Occupational Therapy Is a Vital Member of the Interprofessional Team-Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

Patient perspectives are critical to both the development and application of treatment guidelines. The Arthritis Care & Research Editorial Board asked 3 members of the patient panel to provide their viewpoints and experiences related to the 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis, which is published in this issue of Arthritis Care & Research (1). We are grateful for their contributions. I must first thank the ACR for reaching out to patients with rheumatoid arthritis (RA) directly to be part of the team in creating the 2022 ACR Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Who better to talk to about the efficacy of therapies included in the guidelines than patients themselves, who use these treatments in coordination with medication therapies. As I have had RA since I was 13, you can bet I've used many of these to complement the medications I use. Many of these therapies have been life changing in a positive manner. Treatments included in the guidelines play an integral part in my RA treatment. Since I have had RA for over 40 years, I have leaned on these therapies in concordance with medication. I have sincerely leaned on occupational therapy (OT) and physical therapy (PT) over the years because I have had so many surgeries, and they have helped me get stronger and heal more quickly, along with using splints, and/or made-for-me tools. I have been taught appropriate and correct exercises to do, as well as how to adapt these exercises so they work for me. I can easily say my life without PT and OT would not be as good functionally, as guessing about appropriate exercises could be detrimental and certainly harmful. I have also used different diets to help manage RA symptoms. My rheumatologist and I completely use shared decision-making in every decision we make together. If I have a treatment or integrative therapy I am curious about, I actively bring it up in my in-person visits. I have built a trusting relationship with my rheumatologist. The nurse practitioner in my rheumatologist's office is also a great sounding board for questions, as some treatments could be fads and could be harmful to our bodies. Being open and honest is always recommended. I come to each rheumatologist appointment with a list. I also list the questions in order of importance, because sometimes my rheumatologist and I don't get to all my questions depending on how in-depth we go during the visit. I also think the guideline could be a very useful handout that rheumatologists could share with their patients. These handouts could be made available in rheumatologists’ offices as patients wait for the provider, or via a QR code that can be accessed on our phones. Moreover, the nurse practitioner could be our first outreach for further questions. I strongly feel this guideline can be used hand-in-hand with our medication treatments. So much of learned information comes from social media and it can be difficult to distinguish between a trusted source or an unreliable one. Having links to the recommendations noted in this guideline can only help people with RA. RA is a very painful and debilitating disease to live with. When I was first diagnosed with RA in 2015 at the age of 29, I was desperate for relief of the pain, fatigue, and emotional distress I was experiencing. As a single mother, I was struggling to take care of myself and my son, who was a toddler at the time. In the early years of my diagnosis, I spent thousands of dollars trying different supplements, treatments, and providers for any sort of relief. I felt I needed to try everything available, and there is a lot of misinformation or conflicting information on the internet and from our peers when it comes to relief of disease symptoms. I didn't know where to turn, and I felt lost in trying to determine who to listen to. Managing RA requires more than simply taking the right medications. It requires the right mix of realistic nutrition, adaptations, movement, and lifestyle or behavior changes, not to mention caring for your mental health and dealing with unexpected side effects. Soon following my diagnosis, I realized it was going to take more than medications and a rheumatologist to treat and to learn to self-manage RA. Rheumatologists are often overworked and have many patients to see. Also, they are typically not experts on diet or how to exercise, manage fatigue, or make cooking easier. Questions I had around physical activity or fatigue management were not something my rheumatologist could provide me with answers to. However, my rheumatologist referred me to a local arthritis clinic where I was able to see occupational therapists, physical therapists, clinical social workers, and psychologists with an interest in arthritis care. My rheumatologist recognized that I was struggling with acceptance of my disease and was feeling very alone in my diagnosis, so she referred me for mental health support to address my depression. It wasn't until I had the support of an integrated team that I felt I understood RA and I was able to self-manage my disease more easily. It is important for rheumatologists and other rheumatology professionals to know where to send patients to find these supports but to also refer them early on in the diagnosis and treatment process for the best outcomes. RA is a progressive disease and comes with many different comorbidities, which has made these integrated supports a common part of my treatment plan throughout my journey with RA. Does she or doesn't she – only her hairdresser knows for sure. That was the tagline of a 1960s commercial advertising a hair color product. But if you are a patient with rheumatoid arthritis, your rheumatologist should know for sure what type of integrative treatments you are using. Unfortunately, too many patients avoid telling their doctors what integrative treatments they are using or have tried in the past. They are often fearful of what the doctor might say about these practices. Also, many rheumatologists do not have research-based answers when patients ask about what might work. That is why the 2022 ACR Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis can help. This examination provides a compendium of the best available science about which integrative treatments might work. But instead of 1 expert opinion, it comes from a team of doctors, researchers, and patients who considered all available evidence and published the findings. Doctors should now have a ready reference point when patients ask about any potential integrated treatment. For example, when I asked my rheumatologist about acupuncture, he said he did not favor it. When I asked him why, he said his patient had been drastically overcharged and received no benefit. While I am sure that was true, it did not inform me as to whether the practice might help relieve my pain. The guideline should also benefit rheumatologists who do not have experience with a particular therapy type. Instead of saying they have never heard of a treatment working for someone, rheumatologists will be able to point to this guideline and let the patient know that as of 2022, the therapy in question did or did not have demonstrated efficacy. When research results are put in the hands of the physician and the patient, they are a powerful tool. Such a tool will arm both against the vagaries of the stories about how some untried treatment cured someone's aunt. When confronted with such claims, the physician can point to the guideline and know that a practice was examined if research existed in 2022. Patients may then ask why treatment such as medical marijuana wasn't included as one of the therapies. The answer is simple. At the time of consideration, no published studies shed light on cannabis as a treatment for rheumatoid arthritis. Although many people have strong feelings about the topic, we stuck to our charter and only considered published research for inclusion in these guidelines. That should give both physicians and patients great comfort in knowing that, no matter the pressure, we only considered therapies that have been researched and published. In the end, this guideline will be a bridge between the rheumatologist and patient. Instead of relying on folklore to make recommendations, verifiable research can guide the application of integrative therapies. Because while only her hairdresser knows for sure, a patient's rheumatologist should know it all, and patients should be encouraged to tell the doctor the entire story. I envision that this guideline will do just that. All authors drafted the article, revised it critically for important intellectual content, approved the final version to be published, and take responsibility for the integrity of the data and the accuracy of the data analysis. Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis.

To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n=20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.

To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n=20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.

Background:Given the significant burden of metabolic and functional diseases in rheumatoid arthritis, the American College of Rheumatology (ACR) released lifestyle guidelines in 2022 for exercise, rehabilitation, diet, and additional interventions in rheumatoid arthritis. This study aimed to investigate real-world implementation post-guidelines to identify gaps in adherence, as well as future directions for guideline-based interventions.Methods:A retrospective chart review of adult patients presenting to the rheumatology department was performed at the institution between November 15, 2022, and February 15, 2023, the 3 months immediately following guideline release. Information on demographics, comorbidities, disease control, and immunomodulatory therapy was obtained. Referral patterns for physical therapy, occupational therapy, and behavioral health were reviewed, as well as recommendations for exercise and a Mediterranean diet. The baseline referral patterns were also examined in the year prior to guideline release for both rheumatology and non-rheumatology providers.Results:This study included 791 individuals. In the post-guideline period, 3.5% of the patients received recommendations for an exercise program from a rheumatology provider, and 3.2% and 0.5% received referrals to physical therapy (PT) and occupational therapy (OT), respectively. Post-guideline dietary recommendations for the Mediterranean diet were provided to 0.5% of patients, while referrals to weight loss clinics and behavioral health services were less frequent, each being 0.1%.Conclusion:At 3 months post-guideline release, adherence to the 2022 ACR lifestyle guidelines was low. Additional guideline education for providers and a reduction in barriers to implementation are needed.

Nutrition has received considerable attention as a therapeutic approach for the treatment and management of rheumatoid arthritis (RA). In this issue of Arthritis Care & Research, the importance of nutrition in disease management is highlighted by England et al, in the 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis (1). The intent of this editorial is to recognize the nutritional recommendations reported in the guideline, and to present strategies for health care providers to incorporate nutrition as part of the care plan for patients with RA. While several nutrition interventions have been studied, a Mediterranean-style diet (MD) is the only formal diet conditionally recommended according to the guideline. Other formal diets may offer symptomatic benefits for patients; however the voting panel did not find sufficient evidence to provide a recommendation for such diets. Dietary supplements are also considered in the recommendations. The guideline emphasizes a “food first” approach without additional dietary supplements, although authors acknowledge supplements may be helpful in certain cases. The conditional recommendation for an MD stems from the evidence supporting this type of diet for RA management and reducing the risk of associated comorbidities. Improved physical function, reduced joint swelling, and lessened pain are some benefits described in the MD studies. The primary foods in an MD pattern are olive oil, legumes, whole grains, fruits, vegetables, fish, and a serving of red wine, with moderate dairy, mainly consumed as yogurt and cheese. Red meat, highly processed foods, and sweets are limited in this diet. The MD is considered to have antiinflammatory effects, due to the intake of monounsaturated fats and polyphenols in olive oil, the antioxidants in fruits, vegetables, and red wine, and the omega-3 fatty acids in fish (2). These nutrients have the potential to modulate inflammatory pathways and reduce biomarkers of inflammation. Another relevant aspect of this diet is that it is high in fiber from legumes, whole grains, fruits, and vegetables. Fiber plays an important role in supporting a diverse and healthy microbiome, and alterations in the microbiome are seen among patients with RA (3). A recent study of a cohort of individuals with RA found that higher adherence to an MD resulted in a healthier microbiome profile (4). Aside from the benefits seen in RA, the MD is often described as an ideal eating pattern for cardiovascular disease prevention, which is a significant comorbidity experienced by patients with RA (5). Long-term patient compliance to a diet is important to achieve desired outcomes. Adherence to an MD may be best achieved if the diet pattern is adapted to diverse cultures. The guideline therefore states specifically “a Mediterranean-style diet,” recommending that individual cultural preferences to food and cooking practices are incorporated, while preserving the health-promoting elements of the MD. Food alternatives for the MD as appropriate for other cultures may include substituting or supplementing olive oil with other monounsaturated fats (such as expeller pressed canola oil), including local fish, whole grains, native fruits and vegetables, herbs, and spices. A helpful resource for clinicians and patients on traditional diets that share characteristics of an MD is https://oldwayspt.org/. This site provides information on cultural food patterns with similar nutritional profiles as the MD. Patients interested in following an MD should also consult with a registered dietitian nutritionist (RDN). RDNs are skilled professionals trained to support sustainable dietary changes, with cultural competence in mind. The recent guideline does not recommend other formally defined diets, due to the low certainty of evidence. Despite uncertainty in the research, individual attempts at other therapeutic diets may be of interest to some patients. Tailored vegan and elimination diets often exclude food antigens that trigger immune responses, with the goal of reducing markers of inflammation, joint tenderness, and pain (6). Fasting and diets that mimic fasting have been shown to have antiinflammatory effects (7). These diets have the potential to improve disease activity, however they are restrictive and complex for patients to follow and may increase the risk of nutrient deficiencies. Patients who wish to try these therapeutic diets to manage RA should consult with RDNs and medical providers to ensure safety and prevention of micronutrient deficiencies. Despite growing support for nutrition as a therapeutic component in the management of RA, there are still gaps and challenges in implementing nutritional care. Conflicting outcomes and a range in the quality of evidence among research studies may be one barrier for clinicians to recommend a nutritional approach for patients. More research is needed to strengthen recommendations; however, it is important to acknowledge some known challenges of nutrition studies that are hard to overcome. The gold standard for research is the randomized, double-blind controlled trial. Whole food dietary pattern studies are complex and it is difficult to blind participants to whole foods or nutrients in the study diets. Studies on dietary supplements also have limitations. A major challenge is that the form and dose of a nutrient consumed as a supplement can impact bioavailability and, in turn, effectiveness. Fish oil supplements are recognized by the guideline as potentially beneficial for preventing cardiovascular disease. There is contradicting literature on the effectiveness of omega-3 fatty acids on RA due to the different forms of these fatty acids available for research and consumer use (e.g., re-esterified triglyceride versus ethyl ester forms), varying doses and durations of the studies, and the effects of confounding factors such as baseline dietary intake. Nonetheless, it is critical to continue studying the impact of nutritional therapies on RA, in order to better understand the effects of nutrients on inflammation, microbiota composition, and comorbidities. Research studies on multicultural diets similar in nutrient density to the MD are also needed. Another barrier to including nutritional strategies might be limited access to RDNs. RDNs are essential partners in delivering high quality nutrition care and effectively guiding patients through nutritional interventions. Including RDNs in multidisciplinary RA treatment teams would provide practitioners with unique skills that help patients adhere to nutritional guidelines, improving health and reducing the risk of comorbidities. The American College of Rheumatology recognizes RDNs as part of the team of providers designated to care for patients with rheumatic disease (8). If RDNs are not part of a rheumatology practice, patients can be referred through the online referral database that locates an RDN in their area. Patients and practitioners can access this database at: https://www.eatright.org/find-a-nutrition-expert. This database is maintained by the Academy of Nutrition and Dietetics. In conclusion, the new guideline is a significant step in recognizing the importance of nutrition and other nonpharmacologic interventions for RA. An integrative approach supported by an interdisciplinary team of providers may be optimal for improving clinical symptoms and reducing risk of associated chronic conditions in patients with RA. Dr. Everett drafted the article, revised it critically for important intellectual content, and approved the final version to be published. Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Survey of Occupational Therapy Practice in Hong Kong in 2004

To test the usefulness and cost savings resulting from application of the new American College of Rheumatology (ACR) guidelines for assessing the risk for the development of clinically significant liver disease in rheumatoid arthritis (RA) patients treated with methotrexate (MTX). One-hundred twelve MTX-treated RA patients were prospectively followed up for MTX hepatotoxicity and underwent liver biopsies according to modified guidelines of the Psoriatic Task Force (PTF). All biopsies were graded according to the Roenigk classification. The new ACR recommendations were then retrospectively applied to test their usefulness and cost-effectiveness in this cohort. Based on the PTF guidelines, 66 patients underwent liver biopsies; a total of 110 liver biopsies were performed. Two patients had biopsy-related complications. Five patients were found to have Roenigk grade IIIB or IV histologic abnormalities. The total cost for this group was $111,380. Applying the new ACR criteria, only 15 patients would have undergone liver biopsies; there would have been a total of 18 biopsies, with no complications. Four of the 5 patients with Roenigk grade IIIB or IV liver abnormalities would have been identified. One patient with insulin-dependent diabetes mellitus (IDDM) who was found to have cirrhosis (Roenigk grade IV) on liver biopsy as a result of use of the PTF guidelines would have been missed with use of the ACR guidelines. The total cost for the group receiving biopsies based on the ACR guidelines would have been $16,956. Overall, the new ACR guidelines had 80% sensitivity and 82% specificity and resulted in a cost savings of $1,430 per patient. The new ACR guidelines on MTX monitoring and biopsy surveillance appear to be clinically useful and result in considerable cost savings. However, 1 IDDM patient with significant liver histologic abnormalities would have been missed. We suggest that IDDM be added to the ACR guidelines as a risk factor for MTX hepatotoxicity.

Introduction:The 2015 change in the American College of Rheumatology (ACR) guidelines narrowed indications for initiating treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). This study sought to evaluate trends in total joint arthroplasty (TJA) in patients with RA and to characterize the effect of bDMARDs on arthroplasty risk in this population after the change in ACR treatment guidelines.Methods:A retrospective review was conducted using the PearlDiver database. TJA procedures included total shoulder arthroplasty, total elbow arthroplasty, total hip arthroplasty, and total knee arthroplasty. The Cochran–Armitage Trend Test was used to evaluate trends in the volume of TJA procedures conducted in patients with RA between 2010 and 2019. Logistic regression was used to compare 2-year arthroplasty risk after an initial joint-specific RA International Classification of Diseases 10th Revision diagnosis for RA patients with versus without bDMARD exposure.Results:A total of 2,942,360 patients with RA were identified, and 80,744 (2.74%) underwent TJA between 2010 and 2019. Rates of TJA procedures trended significantly upward over the decade (2.6% versus 5.1%, P < 0.001) with a sharp increase between 2015 and 2016 (2.1% versus 4.9%, P < 0.001). Among the 16,736 identified patients with an initial International Classification of Diseases 10th Revision joint-specific RA diagnosis, 3362 patients (20.09%) were treated with bDMARDs and 13,374 (79.91%) were not. Untreated patients exhibited significantly lower risk of any TJA (5.92% versus 7.73%; odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.64 to 0.82), total hip arthroplasty (OR: 0.69, 95% CI: 0.50 to 0.95), and total knee arthroplasty (OR: 0.63, 95% CI: 0.52 to 0.75) compared with treated patients.Discussion:The volume of TJA procedures conducted in patients with RA has trended markedly upward over the past decade, with a sharp increase after 2015. bDMARD treatment was associated with markedly increased risk of TJA, likely because of initiation of bDMARDs in only those patients with advanced disease per ACR guidelines.

The management of rheumatoid arthritis (RA) follows a treat-to-target approach, as recommended by guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). RA treatment recommendations include an emphasis on frequent disease activity assessments to optimize therapy, recognizing the possibility of timely therapies to slow progression and improve long-term results. The evaluation of joint inflammation, pain, physical function, and clinical indicators is required for comprehensive RA therapy. Current therapeutic goals include achieving low disease activity or remission to enhance the quality of life (QoL) for patients. ACR-endorsed RA disease activity measures, such as the Disease Activity Score in 28 Joints with erythrocyte sedimentation rate or C-reactive protein level, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Activity Scale-II, and Routine Assessment of Patient Index Data 3, are recommended for their precision and sensitivity in supporting treat-to-target strategies. The ACR and EULAR have implemented Boolean-based and index-based remission criteria (SDAI and CDAI, respectively) to evaluate therapeutic effectiveness. The use of these markers regularly aligns with the ACR guidelines, improving adherence to quality indicators in clinical practice and confirming the provision of high-quality RA therapy. This review examines disease activity, function, and QoL measurements in line with the ACR and EULAR guidelines to aid doctors in treating Korean patients with RA.

Research is limited regarding parent-caregiver perspectives of occupational therapy (OT) intervention for children with challenges in sensory processing and integration and whether changes immediately following OT intervention are sustained over time. To evaluate whether changes in identified goals are maintained following OT intervention and to determine what aspects of OT intervention parents-caregivers perceive to be most valuable. A mixed-methods research design. A large midwestern pediatric hospital, with follow-up telephone interviews with parents-caregivers. Sixteen children with sensory challenges and their parents-caregivers. Children participated in 1-hr OT intervention sessions, 3 days per wk, for 6 to 7 wk. Parents-caregivers of children who completed OT intervention were interviewed via the telephone 6 to 12 mo after the intervention. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to determine whether changes were made and sustained over time. Qualitative data on caregiver perceptions of OT intervention were collected via open-ended questions during phone interviews. COPM and GAS scores before intervention were statistically significant compared with scores immediately following intervention and at 6- to 12-mo follow-up. Five themes emerged from the qualitative data. Children with sensory challenges made significant changes related to occupational performance following OT intervention, and goal achievement was sustained over time. Parents-caregivers valued many aspects of the OT program, including the increased frequency of therapy services, the occupational therapist's advanced knowledge and skills, and the education and information provided during the program. Plain-Language Summary: This study supports the results of previous studies on OT intervention for children with challenges in sensory processing and integration. The study also adds to the body of knowledge that shows that changes and progress toward goals that result from skilled OT intervention can be sustained over time. The study showed that children participating in OT intervention made statistically significant changes while receiving OT services and maintained progress after intervention ended; however, the children did not continue to make significant progress toward goals once skilled OT services ended. Parents and caregivers of children with sensory challenges reported that they found OT intervention to be beneficial. Other important factors influencing the effectiveness of OT intervention that were identified by parents-caregivers included the education provided by the occupational therapist, the increased frequency of therapy services, and the increased knowledge and skills of the occupational therapists who provided the intervention.

BackgroundPeople living with chronic pain (CP) face many daily challenges. Although occupational therapists (OTs) have the expertise to help these individuals regain a meaningful life, their services are not widely available in primary care settings. This study aimed to identify the needs of people with CP who seek primary care and to propose OT interventions in this context.MethodsA qualitative descriptive study was conducted. Twenty-three semi-structured interviews were carried out with OTs (n = 5), nurses (n = 4), physicians (n = 4), and individuals with CP (n = 10) regarding CP needs and OT practice in primary care teams. After the interviews, mixed thematic analysis was conducted using an iterative approach. McColl and Law’s classification of occupational therapy interventions was used to organize the results.ResultsFourteen needs were identified by people with CP when seeking primary care: four were related to service organization (accessibility, comprehensiveness, multidisciplinary care, and support for navigating the system), four were related to the therapeutic relationship (recognition of experience, support, active listening, and partnership), and six were related to pain management (occupational participation, education, medication management, pain relief, psychological support, and group participation). Regarding occupational therapy, nine occupational therapy interventions were identified: four were oriented toward the person (physical training, self-management and posture skills development, and education), four were oriented toward the environment (environmental modifications, service orientation, and psychological and emotional support), and one was oriented toward the occupation (support to perform various occupations).ConclusionThis study presents multiple specific primary care needs of people with CP and highlights how these needs closely align with the scope of occupational therapy practice. The study findings contribute to knowledge about occupational therapy clinical pain management activities in the context of primary care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-025-03103-6.