Introduction For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.
Introduction. We present this case of a British patient living and working in Africa who used audiovisual (SKYPE) equipment as a treatment option for remote consultation. This was investigated in response to a request by the patient for further postoperative support at a distance after a complex hand surgery procedure. Methods. Audiovisual (SKYPE) equipment was used by the team in combination with manual therapy as a means of seeking advice, progressing treatment and liaison with a specialist hand therapist and surgeon. The audiovisual equipment was used to complete follow-up of treatment episodes once the patient had returned to Africa. Results. After five months of audiovisual consultations with the surgeon and clinical specialist hand therapist, the patient reported significant reductions in anxiety regarding the management of his extensive hand injury. The patient's active and passive range of movement and Disabilities of the Arm Shoulder and Hand scores had all improved. The wider multidisciplinary team in his local area was supported by a specialist service and evidence was gathered to support the organizational benefits of using audiovisual equipment. Conclusion. This case report highlights the potential, clinical and cost benefits of utilizing audiovisual equipment in conjunction with other treatments in the management of remote hand injury patients.
Objective
To describe current practice among hand therapists in the UK when ordering and interpreting radiographs in clinical practice, in order to define confidence and establish national baselines. To highlight, promote discussion and propose the possible requirement for standardized education and a formal systematic assessment protocol for radiographic interpretation.
Methods
All British Association Hand Therapist (BAHT) registered centres in the UK were sent questionnaires and data collections sheets in order to ascertain current practice.
Results
The data suggest that of the 75 hand therapy centres in the UK who participated in this study 50.6% have therapists ordering radiographs. Of these 36% have formalized teaching and only 5.3% use a formal systematic assessment protocol for hand radiograph interpretation. The average confidence level on a visual analogue scale (VAS) was 5 (some confidence) with only four centres demonstrating above 6 (confident). Increased confidence levels were found to be associated with the availability of formal training and systematic assessment tools.
Conclusion
Centres using formalized training demonstrated a higher level of confidence than those without. The highest levels of confidence were in those centres whose therapists used a formal systematic assessment tool. The data collected suggests an education programme and standardized assessment protocol may assist the confidence of hand therapists in the radiographic assessment of hands.
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