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Judkins JL, Nguyen VT, Richardson MD, Roy TC. Association between availability of direct access to army occupational therapy with return to duty in active-duty soldiers. J Hand Ther 2024:S0894-1130(23)00194-1. [PMID: 38320939 DOI: 10.1016/j.jht.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Upper extremity musculoskeletal injuries are common with active-duty Army Soldiers and result in increased limited duty days. Patient satisfaction and surgery rates improve with direct access to occupational therapy in the civilian community. PURPOSE Examine the amount of time from initial evaluation following an upper extremity musculoskeletal injury (MSKI) to return to full duty plus occupational therapy (OT) utilization in Army Soldiers. STUDY DESIGN Retrospective observational. METHODS Electronic health records and profiles from 18,206 US active-duty Army soldiers with MSKI and OT evaluation between 2017-2018 were examined. Repeated measures generalized estimating equations provided the rate ratios (RRs) for OT healthcare utilization (total number of OT evaluations and treatment visits) by days to first OT evaluation and limited duty profile (total days on profile). RESULTS Soldiers were on average 32.0 (SD = 8.9) y/o, predominantly senior enlisted (45.7%), white (58.0%), male (81.4%), 10.0 (SD = 8.4) years of service, and high school or less educated (51.3%). There were 22,617 UE MSKIs with an OT evaluation and 4936 UE MSKIs with profiles. Compared with UE MSKIs with an OT evaluation on the same day, there was a significant increase in rates of OT utilization for 1-7 days (RR: 1.4, 95% CI: 1.3, 1.5), 8-14 days (RR: 1.3, 95% CI: 1.2, 1.4), 15-30 days (RR: 1.4, 95% CI: 1.3, 1.5), 31-60 days (RR: 1.5, 95% CI: 1.4, 1.6), and +60 days later (RR: 1.6, 95% CI: 1.5, 1.7). Similar differences in rates for limited duty profiles were found. CONCLUSION A greater number of days between diagnosis of UE MSKI and OT evaluation results in greater rates of OT utilization and longer temporary profile. Results suggest that earlier intervention by OT may decrease recovery and healthcare utilization of soldiers.
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Affiliation(s)
- Jason L Judkins
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Vy T Nguyen
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Melissa D Richardson
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tanja C Roy
- Occupational Health Sciences, Defense Centers for Public Health, Aberdeen, MD, USA
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Sheerin M, O'Riordan C, Conneely M, Carey L, Ryan D, Galvin R, Morrissey AM. Effectiveness of occupational therapy interventions on function and occupational performance among adults with conditions of the hand, wrist, and forearm: A systematic review and meta-analysis. Aust Occup Ther J 2024; 71:175-189. [PMID: 37794565 DOI: 10.1111/1440-1630.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis examines the effectiveness of occupational therapy interventions for adults with conservatively managed conditions of the hand, wrist, and forearm. METHODS Searches were carried out in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, MEDLINE (OVID), EMBASE, and PubMed. Grey literature was searched for via Google Scholar. A systematic literature search was undertaken for randomised studies that examined occupational therapy interventions for treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of occupational performance, satisfaction with occupational performance, pain, and quality of life. Meta-analyses were completed, and GRADE was used to determine the certainty of evidence. RESULTS Twelve studies with 1429 participants were identified. Interventions included combinations of occupation-based intervention, assistive device provision, education, orthosis provision, and exercise programmes for arthritis, carpal tunnel syndrome, and fracture and tendon injuries of the hand, wrist, and forearm. Occupational therapy resulted in an improvement of function (REM, SMD -0.27, 95% CI -0.00 to -0.53, I2 = 69%, low certainty evidence) (p = 0.05), occupational performance (REM, SMD 0.83, 95% CI 1.61-0.06, I2 = 91%, low certainty evidence) (p = 0.04), satisfaction with occupational performance (REM, SMD 0.74, 95% CI 1.42-0.05, I2 = 89%, low certainty evidence) (p = 0.03), and pain reduction (FEM, MD -1.35, 95% CI -0.84 to -1.86, I2 = 0%, moderate certainty evidence) (p < 0.00001). CONCLUSION Further high-quality research is recommended to determine the effects of occupational therapy interventions on specific upper limb conditions, inclusive of a broader range of clinical and patient reported outcome measures.
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Affiliation(s)
- Margo Sheerin
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cliona O'Riordan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Mairead Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Leonora Carey
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Damien Ryan
- ALERT- Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ann-Marie Morrissey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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O'Donnell M, Eadie P, Dorairaj J, Stapleton T. Advanced practice occupational therapy led triage and treatment clinic for patients with carpal tunnel syndrome in an Irish public hospital. Musculoskeletal Care 2023; 21:633-643. [PMID: 36760197 DOI: 10.1002/msc.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION A pilot CTS Triage and Treat clinic led by an Advanced Practice Occupational Therapist was established to address the CTS wait list at a large urban hospital. The aims of this pilot were to develop a clinical triage and screening protocol to inform the stratification of patients for suitable treatment options and to reduce waiting time. METHODS A cross sectional study with follow up was conducted, patients on the wait list at time of commencement of the pilot and subsequent referrals over a 1-year period were recruited. Triage consisted of tests of sensibility, self-rating measures, provocative tests and detailed patient to inform the subsequent treatment stratification, conservative, injection, surgery, or further investigation. Nonparametric analyses were used to test relationships between the test scores and to complete subgroup comparisons. RESULTS Eighty-nine patients were triaged over the pilot period, 62 (70%) had a positive Phalen's at triage. Following triage 48 (54%) patients were stratified for conservative management, injection (n = 23, 26%) and surgery/differential diagnosis (n = 18, 20%). Statistically significant differences in BCTQ (SSS and FSS) and Q-DASH scores were noted across the three outcome groups, with lower scores among those commenced on conservative management. BCTQ (SSS) scores were aligned with the Semmes Weinstein Monofilaments sensibility thresholds. Wait times showed a marked decrease from 10 to 2 months over the period of the pilot. DISCUSSION Findings highlight the positive impact of occupational therapy led triage and treat approach in the reduction of wait time for assessment and treatment for patients with CTS.
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Affiliation(s)
- Michelle O'Donnell
- Department of Occupational Therapy, St James's Hospital, Dublin, Ireland
| | | | | | - Tadhg Stapleton
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
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Lewis KJ, Coppieters MW, Vicenzino B, Hughes I, Ross L, Schmid AB. Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery. Int J Health Policy Manag 2022; 11:1001-1008. [PMID: 33590739 PMCID: PMC9808184 DOI: 10.34172/ijhpm.2020.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS. METHODS This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1). RESULTS Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (P=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)). CONCLUSION Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.
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Affiliation(s)
- Karina J. Lewis
- Occupational Therapy Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Hughes
- Office of Research Governance and Development, Gold Coast University Hospital, Southport, QLD, Australia
| | - Leo Ross
- Division of Allied Health, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Sobb JA, Tharakan C, Beazley J. Allied health led post-operative hand clinic: Evaluation of an alternative model of care. Aust Occup Ther J 2021; 69:77-88. [PMID: 34533225 DOI: 10.1111/1440-1630.12771] [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: 03/18/2021] [Revised: 08/10/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To assist with the increasing orthopaedic workload, an allied health led hand therapy clinic was established to manage people having routine hand surgeries. The aim of this study was to evaluate patient and doctor satisfaction and safety of this alternative service delivery model. METHODS Prospective multimethod design evaluation was undertaken by occupational therapists and physiotherapists working in the field of hand therapy. Satisfaction surveys were completed by orthopaedic doctors and patients. Patient outcomes were assessed at 6 weeks post operatively using the Quick Disability of Arm, Shoulder and Hand questionnaire, total active range of motion, Crawford Classification, sensation using light touch and pain with activity utilising Wong Baker FACES® Pain Rating Scale. Quantitative satisfaction survey data were analysed and presented as frequencies and percentages with open question responses analysed using a qualitative description approach. All complications and readmissions within a 3-month period were identified and recorded to assess safety of this model of care. RESULTS For the 6-week post-operative review, 81 patients were seen by an allied health professional rather than a doctor. Patient satisfaction was high with 90% of patients satisfied with post-operative care provided by allied health; 2% of patients preferred to be seen by a doctor. Doctor satisfaction was also high with 95% of doctors being satisfied and confident with the quality of care provided. A high proportion of patients reported pain 2/10 or less with activity (82.72%), had full sensation (69.14%), excellent range of motion (82.72%), and Quick Disability Arm, Shoulder and Hand scores on average were below 25% indicating minimal functional deficits. Only five patients required doctor involvement post-operatively. CONCLUSION The allied heath led service delivery model was demonstrated to be safe and have high patient and doctor satisfaction, indicating an acceptable alternate pathway for management of people following routine hand surgery.
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Affiliation(s)
- Jo-Anne Sobb
- Hand Therapy Clinic, Cairns Hospital Orthopaedic Department, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.,Occupational Therapy, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Claire Tharakan
- Hand Therapy Clinic, Cairns Hospital Orthopaedic Department, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.,Occupational Therapy, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - James Beazley
- Hand Therapy Clinic, Cairns Hospital Orthopaedic Department, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Burton C, Palmer MA, Fanton L, Cox R, Wishart LR. Multi-site evaluation of advanced practice hand therapy clinics for the management of patients with trigger digit. J Hand Ther 2021; 35:655-664. [PMID: 34334276 DOI: 10.1016/j.jht.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Prospective cohort design. BACKGROUND Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking. PURPOSE OF THE STUDY To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals. METHODS Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed. RESULTS 104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service. CONCLUSION Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.
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Affiliation(s)
| | - Michelle A Palmer
- Queensland Health, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Lauren Fanton
- Queensland Health, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Ruth Cox
- Queensland Health, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Laurelie R Wishart
- Queensland Health, Centre for Functioning and Health Research, Buranda, QLD, Australia
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