of fatigue-related interference with daily activities.[10]

The effectiveness of lifestyle redesign has been tested in a randomized controlled trial of 460 elderly subjects.[11] Compared with untreated controls, the intervention group showed favorable changes in various measures. These included bodily pain, vitality, social functioning, mental health, life satisfaction and depressive symptomatology (p<0.05).

The message from this work is clear: the medical community needs to engage with chronic pain sufferers in a more universal way, to improve functional outcomes and quality of life and reduce pain. Occupational therapy can play a key role in this process.

References

1. Persson E, Lexell J, Rivano-Fischer M, Eklund M. Everyday occupational problems perceived by participants in a pain rehabilitation programme. Scand J Occup Ther 2013;20:306-314.

2. Klinger L, Klassen B. What does an occupational therapist do for someone living with chronic pain? Canadian Pain Coalition Newletter 2011;4(2):12.

3. Andrew R, Derry S, Taylor RS, Straube S, Phillips CJ. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Pract 2014;14:79-94.

4. Macedo AM, Oakley SP, Panayi GS, Kirkham BW. Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Arthritis Rheum 2009;61:1522-1530.

5. Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ 2010;340:c1035.

6. Lambeek LC, Bosmans JE, Van Royen BJ, et al. Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial. BMJ 2010;341:c6414.

7. Kornblau BL. Lifestyle redesign. Available at: www.painweek.org/education_posts/lifestyle-redesign/. Accessed 09 October 2014.

8. University of Southern California Division of Occupational Science and Occupational Therapy. Lifestyle Redesign® Pain Management Program. Available at: chan.usc.edu/patient-care/faculty-practice/pain-management. Accessed 09 October 2014.

9. McNulty S. Lifestyle redesign®: a successful tool for pain management. Available at: issuu.com/painweek/docs/hch-07_lifestyle_redesign__kornblau_and_mcnulty_. Accessed 09 October 2014.

10. Murphy SL, Lyden AK, Smith DM, Dong Q, Koliba JF. Effects of a tailored activity pacing intervention on pain and fatigue for adults with osteoarthritis. Am J Occup Ther 2010;64:869-876.

11. Clark F, Jackson J, Carlson M, et al. Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial. J Epidemiol Community Health 2012;66:782-790.

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