IntroductionChartered Physiotherapists, those registered with the Health Professions Council UK, are equipped to respond to the needs of lupus patients through effective and appropriate assessment of specific problems identified by individuals. Symptoms vary within and across patients and so it is important to identify the specific concerns, along with a careful consideration of the general features that may be apparent at assessment. Good clinical judgement should lead physiotherapists to determine how they might provide effective management and suitable treatment options based upon best evidence available to them. Therapy and rehabilitation goals should aim at increasing efficiency in activity, with a view to maintaining and improving quality of life.
Management and TreatmentAt assessment, clinicians will engage in a two-fold process. They will approach lupus as a multi-system disease affecting many tissues and organ systems whilst evaluating the consequence of these changes on a person’s life style and their possible aspirations. A diligent review of these factors will contribute in some measure in proposing physiotherapeutic management and other treatment.
The aim of the physiotherapist in the care of the lupus patient will be to provide:
• Appropriate, ongoing assessment of individuals and management of key clinical features and symptoms
• Propose and agree possible therapeutic strategies with patients
• Consider means for future access and review
It is understood that around 60% of people with lupus describe muscle pain, muscle weakness and tenderness. About 90% have some evidence of arthritis and associated joint problems. These compound the experience of day-to-day living. Faced by such issues, the physiotherapist in discussion with the patient may opt for one, or a combination of the following:
• Management of inflammation and the principles of joint protection
• Pain Management
• Encourage and facilitate efficient movement
• Appropriate exercise prescription
• Consider energy conservation
• Possible ergonomic advice for home, the work place or leisure
• Other coping techniques, stress reduction, relaxation, strategies to assist self
• Education of carers
Physiotherapists have a variety of manual skills and other treatment modalities as part of their therapeutic provision. These will be considered carefully and on an individual basis. They may include exercise prescription, activity to promote efficient movement, improve exercise capacity and encourage good posture and functional movement. Along with this, the use of other modalities that promote pain relief, reduce joint stiffness, reduce muscle discomfort and encourage relaxation will be considered. Typically, therapeutic modalities, including use of electrical equipment and hydrotherapy, can be used to assist pain relief and reduce the effects of inflammation. Complementary therapeutic options, including acupuncture, may be available.
Some of the treatments available include:
• Interferential Therapy
• Appropriate Manual Therapy
Increasingly, the move within healthcare is to involve patients at every stage of their care and lupus patients should reasonably expect both direct treatment and assistance in developing and appraising self-management skills so they can cope with daily life, demands and choices. Modern healthcare encourages a partnership approach and liaison/consultation with occupational therapists (and other health professionals) may be essential in terms of further specialist advice and expertise. Such items as working/ resting splints and other aids/equipment may be necessary for home and work life, these may be better provided through occupational therapy services.
General Practitioners should consider referring their lupus patients to Physiotherapy Services; these are often available locally within Primary Care Trusts, local rehabilitation day units or health centres.
Finally, changes in government directive regarding health care initiatives and services have led to general programmes becoming available including the Expert Patient Programmes and a course in Challenging Arthritis. In some areas specific clinics and services will be apparent. It is worth investigating what local provision can offer.
School of Health Sciences
University of Birmingham
Birmingham, B15 2TT