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Hansen AØ, Kielsgaard K, Larsen SM. Management of everyday life after a hand operation-A qualitative study of patients with a weak sense of coherence. J Hand Ther 2024:S0894-1130(23)00203-X. [PMID: 38278696 DOI: 10.1016/j.jht.2023.12.016] [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: 08/14/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND A hand-related disorder (HRD) has a more significant impact on participation in everyday life for patients with a weak sense of coherence (SOC) compared to those with a strong SOC. Therefore, understanding how patients with a weak SOC manage the conditions of everyday life after a hand operation is of clinical interest. PURPOSE This study aimed to explore how patients with a weak SOC experience and manage the conditions of everyday life after an operation for an HRD. STUDY DESIGN A qualitative design with a hermeneutic approach. METHODS An in-depth interview was conducted with each of eight adults-five women and three men-with an HRD and a weak SOC (SOC-13 score <52). Participants with varying HRDs were interviewed once between six and 13 weeks after the hand operation. Data were analyzed based on a hermeneutic approach. RESULTS The analyses resulted in five themes: even more conditions to handle, challenges in everyday life, managing everyday life, different expectations, and the influence of information on everyday life. The lives of most participants were significantly impacted: they experienced a range of difficulties managing their activities and roles after their operation. The participants felt uncertain about managing everyday life and the future and expressed unfulfilled expectations for different reasons. All wanted individualized information about what to expect. CONCLUSIONS Participants had several conditions in life that challenged their everyday lives, and the HRD made their everyday lives even more challenging. The extent to which they felt affected appeared to relate to their perception of their presurgery activities. They had several strategies to manage everyday life but used these to varying extent. Their expectations about the outcome had both positive and negative effects on their ability to manage everyday life, and individually adapted information was requested about what to expect and how to cope with everyday life after the surgery.
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Affiliation(s)
- Alice Ørts Hansen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Kamilla Kielsgaard
- Department of APO (Aktiv Pleje og Omsorg), Municipality of Nordfyn, Denmark; Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Stina Meyer Larsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark; Health Sciences Research Centre, UCL University College, Odense, Denmark.
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Hayes K, Dos Santos V, Costigan M, Morante D. Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services. Aust Occup Ther J 2023; 70:142-156. [PMID: 36193547 PMCID: PMC10092512 DOI: 10.1111/1440-1630.12844] [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: 01/16/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Rural communities contribute to national wellbeing, identities, economies, and social fabrics yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about non-urban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focussed services are more commonly discussed. Understanding intentions expressed in publications about non-urban service design may identify assumptions/limitations to current approaches and contribute to improved future services. METHODS Each of 117 publications identified in a scoping review was read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes. The first author reinterrogated the publications and coded data to identify relevant examples to support the identified themes. RESULTS Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes (i) Extension of urban practice and (ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme (iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focussed on developing non-urban communities and promoting justice. CONCLUSION The hegemonic paradigm links occupational therapy services with neoliberal notions of individualism, private provision of care, and efficiency/market value, rather than the occupational therapy values for justice. The profession must consider our role in perpetuating injustice for non-urban people and consider if and how more contextually tailored counter hegemonic place-based paradigms can be developed from and with regional, rural, and remote practice.
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Affiliation(s)
- Karen Hayes
- School of Allied Health, Exercise and Sports SciencesCharles Sturt UniversityPort MacquarieNew South WalesAustralia
| | - Vagner Dos Santos
- School of Allied Health, Exercise and Sports SciencesCharles Sturt UniversityPort MacquarieNew South WalesAustralia
| | - Moses Costigan
- Manning Mental Health UnitNSW HealthTareeNew South WalesAustralia
- Providence WellbeingPort MacquarieNew South WalesAustralia
| | - Danielle Morante
- Port Macquarie Base HospitalNSW HealthPort MacquarieNew South WalesAustralia
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Is EE, Gudek K, Oral A, Sindel D. Shedding light on work-related and non-work-related hand injuries from the social work perspective. Work 2023:WOR211146. [PMID: 36683524 DOI: 10.3233/wor-211146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Upper extremity injuries may cause not only physical but also serious social and psychological problems in workers. OBJECTIVE The aim of this study was to compare demographic and work-related features of persons with hand injuries who sustained a work-related or a non-work-related injury to gain insights into possible predisposing factors for work-related injuries as well as psychosocial consequences of hand injuries from the social work perspective. METHODS This case-control study was conducted on 30 work-related and 30 non-work-related hand injury patients. The patients were evaluated using a questionnaire designed by the authors based on the principles of social work involving demographics, work-related features, thought-emotion-behaviour features, family and friend relationships, need for family support and professional psychosocial support. Survey data from both groups were statistically analysed using descriptive statistics, Chi-square and Fisher Exact test. RESULTS When compared with the non-work-related hand injury group, the majority of the subjects of the work-related hand injury group were blue-collar workers (p = 0.003), had a lower level of education (p < 0.001), worked off-the-clock (p = 0.015), held the employer responsible for the accident (p < 0.001), needed more time to return to work (p = 0.014), were worried about the future (p = 0.045), and expressed loss of joy (p = 0.004). CONCLUSION Hand injuries, regardless of their relation to work, lead to important psychosocial problems which need to be evaluated widely and carefully focusing on the patient and patient's environment, work environment in this case.
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Affiliation(s)
- Enes Efe Is
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Kemal Gudek
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilsad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study. J Hand Ther 2021; 34:341-347. [PMID: 32354498 DOI: 10.1016/j.jht.2020.03.002] [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: 01/30/2019] [Revised: 09/01/2019] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Occupation-based intervention (OBI) in hand therapy has shown superior benefits in patient-reported performance and physical measures; however, only a few studies have used OBI. We developed a decision-aid to promote the use of an injured hand in the real world (Aid for Decision-making in Occupation Choice for hand; ADOC-H) PURPOSE: To investigate the clinical utility of the ADOC-H (paper version) in patients with distal radius fractures. STUDY DESIGN A prospective case series and a clinical survey for occupational therapists. METHODS This study comprised a prospective patient case series of 8 patients with distal radius fractures, treated using Volar locking plates, and a clinical survey of 4 experienced occupational therapists. RESULTS No patient or therapist complaints or drop-outs were reported. Active range of motion (wrist), Grip strength, and Disabilities of the Arm, Shoulder, and Hand scores improved for all patients. The ADOC-H induced 158 activities using the injured hand, with activities of daily living (69.8%) selected earlier in the treatment period, and instrumental activities of daily living (63.3%) selected later. The feedback and case studies suggested that the ADOC-H was useful for patients who were afraid of using the hand and, interestingly, patients who were able to use their hand without pain or other problems. The clinical survey showed that most therapists found the ADOC-H effective in facilitating real-life use of an injured hand. CONCLUSIONS The ADOC-H paper version is an useful tool that can be applied to facilitate patients with distal radius fractures to use their injured hands in real-life settings.
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Hansen AØ, Kristensen HK, Cederlund R, Möller S, Tromborg H. An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale-A randomized controlled trial. J Hand Ther 2021; 33:455-469. [PMID: 32156580 DOI: 10.1016/j.jht.2019.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/20/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A nonblinded randomized controlled trial. INTRODUCTION Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC). PURPOSE OF THE STUDY To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects. METHODS A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI) or a physical exercise-based occupation-focused intervention. The primary outcome, functioning, was measured using the Disability of the Arm, Shoulder and Hand questionnaire. Primary endpoint was at three months. Patients were followed up for a year. RESULTS No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times. CONCLUSIONS OBI as delivered in this study was not superior to physical exercise-based occupation-focused intervention in this patient group. However, in taking a client-centered approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice.
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Affiliation(s)
- Alice Ørts Hansen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Orthopaedic Surgery, Odense University Hospital, Odense C, Denmark; Department of Rehabilitation, Odense University Hospital, Odense C, Denmark.
| | - Hanne Kaae Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Rehabilitation, Odense University Hospital, Odense C, Denmark; Health Sciences Research Center, University College Lillebaelt, Odense M, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; OPEN - Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Hans Tromborg
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Orthopaedic Surgery, Odense University Hospital, Odense C, Denmark
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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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Chown G, Beckwold M, Chernosky H, Lozoskie J, Yerkes A. The Use of Psychosocial Services Post Hand and Upper Limb Injury and Trauma: A Pilot Study. Hand (N Y) 2018; 13:529-537. [PMID: 28877603 PMCID: PMC6109901 DOI: 10.1177/1558944717725373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research demonstrates that hand injuries may cause psychological difficulties. To enhance recovery, therapists must provide appropriate referrals. The purpose of this study was to explore the use of psychosocial services by occupational therapists (OTs) and certified hand therapists (CHTs) post hand and upper limb injury or trauma. METHODS A quantitative survey design was implemented using a self-made questionnaire, which consisted of questions regarding demographic information, types and frequency of hand and upper limb injuries, psychiatric diagnoses, frequency of psychosocial service referrals, frames of references used, types of psychosocial assessments and interventions employed, and barriers to psychosocial services. The questionnaire was randomly distributed to 29 therapists. RESULTS The most frequently recorded frame of reference was the Biomechanical. Only 17.2% participants implemented psychosocial assessments. Sixteen of the 29 participants referred to 9 possible psychosocial services; however, majority of referrals were "occasionally." OTs specialized in mental health, behavioral specialists, and social workers were recorded with the least amount of referrals. A Spearman rank correlation found a weak, but significant inverse relationship between referrals by therapists and years of experience as an OT or CHT (-0.322 and -0.351, P < .05, respectively). CONCLUSIONS Therapists appear to be biomechanically oriented which may impact outcomes. An inverse correlation was found where the less experience participants had, the more likely they were to refer to psychosocial services. The results emphasized the lack of psychosocial assessments, interventions, and referral services being used by therapists. Further education to therapists, third parties, and other health professionals is warranted.
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Poulsen HS, Hansen AØ. Occupational performance problems identified by 507 patients: An insight that can guide occupation-based hand therapy. HAND THERAPY 2018. [DOI: 10.1177/1758998318784316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Several barriers challenge the use of occupation-based interventions in hand therapy. An outpatient clinical setting can be prepared in such a way as to address the most common occupational performance problems which might promote an occupation-based intervention. To this end, more knowledge is needed about which problems patients with hand-related disorders consider most important. Methods Interviews using the Canadian Occupational Performance Measure (COPM)were conducted with 507 patients. Data were entered into Microsoft Excel in the COPM categories: Self-care, productivity and leisure and analysed using descriptive statistics. Data concerning main problem areas were categorized according to the Taxonomic Code of Occupational Performance (TCOP). The analysis included the number of prioritized occupational performance problems (NPOPP) in each COPM category/subcategory; the NPOPP in each category is relative to gender and age and the most frequent problems. Results The total NPOPP was 2384. Problems within productivity and self-care constituted the largest proportion, respectively, 46% and 40%. Gender or age affected the NPOPP in each category to a limited extend. Problems were expressed at all levels in the TCOP, except the lowest level. The most frequently expressed problem was use of utensils when eating. Conclusion The problems mostly concern productivity and self-care, regardless of gender or age. Patients consider problems at the levels of occupation, activities, tasks and actions to be important and meaningful to address in their intervention. This study provides useful knowledge that can be applied when preparing a setting to address the most common problems, which could lead to the promotion of occupation-based interventions.
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Affiliation(s)
- Helle S Poulsen
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
| | - Alice Ø Hansen
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Research Unit for Rehabilitation, University of Southern Denmark, Odense, Denmark
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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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Che Daud AZ, Yau MK, Barnett F, Judd J, Jones RE, Muhammad Nawawi RF. Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial. J Hand Ther 2016; 29:30-40. [PMID: 26847318 DOI: 10.1016/j.jht.2015.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/23/2015] [Accepted: 09/21/2015] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized Controlled Trial (RCT). INTRODUCTION Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PURPOSE The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. METHOD A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. RESULTS Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. CONCLUSION This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.
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Affiliation(s)
- Ahmad Zamir Che Daud
- Discipline of Occupational Therapy, School of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland 4811, Australia; Department of Occupational Therapy, Faculty of Health Sciences, Universiti Teknologi Mara, Puncak Alam 32000, Selangor, Malaysia.
| | - Matthew K Yau
- Discipline of Occupational Therapy, School of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland 4811, Australia
| | - Fiona Barnett
- Institute of Sport and Exercise Science, School of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland 4811, Australia
| | - Jenni Judd
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland 4811, Australia; Anton Breinl Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland 4811, Australia
| | - Rhondda E Jones
- School of Marine and Tropical Biology, James Cook University, Townsville, Queensland 4811, Australia
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Kingston G, Williams G, Judd J, Gray M. The functional impact of a traumatic hand injury: a comparison of rural/remote and metropolitan/regional populations. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.9.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The aim of this research was to explore the commonalities and differences in the issues associated with the functional recovery and rehabilitation of a traumatic hand injury experienced by people in rural/remote and metropolitan/regional areas of North Queensland, Australia. Methods: Responses to a previously mailed survey exploring the functional impact on a rural/remote population and a metropolitan/regional population were used for analysis and comparison. Findings: Both populations reported a loss of movement, pain and stiffness, and a significantly greater percentage of metropolitan/regional respondents reported a loss of strength. Leisure and work tasks were affected for both groups as a result of their impairment. Rural and remote respondents would have liked more appointments but found that it was expensive to get to them. There was a significant reduction for both populations of respondents reporting their occupation as labourers after having a hand injury. There was also a significant increase in those who reported undertaking home duties, were pensioners or unemployed. Conclusion: A traumatic hand injury can have a moderate to extreme impact on work and leisure, regardless of residential location. Contextual factors related to living in rural and remote areas can be both a barrier and a facilitator to participation in functional activities. A review of service provision in rural/remote areas to address concerns regarding the expense of attending appointments and the minimal number of appointments required for rural and remote residents following a traumatic hand injury is recommended. Distance technology such as telehealth can increase flexibility of treatment and reduce the requirement to travel. The ongoing development and implementation of this technology is important to facilitate equitable health care between rural/remote and metropolitan/regional populations.
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Affiliation(s)
- Gail Kingston
- Adjunct lecturer, Occupational Therapy, College of Health Sciences. James Cook University; Occupational therapist, The Townsville Hospital, Queensland, Australia
| | - Gary Williams
- Lecturer, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Queensland, Australia
| | - Jenni Judd
- Adjunct principal research fellow, College of Medicine and Dentistry, James Cook University and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Queensland, Australia; adjunct associate professor, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Marion Gray
- Postdoc fellow, Washington, DC, USA; Professor, discipline and program leader, Occupational Therapy, School of Health and Sport Sciences, University of Sunshine Coast, Queensland, Australia
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Powell RK, von der Heyde RL. The inclusion of activities of daily living in flexor tendon rehabilitation: a survey. J Hand Ther 2014; 27:23-9. [PMID: 24238929 DOI: 10.1016/j.jht.2013.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED Studies have shown that patients restricted to one-handed use due to trauma or surgery often have difficulty with activities of daily living (ADLs). In order to assess hand therapists' perspectives and practices regarding ADL assessment and intervention, a 21-item survey was e-mailed to members of the American Society of Hand Therapists (ASHT). Results of the survey indicate that the majority of hand therapists surveyed (97.5%) feel that ADL performance is an important part of hand therapy practice and that teaching adaptive strategies is a high priority in the early weeks of flexor tendon rehabilitation, but less than half (45.5%) actually provide a formal assessment of ADL performance in order to discover patients' ADL needs. Reasons for this discrepancy between beliefs and practices are explored through participants' comments in the survey. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Rhonda K Powell
- Milliken Hand Rehabilitation Center, The Rehabilitation Institute of St. Louis, MO, USA.
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Kingston GA, Williams G, Gray MA, Judd J. Does a DVD improve compliance with home exercise programs for people who have sustained a traumatic hand injury? Results of a feasibility study. Disabil Rehabil Assist Technol 2013; 9:188-94. [PMID: 23789615 DOI: 10.3109/17483107.2013.806600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This feasibility study sought to determine if compliance and understanding of a home exercise program following a traumatic hand injury is improved when patients are provided with a DVD and a brochure when compared to using brochures only. METHOD Patients who presented with a traumatic hand injury and commenced on a hand therapy protocol were randomly assigned into two groups. The control group received brochures while the experimental group were provided with exercise instructions on DVD as well as brochures. Compliance was measured through the use of exercise diaries, clinic attendance, a checklist to measure correctness and understanding of exercises and a follow-up survey. RESULTS No significant improvement was found in the mean exercise compliance score (p = 0.344) between the intervention and control groups. From the survey results almost half of all participants reported that pain interfered in their ability to perform their home exercises and a third acknowledged that time limited their ability to perform their exercises. CONCLUSION Findings demonstrate the multidimensional nature of compliance. The provision of DVD technology, while not shown to cause a statistically significant change in overall compliance, did help improve understanding of exercises; as such DVDs could be utilised as part of a program that facilitates the patient--therapist relationship. IMPLICATIONS FOR REHABILITATION Limited time and level of pain are highlighted as reasons for non compliance with exercise and treatment programs. The use of DVDs can improve understanding and execution of exercises and can be part of a treatment program that facilitates increased patient therapist contact for rural and remote clients.
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Affiliation(s)
- Gail A Kingston
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University , Townsville , Australia
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