Early occupational therapy intervention

Practice guidelines demonstrate that early engagement in occupational therapy could improve the prognosis for returning to normal activities. Remaining active is a key component for a positive recovery following an injury.

Unfortunately, often, an injured individual will adopt a counterproductive behavior as a protective mechanism, prioritizing rest and avoiding activities that might increase pain. Certainly, during the acute phase, this protective approach is appropriate. However, these avoidance behaviors often become predominant and persist over time.

Why aren’t patients referred to occupational therapy earlier?

In the case of, for example, lower back pain, even during the acute phase (0 to 4 weeks), though specific exercises and strengthening may not yet be proven effective at this stage, maintaining an active lifestyle while respecting symptoms contributes to a favorable condition progression. The occupational therapist thus becomes a professional of choice to encourage the patient to remain active while guiding them in the gradual resumption of regular activities. To quickly break the cycle of fear-avoidance, the occupational therapist can:

• Start educating the patient about the condition and principles of proper posture to adopt.
• Identify energy and pain management strategies.

Address individual or environmental obstacles related to returning to activity more promptly.

Moving forward, during the subacute phase (4 to 12 weeks), it’s shown that passive treatments (e.g., physiotherapy, massage therapy, osteopathy) are more effective when combined with exercises and education. Occupational therapy, advocating an active approach, becomes a valuable complementary service alongside physiotherapy. To progressively enhance capabilities necessary for the resumption of problematic daily and work activities, the occupational therapist can:

• Establish a personalized program of graded functional exercises with the patient.
• Facilitate the gradual integration of various acquired skills by simulating different functional tasks.

Additionally, the occupational therapist:

• Evaluates work capacities to create a plan that aligns with the worker’s abilities while encouraging a secure return to employment.
• Becomes an important ally for the physician and insurer concerning return to work.

In summary, by promoting gradual activity while respecting painful symptoms from the beginning of rehabilitation, the occupational therapist acts preventively to avoid the development of psychosocial factors that have been demonstrated as contributors to pain chronicity (e.g., fears and beliefs, catastrophizing, kinesiophobia). These factors can become significant obstacles to resuming daily and productive activities.

Physiothérapie Boisbriand Team

References: [i] Direction de santé publique – Agence de la santé et des services sociaux de Montréal. (2006). “Clinique des Lombalgies Interdisciplinaire en Première ligne (CLIP).” [ii] Van Tulder, M. W., A. Malmivaara, et al. (2000). “Exercise therapy for low back pain.” Spine 25(21): 2784-2796. [iii] Hilde, G., K. B. Hagen, et al. (2004). “Advice to stay active as a single treatment for low-back pain and sciatica.” The Cochrane Database of Systematic Reviews 2. [iv] Furlan, A. D., L. Brosseau, et al. (2005). “Massage for low-back pain.” The Cochrane Database of Systematic Reviews 2.