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The use of occupation-based interventions and assessments in hand therapy: A cross-sectional survey. J Hand Ther 2021; 36:214-220. [PMID: 34972606 DOI: 10.1016/j.jht.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The purpose of this study was to gather information on how hand therapists incorporate occupation-based interventions in their clinical practice and what outcome measures hand therapists use to measure the occupational performance of their clients STUDY DESIGN: Cross-Sectional Survey Design. METHODS The 16-item Survey was distributed to members of the American Society of Hand Therapists on two occasions. RESULTS Three hundred eleven hand therapists responded to the survey. Hand therapists use a variety of occupation-based interventions (OBI) in clinical practice and most believe they are important. Findings from this study reveal that incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely. One hundred twenty-six (41%) respondents indicated that they use occupation-based activities 26-50% of the time with their clients. DISCUSSION The top three OBI interventions used by hand therapists included dressing tasks, cooking and meal preparation, and in hand manipulation of coins and medication. The lack of understanding of the theoretical models regarding occupation-based interventions may be a barrier toward implementation of occupation-based interventions and assessments as many hand therapists may have trained under a medical model. CONCLUSION Most respondents to this survey indicated that they believe OBI should be performed by hand therapists and use them routinely in practice. The most frequently used type of assessment was the DASH (Disabilities of the Shoulder Arm & Hand). The least frequently used assessment was the Short Form 36 and patient specific occupation-based assessment.
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Visser E, de Klerk S, Jacobs-Nzuzi Khuabi LA, Joubert M. Occupation-based intervention in therapy for upper limb musculoskeletal conditions: A systematic review. HAND THERAPY 2021; 26:146-158. [PMID: 37904833 PMCID: PMC10584053 DOI: 10.1177/17589983211054643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/20/2021] [Indexed: 11/01/2023]
Abstract
Introduction Using meaningful activities as a treatment modality is characteristic of occupation-based intervention (OBI). The benefits of OBI have been described, but not the effectiveness thereof. The aim of this review was to assess the effectiveness of OBI in relation to the type, commencement, duration and outcomes as reported in literature. Methods A comprehensive search of electronic databases was conducted, including EBSCOHost, PubMed, Cochrane Register for Controlled Trials, Web of Science, OTSeeker, PEDro and Google Scholar. Search terms included 'occupation-based', 'occupation-centered', 'intervention', 'upper limb' and 'outcome measures'. Studies including OBI for neurological or paediatric cases were excluded. Results Twelve studies met the inclusion criteria. Using the PEDro scale, three of the studies, all randomised controlled trials (RCTs), were viewed as high quality, one of fair and one of poor quality. Due to the heterogeneity of the studies, a meta-analysis was not possible, and a narrative synthesis is presented. Five studies used interviewing together with the Canadian Occupational Performance Measure (COPM) to determine the client's occupational profile when choosing meaningful activities. The commencement and duration of OBI varied amongst the studies, and a variety of outcome measures were used to determine the effectiveness of OBI. Discussion OBI used together with biomechanical approaches shows promising effectiveness. Outcome measures such as the COPM and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) that measure activity and participation, should be employed in client-centered practice. More robust scientific evidence regarding the effectiveness of OBI is needed.
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Affiliation(s)
- Elreen Visser
- Division Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan de Klerk
- Division Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lee-Ann Jacobs-Nzuzi Khuabi
- Division Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marleen Joubert
- Division Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Berlet L, Kaskutas V. Developing occupation kits in a Hand Therapy Student Experiential Learning Clinic. HAND THERAPY 2020. [DOI: 10.1177/1758998320912680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Combining occupation-based and biomechanical approaches is effective to increase function after hand injury. This project developed and evaluated occupation kits as a means to increase occupation-based practice. Methods Descriptive study that utilized existing Disabilities of the Arm, Shoulder and Hand data from 642 patients treated by hand surgeon and patients in our Hand Therapy Student Experiential Learning Clinic (HTSELC) to identify difficult activities. These data informed the selection of occupational areas to address with the kits. Biomechanical demands of each kit developed were quantified by 10 student therapists using the Abilities Questionnaire. Fourteen occupational therapists reviewed and rated the usefulness of each kit by survey. Kits were piloted in the HTSELC, and student therapists documented the percentage of time delivering each intervention type: activity/occupation, preparatory methods and tasks, education, advocacy, and group. The degree of occupation-based practice was compared using intervention type percentages before and after introduction of the kits. Results Ten kits were created to address most occupation categories within occupational therapy’s scope of practice. Kits include procedures, safety precautions, and a standardized scale to objectively measure performance. Clinicians noted that kits reflected each occupation well (3.7/5) and 45% reported they were likely to use the kits. After the kits became available in the HTSELC, the percentage of interventions at the occupation/activity level increased from 19% to 26% and biomechanical interventions, including preparatory methods and tasks, decreased from 61% to 49%. Conclusion This research suggests that occupation kits can be a first step to help therapists deliver occupation-based interventions in hand therapy settings.
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Affiliation(s)
- Logan Berlet
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Vicki Kaskutas
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
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Ransby TB, Hansen AØ, Rolving N. Psychometric properties of the Assessment of Motor and Process Skills in patients undergoing rehabilitation following hand-related disorders. HAND THERAPY 2020. [DOI: 10.1177/1758998320912761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Assessment of Motor and Process Skills (AMPS) has been proven to be a suitable measurement tool for assessing performance-based ADL ability; however, its reliability and validity have not been tested on patients with hand-related disorders. Methods Patients referred for outpatient hand rehabilitation were assessed with AMPS, The Canadian Occupational Performance Measure (COPM), dynamometer and goniometer at baseline and after eight weeks of hand therapy. Construct validity and responsiveness of AMPS were assessed by hypothesis testing. Construct validity was assessed by correlating the baseline score of AMPS with the baseline score of the other measurement tools. Responsiveness was assessed by correlating the change scores of each measurement tool with a Global Rating Scale. Results Fifty-one patients were recruited. The construct validity of AMPS indicated that the various measurement tools captured different aspects to functioning from the AMPS, as the correlations between AMPS and the other measurement tools were generally weak to low (r < 0.25 to 0.49). AMPS was less responsive than COPM when correlated with the GRS. The correlation between COPM and GRS was r = 0.62 compared with the AMPS motor, r = 0.45 and AMPS process, r = 0.33. Relative responsiveness of AMPS is similar to that of the dynamometer (r = 0.39) and goniometer (r = –0.34). Discussion In a sample of 51 patients, this study found that the construct validity of AMPS seemed to be moderate, while the responsiveness of AMPS seemed to be poor. However, due to the small sample size no conclusions can be made, and should be further assessed in larger studies.
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Affiliation(s)
- Thea Birch Ransby
- Department of Physical and Occupational Therapy, Diagnostic Center Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Alice Ørts Hansen
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nanna Rolving
- Department of Physical and Occupational Therapy, Diagnostic Center Silkeborg Regional Hospital, Silkeborg, Denmark
- DEFACTUM, Central Denmark region, Aarhus, Denmark
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Troianello T, Yancosek K, Rhee PC. Unilateral hand training on functional performance in patients with upper extremity trauma. J Hand Ther 2020; 32:25-34.e2. [PMID: 29198476 DOI: 10.1016/j.jht.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Case series. INTRODUCTION Upper extremity (UE) trauma and subsequent immobilization affects functional performance. PURPOSE OF THE STUDY Determine the usefulness and feasibility of unilateral hand training (UHT) on improving functional performance in patients with UE trauma. METHODS Nine participants received UHT within 10 days of immobilization. Functional performance, dexterity, grip, and pinch strength were measured at initial and 4-week visits. Qualitative interviews were coded to develop themes. RESULTS All Jebsen-Taylor hand function test subtests improved from pretest to post-test. Disabilities of the Arm, Shoulder and Hand scores of all 9 participants improved. Functional performance was more impaired for participants with dominant UE injury. Four themes emerged: participants were forced to alter or avoid most daily activities, had an increased dependency on others, took longer to perform activities, and felt UHT decreased the impact of UE trauma on function. DISCUSSION Functional performance was impaired for all participants. Participants believed that UHT was useful and contributed to improved function. CONCLUSION This case series tracked a comprehensive intervention based on a holistic activities of daily living framework that considered the nuances of individual complexities of immobilization following hand trauma. Knowledge from this study supports an early intervention like UHT to educate clients on effective strategies to improve immediate activities of daily living functioning and potentially prevent longer term impairments.
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Affiliation(s)
- Tara Troianello
- Department of Rehabilitation Medicine, San Antonio Military Medical Center, Army-Baylor Doctor of Science in Occupational Therapy Program, San Antonio, TX, USA.
| | - Kathleen Yancosek
- Department of Rehabilitation Medicine, San Antonio Military Medical Center, Army-Baylor Doctor of Science in Occupational Therapy Program, San Antonio, TX, USA
| | - Peter C Rhee
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
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Relevance of grasp types to assess functionality for personal autonomy. J Hand Ther 2019; 31:102-110. [PMID: 28341325 DOI: 10.1016/j.jht.2017.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/06/2016] [Accepted: 02/06/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional research design. INTRODUCTION Current assessment of hand function is not focused on evaluating the real abilities required for autonomy. PURPOSE OF THE STUDY To quantify the relevance of grasp types for autonomy to guide hand recovery and its assessment. METHODS Representative tasks of the International Classification of Functioning, Disability and Health activities in which the hands are directly involved were recorded. The videos were analyzed to identify the grasps used with each hand, and their relevance for autonomy was determined by weighting time with the frequency of appearance of each activity in disability and dependency scales. Relevance is provided globally and distinguished by hand (right-left) and bimanual function. Significant differences in relevance are also checked. RESULTS The most relevant grasps are pad-to-pad pinch (31.9%), lumbrical (15.4%), cylindrical (12%), and special pinch (7.3%) together with the nonprehensile (18.6%) use of the hand. Lumbrical grasp has higher relevance for the left hand (19.9% vs 12%) while cylindrical grasp for the right hand (15.3% vs 7.7%). Relevancies are also different depending on bimanual function. DISCUSSION Different relative importance was obtained when considering dependency vs disability scales. Pad-to-pad pinch and nonprehensile grasp are the most relevant grasps for both hands, whereas lumbrical grasp is more relevant for the left hand and cylindrical grasp for the right one. The most significant difference in bimanual function refers to pad-to-pad pinch (more relevant for unimanual actions of the left hand and bimanual actions of the right). CONCLUSIONS The relative importance of each grasp type for autonomy and the differences observed between hand and bimanual action should be used in medical and physical decision-making. LEVEL OF EVIDENCE N/A.
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Burley S, Cox R, Di Tommaso A, Molineux M. Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective. Aust Occup Ther J 2018; 65:533-543. [PMID: 30132914 DOI: 10.1111/1440-1630.12507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective. METHOD This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes. RESULTS The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity. CONCLUSION Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.
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Affiliation(s)
- Samantha Burley
- Mental Health Services, South West Healthcare, Warrnambool, Victoria, Australia.,Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Ruth Cox
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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Burley S, Di Tommaso A, Cox R, Molineux M. An occupational perspective in hand therapy: A scoping review. Br J Occup Ther 2018. [DOI: 10.1177/0308022617752110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction There have been calls for the occupational therapy profession to realign with its values around occupation. However, the profession faces challenges in practice areas that have historically been underpinned by a biomechanical approach, such as hand therapy. The aim of this scoping review was to describe what is known about an occupational perspective in the hand therapy literature. Method This scoping review utilised a recognised five-step approach. A search was conducted in four databases for papers published between 2005 and 2016. Numerical and thematic analyses were employed, using the Canadian Practice Process Framework as a theoretical framework. Results Fifty papers were included in the scoping review. Six themes were identified: the centrality of occupation; inconsistencies in terminology; where in the occupational therapy process?; informal discussion as a key occupational strategy; occupational therapists’ expectations of patients; and a bottom-up approach focusing on biomechanical strategies to implementing the plan. Conclusion Whilst there has been some integration of an occupational perspective into hand therapy literature, there are still challenges. Inconsistent terminology, the lack of an occupational perspective throughout the occupational therapy process and a bottom-up approach to interventions all demonstrate the continuing tensions between the biomechanical approach and an occupational perspective.
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Affiliation(s)
- Samantha Burley
- Occupational Therapist, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Amelia Di Tommaso
- Lecturer, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Ruth Cox
- Director of Occupational Therapy, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Matthew Molineux
- Professor and Head, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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Kingston GA. Commentary: Rehabilitation for Rural and Remote Residents Following a Traumatic Hand Injury. Rehabil Process Outcome 2017. [DOI: 10.1177/1179572717734204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A traumatic hand injury can involve damage to a number of structures including skin, nerves, tendons, muscle bone, and soft tissue. Impairments such as pain or stiffness and loss of range of motion can last for many years and result in a moderate to extreme impact on a person’s day-to-day life. Work, leisure, financial security, and emotional well-being often most affected. This commentary provides an analysis of those factors that inhibit (barriers) and support (enablers) the provision of hand therapy rehabilitation in rural and remote areas. Providing a collaborative and flexible rehabilitation programme to rural and remote residents following a traumatic hand injury can be seen as a challenge due to issues such as a limited access to health care services. Established protocols that work in regional or metropolitan locations are unlikely to be effective and innovative and pragmatic strategies are required. The provision of a collaborative and flexible rehabilitation programme regardless of residential location is an important part of the therapist’s intervention plan.
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Affiliation(s)
- Gail A Kingston
- Occupational Therapy Department, The Townsville Hospital, Townsville, QLD, Australia
- Occupational Therapy Department, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
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Marik TL, Roll SC. Effectiveness of Occupational Therapy Interventions for Musculoskeletal Shoulder Conditions: A Systematic Review. Am J Occup Ther 2017; 71:7101180020p1-7101180020p11. [PMID: 28027039 PMCID: PMC5182015 DOI: 10.5014/ajot.2017.023127] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.
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Affiliation(s)
- Tambra L Marik
- Tambra L. Marik, OTD, OTR/L, CHT, is Hand Therapy Elective Track Director, Rocky Mountain University for Health Professions, Provo, UT, and Staff Therapist, ATI Physical Therapy, Tacoma, WA;
| | - Shawn C Roll
- Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Wong AL, Wilson M, Girnary S, Nojoomi M, Acharya S, Paul SM. The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review. J Hand Ther 2017; 30:447-456. [PMID: 28400179 PMCID: PMC5632567 DOI: 10.1016/j.jht.2017.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/14/2017] [Accepted: 02/28/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review INTRODUCTION: There exist numerous combinations of orthoses and motion protocols for the treatment of proximal extensor tendon injuries. PURPOSE The purpose of this study was to determine the optimal combination of motion protocol and orthotic treatment for the rehabilitation of proximal extensor tendon injuries (zones IV-VIII). METHODS A systematic review of English language randomized clinical trials and cohort studies investigating extensor tendon rehabilitation from 1960 to 2016 was conducted in MEDLINE, Embase, Cochrane, CINAHL, PEDro, and OTseeker. Outcomes of total active motion, grip strength, return to work, patient attrition, and patient-reported outcomes were compared. RESULTS Eleven studies of predominantly average quality (1, low; 8, average; and 2, high) were included in the final review. Results were difficult to compare due to differences in reporting. Early total active motion and final grip strength were greater with dynamic extension orthoses (191°-214°; 35-38 kg/89% contralateral side) and relative motion orthoses (205°-236°; 85%-95% contralateral side) compared to static orthoses (79°-202°; 23-34 kg/59% contralateral side). Four studies excluded patients who did not follow up, and loss to follow-up was 12%-33% in the other studies. Patient-reported outcomes were not comparable, as they were only included in 3 studies, and each used a different assessment tool. CONCLUSION Average quality evidence supports the use of early active motion (EAM) as the superior motion protocol, but optimal orthosis to deliver EAM could not be determined. Prospective research should focus on patient-reported outcomes and the design of orthoses that facilitate the use of the EAM. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Alison L Wong
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States,Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Canada
| | - Madeline Wilson
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Sakina Girnary
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Matthew Nojoomi
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Soumyadipta Acharya
- Center for Bioengineering, Innovation and Design, Johns Hopkins University, Baltimore, United States
| | - Scott M Paul
- Rehabilitation Medicine Department, NIH Clinical Center, Bethesda, United States,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, United States,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, United States
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Dy LB, Yancosek KE. Introducing purposeful activity kits in a hand rehabilitation practice: Effects on clinical practice patterns and job satisfaction among occupational therapy practitioners. HAND THERAPY 2016. [DOI: 10.1177/1758998316657844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Facilitating function through occupation and purposeful activity is the basic tenet of occupational therapy. However, the majority of research in hand rehabilitation clinics continues to focus on biomechanical interventions. The purpose of this research was to study practice patterns and personal opinions of occupational therapy practitioners before and after providing purposeful activity kits to an outpatient occupational therapy hand clinic. Methods Mixed-method design to evaluate an 8-week intervention of providing purposeful activity kits to a busy, military outpatient hand clinic. A paper survey was administered to nine occupational therapy practitioners before and after the intervention. Qualitative data were gathered through semi-structured interviews. Results A descriptive analysis indicated an increase in the use of activities, crafts, and occupation after the introduction of the purposeful activity kits. Practitioners consistently reported time as the top factor in their inability to incorporate more purposeful activities. Qualitative results support use of the new activities during both intervention and evaluation due to the focus on function and ease of use of the kits. Conclusion Purposeful activities can enhance any rehabilitation clinic in an organized, cost-effective manner. Practitioners responded positively toward the added equipment; however, it will take time and effort to adjust the theoretical decision making of practitioners. Additional participants and length of intervention is needed.
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Affiliation(s)
- Laura B Dy
- Brooke Army Medical Center, Occupational Therapy Department, San Antonio, Texas, USA
| | - Kathleen E Yancosek
- Brooke Army Medical Center, Occupational Therapy Department, San Antonio, Texas, USA
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Grice KO. The use of occupation-based assessments and intervention in the hand therapy setting - A survey. J Hand Ther 2016; 28:300-5; quiz 306. [PMID: 25990443 DOI: 10.1016/j.jht.2015.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/05/2015] [Accepted: 01/12/2015] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Descriptive survey. INTRODUCTION This study specifically explored the use of occupation-based assessments and intervention in the hand therapy setting, but also more generally, current practice trends about all assessments being utilized in this setting, frequency of their use, and therapists' perceptions about them. METHODS An online survey was distributed via email to members of the American Society of Hand Therapists (ASHT). The survey consisted of ten questions and was administered via Survey Monkey. RESULTS Responses were received from 22% of those surveyed. A descriptive analysis was completed of the results and indicated that over half use occupation-based assessments on a daily basis; most are related to ADL function and used for the development of goals. The primary reason for not utilizing occupation-based assessments is time limitation. Seventy-nine percent believe these measures are important for the services provided in the hand therapy setting. CONCLUSION Occupation-based assessments and intervention are not utilized as much as therapists would like in the hand therapy setting, primarily due to time constraints. While not formally assessed, the majority of those who responded indicated that they do address occupation in their assessments and interventions. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Kimatha Oxford Grice
- Department of Occupational Therapy, The University of Texas Health Science Center, 7703 Floyd Curl Drive, MC 6245, San Antonio, TX 78229, USA.
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Weinstock-Zlotnick G, Bear-Lehman J. How therapists specializing in hand therapy evaluate the ability of patients to participate in their daily lives: An exploratory study. J Hand Ther 2016; 28:261-7; quiz 268. [PMID: 26001585 DOI: 10.1016/j.jht.2014.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/15/2014] [Accepted: 12/30/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Exploratory, Survey Design. INTRODUCTION A gap in current knowledge exists regarding how therapists evaluate patient difficulty participating in life situations. PURPOSE The goal is to explore how therapists measure participation. METHODS A survey questionnaire was developed, piloted, and tested for reliability and validity. Convenience sample of 249 participants responded, providing information about assessment tools employed, problems and goals identified, indications for patient discharge, and participants' demographics. RESULTS Participants used tools to measure body structures/functions, and informal discussion about daily activities, daily to weekly. Participation measures were employed monthly or less. Participation was noted more often in goals than problems identified in case study vignettes. Body structures/functions and participation were considered equally when anticipating patient discharge. CONCLUSIONS Evaluations principally employed tools and identified problems relevant to impairments in body structures/functions. Yet, when looking forward, setting goals and anticipating discharge, patients' participation needs were also attended. LEVEL OF EVIDENCE 2c.
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Abstract
Ongoing clinical and basic research has improved understanding of flexor tendon mechanics and physiology for surgical repair and rehabilitation after a zone II flexor tendon repair. Yet, the ideal surgical repair technique that includes sufficient strength to allow safe immediate active motion of the finger, without excessive repair stiffness, bulk or rough surfaces resulting in excessive resistance to flexion, does not exist. After optimizing the repair, the surgeon and therapist team must select a rehabilitation plan that protects the repair but helps to maintain tendon gliding. There are 3 types of rehabilitation programs for flexor tendon repairs: delayed mobilization, early passive mobilization, or an early active mobilization. No guideline for rehabilitation should be followed exactly. Many factors influence therapy decisions, including repair technique, associated tendon healing, passive versus active range of motion, edema, and tendon adhesions. These factors can assist in guiding rehabilitation progression and promote functional range of motion, safely mobilize the repaired tendon(s) and prevent gapping, rupture, and adhesions.
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Kingston GA, Williams G, Judd J, Gray MA. Hand therapy services for rural and remote residents: Results of a survey of Australian occupational therapists and physiotherapists. Aust J Rural Health 2015; 23:112-21. [DOI: 10.1111/ajr.12141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gail A. Kingston
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; Anton Breinl Centre for Health Systems Strengthening James; Cook University; Townsville Queensland Australia
- The Townsville Hospital; Townsville Queensland Australia
| | - Gary Williams
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; Anton Breinl Centre for Health Systems Strengthening James; Cook University; Townsville Queensland Australia
| | - Jenni Judd
- Faculty of Medicine, Health and Molecular Sciences; Anton Breinl Centre for Health Systems Strengthening James; Cook University; Townsville Queensland Australia
| | - Marion A. Gray
- Occupational Therapy; School of Health and Sport Sciences; University of Sunshine Coast; Sunshine Coast Queensland Australia
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