Arthritides

The effects of arthritis are complex and largely interdependent. Pain may produce physical disability, which in turn can produce social disability and changes in HRQOL. Joint and muscle disuse resulting from physical disability produces muscle atrophy, bone density loss, and may lead to further pain.\ud People with arthritis should be encouraged to manage their own illness and take responsibility for their own care in the long term. Both physical and manual therapies may appropriate for people with arthritis, depending upon their readiness to adopt self-management strategies. \ud ASMPs, based on Lorig's work, are offered through arthritis foundations in many countries around the world. These programs have been well evaluated, and shown to improve both physical and psychological well-being in people with arthritis. Furthermore, these programs appear to reduce the direct healthcare costs associated with arthritis care (Lorig et al 1993). ASMPs are of greatest use to people in the action and maintenance stages of change (Kerns & Rosenberg 2000). \ud Therapists can use consultations as a vehicle for communication with clients, and to assist them in the transition from practitioner-driven to client-driven care, from the early to later stages of change. Practitioners of the passive (usually manual) therapies are advised to use deliberate tactics such as mutually agreed care contracts to prevent client dependence