Usually by the time the patient with rheumatoid arthritis requires or opts for surgery, there would have been quite a bit of joint damage and some degrees of subluxation or deformity of the joints. Comprehensive occupational therapy assessment would include physical, physiological, psychological, social and environmental perspectives of the patient with rheumatoid arthritis. It is often at this stage also that many of the patients would probably have stopped any form of paid employment, except for housewives who would still be doing household chores.
The things that the hand occupational therapist will be looking out for includes power, presence of deformity, any signs of subluxation, skin temperature, pain and range of motions will be assessed. Given the fact that rheumatoid arthritis has its cycles of exarcebations and remissions, it'd be good to keep an assessment mindset over at least 3 sessions to ascertain the hand and its function. It'd be good also to breakdown the assessment over 2-4 sessions depending on patient's ability to tolerate each session, as not all patients would like to keep travelling to the clinic.
The hand occupational therapist would then perform a series of checks, one of them is the informal interview. The results of the informal interview may be rather inaccurate as the patient might refer to a time prior to the onset of the disease, and since the disease is progressive they might not be very accurate as well. It'd be best to combine a variety of assessment tools eq quantitative and qualitative approach to have a more holistic idea to their hand function.
Essentially, it is best for the hand occupational therapist to perform a practical assessment task on the patient, covering the activities of daily living (ADL).
The ADL activity assessment should include but is not limited to:
1. dressing: able to wear and take off own clothing, including undergarments and prostheses, if any
2. personal hygiene: brushing teeth, wiping/washing face, handwashing
3. toileting: ability to perform voiding activities
4. feeding: feeding and drinking during meal times
5. mobility: walking, stairs management, transfers
6. housework: cleaning, laundry, marketing, money management
7. communications: using a phone to SMS or make calls, writing, typing etc.