Successfully Working with PT and OT

Thursday, September 13, 2007

By: Wendy Radonovich-Crum OTR/L

Reprinted from FMOnline


Many people with fibromyalgia have seen a physical therapist in their quest for symptom relief. Therapy treatments tend to focus on localized pain symptoms. Since research on the cause of fibromyalgia indicates symptoms are not localized, standard therapy is not usually successful; in fact many people complain that therapy “made their symptoms worse.”

At Total Rehab Care, an outpatient therapy facility that is a department of Washington County Hospital, in Washington County, Maryland, we have a fibromyalia therapy program that includes both physical and occupational therapy. Patients are seen for individual evaluations by a physical and occupational therapist and then are seen in a group setting, once a week for seven consecutive weeks. For those who attend regularly, the program has a proven track record with patients showing a positive outcome as demonstrated by decreased scores on the fibromyalgia impact questionnaire (FIQ).

Physical therapists see patients for stretching, aquatic exercise, strengthening, TENS (transcutaneous electrical nerve stimulation) unit trial. Most importantly, patients learn how to determine their target heart rate and apply that to their exercise program. Patients develop an exercise program that they will continue after being discharged from therapy.

While many people with fibromyalgia have seen a physical therapist, few have seen an occupational therapist. Occupational therapy is in a unique position to instruct people with fibromyalgia in management techniques that can empower them and be used for a lifetime. Occupational therapy focuses on the whole person through their activities of daily living (ADL). Therapists work with patients to find a balance between work, rest, and play. By learning adaptive techniques, energy conservation, pain management, relaxation techniques, problem solving, sleep hygiene, communication techniques, and goal-setting, patients are able to determine life changes that will allow them to optimize their function within their limitations. With therapist assistance, patients develop a daily and weekly schedule that they will continue after discharge. The schedule is designed to provide the balance of work, rest and play needed for optimal symptom management.

One of the biggest keys to patient success in a therapy program is the patient’s grasp of two concepts:
1) Exercise is required. Patients are instructed to think of exercise as a medicine, like high blood pressure pills. People with fibromyalgia must exercise.

2) There is no magic cure. If patients’ expectations are that they will be “cured”— have no pain or fatigue—they are destined to be disappointed. It is important that therapists work with patients to establish realistic goals.

When seeking a fibromyalgia therapy program, consider and ask about these things:

  • What outcome measure is used? How do you know this program works?
  • What specialized services are available for people with fibromyalgia? What training has the therapist had related to fibromyalgia?
  • How long does the program last? (Research suggests a program should be at an average of 6-8 weeks long for optimal patient benefit.)
  • Treatment sessions should be organized and standardized to assure quality of care. While you want a program that meets your individualized needs, you also want to know there are specific topics covered and goals designed for someone with fibromyalgia.
  • Set goals that are very small but progress regularly—for example: I will walk two minutes daily. Next week, I will walk three minutes.
  • Expect pain to get worse before it gets better. You should expect an improvement after you have maintained a regular exercise program for 6-8 weeks.
  • Expect fatigue to progressively improve with increased exercise and better quality of sleep.