- 1. Iris Luanne De La Calzada, OTR/LBoston UniversityMay
2009
2. Purpose Limitations of researchIntroductionImplications
forThe patient-orientedpractice/policiesapproachMy practice
scenarioWhat is the difference? ReferencesThe questionSearch
methodsMajor findingsConsistencies andinconsistencies 3. To look at
evidence-basedinformation on the superiority of apatient-oriented
handrehabilitation program overconventional methodsTo determine the
significance ofthe role of occupational therapistsin such
programsTo determine the various ways ofimproving service delivery
in out-patient hand clinic 4. Work-related upper extremity injuries
Loss of productivity Increased medical costs for injured workers
Increased disability payments for employersMOST COMMON
CAUSES:SPRAINS & STRAINSPOOR BODY MECHANICS &
POSITIONFALLSUnited States Bureau of Labor Statistics Fact Sheet.
(November 20, 2008).Nonfataloccupational injuries and illnesses
requiring days away from work,2007. Retrieved on March 24, 2009
from website:http://www.bls.gov/news.release/pdf/osh2.pdf 5. WHAT
IS IT?a concept that uses an ongoing investigation of factorsthat
increase quality of care delivered based on :1. Functional
outcomes2. Client satisfaction3. Overall reduced workers
compensation cost- uses a client-centered toolkit-patient is an
active participantHarth, A., Germann, G., Jester, A. (2008).
Evaluating the effectiveness of a patient-oriented hand
rehabilitation programme. The Journal of Hand Surgery
(EuropeanVolume),33E(6). 772-778. * 6. Mossberg, K. and McFarland,
C. (2001). A patient-oriented health status measure foroutpatient
rehabilitation. American Journal of Physical Medicine &
Rehabilitation,80(12). 896-902. 7. The Question:For adults with
work-related upper extremity injuries,does a patient-oriented hand
rehabilitation result inearlier return to work and improved
functionaloutcomes than conventional occupational
therapyintervention? 8. 6 full-text articles in English were chosen
9. Consistently good results in 3 studies in terms offunctional
outcomes using the patient-orientedapproach compared to traditional
approach 10. Adults: 16-64 yearsNo RCTs, all 6 studies withRacial,
ethnic, or different non-RCT designssocioeconomic groups not 4
measured work as outcomeconsidered with good results4 of 6 studies
had more male Attitudes toward return toparticipants work and
actual return toVarious orthopedic /non- work after discharge
notorthopedic injuries andexploreddisordersDASH was a useful toolNo
mention of training for CIQ scores with poorprofessional providers
correlationOnly 1 study with exclusiveoccupational therapy 11.
Weak, AOTA levels I-IV Patient-orientedOTs as contributorsapproach
is NEW!No RCTs done within last US healthcare is not5-10 years
government controlledSample sizes >20 All studies found did
notLack of uniformity onmeasure occupationalresearch methodology
therapy contribution in hand rehabilitation inLack of practice
standards isolationin quality assuranceStrongest evidence
fromstudies completed abroad 12. Complete more RCTs in theFocus on
role of OTs in theUnited Statestransition to from medicalPromote
OTs as primary model to patient-orientedresearchers or team
leadersservice deliveryor consultantsResearch payment and MY
PRACTICE SCENARIO:reimbursement system Advocate the creation of
RTWAdvocate patient-orientedand hand rehabilitationhand
rehabilitation and RTWprogramsprograms as added employee Adapt the
patient-orientedbenefits service deliveryEmphasize OTs
responsibility Use evidence-based data ason the psychosocialguide
for practicecomponents 13. ReferencesCase-Smith, J. (2003).
Outcomes in hand rehabilitationusing occupational therapy services.
American Journalof Occupational Therapy, 57. 499-506. *European
Federation Societies for Hand Therapy (EFSHT)Education Committee
(2008). European Certified Hand Therapist Profile. Retrieved on
January 27, 2009 from website:
http://www.eurohandtherapy.org/documents/EFSHT_Hand_Therapist_Profile.pdfHand
Therapy Certification Commission (2001). Who is ahand therapist?
Retrieved on March 19, 2009 from website:
http://www.htcc.org/about/index.cfmHarth, A., Germann, G., Jester,
A. (2008). Evaluating theeffectiveness of a patient-oriented hand
rehabilitationprogramme. The Journal of Hand Surgery
(EuropeanVolume),33E(6). 772-778. *Goodman, G., Browning, M.,
Campbell, S., Hudak, H.(2005). Evaluation of an occupational
rehabilitationprogram. Work Journal, 24. 33-40. *Lieberman, D.,
&Scheer, J., (2002). AOTAs evidence-based literature review
project: An overview. AmericanJournal of Occupational Therapy, 56
(3). 344-349.Matheson, L., Isernhagen, S., Hart, D. (2002).
Relationshipsamong lifting ability, grip force, and return to
work.Journal of the American Physical Therapy Association,82(3).
249-256. *Mossberg, K. and McFarland, C. (2001). A patient-oriented
health status measure for outpatient rehabilitation. American
Journal of Physical Medicine & Rehabilitation,80(12). 896-902.
14. Pomerance, J. (2009). Return to work in the setting of
upperextremity illness. Journal of HandSurgery, 34A.137-141.Rempel,
D., Harrison, R., and Barnhart, S. (1992). Work-relatedcumulative
trauma disorders of theupper extremity. Journal of the American
Medical Association, 267(6). 838-842.The German Federal Ministry of
Education and Research. (2006). Patient-oriented research.
Retrievedon January 27, 2009 from website:
http://www.bmbf.de/en/6647.php#topTschernetzki-Nielson, P.,
Brintnell, E., Haws, C., Graham, K. (2007). Changing to an
outcome-focusedprogram improves return to work outcomes. Journal of
OccupationalRehabilitation, 17. 473-486.*United States Bureau of
Labor Statistics (2007, May). Occupational Employment
andWages:Occupational Therapists. Retrieved on April 14, 2009
fromwebsite:http://www.bls.gov/oes/2007/may/oes291122.htmUnited
States Bureau of Labor Statistics Fact Sheet. (November 20, 2008).
Nonfataloccupationalinjuries and illnesses requiring days away from
work, 2007. Retrieved on March 24, 2009 fromwebsite:
http://www.bls.gov/news.release/pdf/osh2.pdfWong, J., Fung, B.,
Chu, M., Chan, R. (2007). The use of disabilities of the arm,
shoulder, and handquestionnaire in rehabilitation after acute
traumatic hand injuries. Journal ofHand Therapy, 20.49-56. *
