For clinicians

Occupational therapy

OT, occupational therapist

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Bottom lineOccupational therapy supports function through joint protection, energy conservation and activity pacing, splinting for pregnancy-related hand problems (for example carpal tunnel), assistive equipment, and ergonomic set-up for infant care and feeding. Evidence is modest but the rationale in inflammatory and connective tissue disease is strong.

In practice

Joint protection ●●○○low evidenceconditional

The 2018 ACR/NPF psoriatic arthritis guideline conditionally recommends occupational therapy for people with active PsA (low-quality evidence), alongside physical therapy and exercise. This supports OT as part of inflammatory-arthritis care; it is a general (non-pregnancy) recommendation, applied here to the pregnancy setting by extension. Joint protection education reduces mechanical stress on affected joints; particularly relevant as ligamentous laxity increases in pregnancy.[1]

Energy and pacing ●●○○low evidenceconditional

Energy conservation and activity pacing strategies address the fatigue burden of rheumatic disease, extended into the postpartum period.[1]

Hands and splinting ●●○○low evidenceconditional

Splinting and ergonomic modification help pregnancy-associated carpal tunnel syndrome and small-joint symptoms; many settle postpartum.[1]

Setting up for baby care ●●○○low evidenceconditional

Ergonomic set-up for feeding, lifting, and carrying, plus assistive equipment, reduces strain during infant care.[1]

Key points

PointEvidence
OT targets function and participation across pregnancy and the postpartum transition.[1]●●○○low evidenceconditional

References

  1. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken). 2019;71(1):2-29. https://doi.org/10.1002/acr.23789