Following a traumatic hand injury, people experience a significant disruption to their lives. This qualitative study attempts to describe the lived experience of five people coping with the consequences of an extrinsic flexor tendon injury to their hands. Individual open-ended interviews were undertaken and a phenomenological analysis was used. The findings highlighted several themes, four of which were common to each participant: i) minimising the impact of the injury; ii) struggling and coping; iii) trying to elicit help from others, and iv) feelings of dependency. Implications for the provision of hand therapy services to this client group, suggested by this research, are the need to identify people on whom patients will be dependent and to include them in treatment planning; the need to monitor patients’ mood states; the need for hand therapists to be more wide ranging when identifying and negotiating strategies for managing their rehabilitation time and to take a broader view of the rehabilitation process and not to focus exclusively upon exercise and splinting guidelines.
Challenging rehabilitation regimes following flexor tendon surgery require patients to complete an hourly exercise regime and wear a thermoplastic splint constantly for four to six weeks. Building on earlier research by the first author the data from his interviews of five peoples' experiences and meanings of their rehabilitation was re-analysed using a phenomenological lifeworld approach. The individuals were found to cope in different ways and degrees with the frustration of disability. Three themes*''struggling-adapting'', ''retreating-battling'' and ''denying-accepting''*capture something of the ambivalence of their experience. The findings also provide insight into how flexor tendon injury, and subsequent surgery and rehabilitation, impact on individuals' lifeworlds. Damage wreaked on daily life comes as a surprise. In different ways, they are all challenged to come to terms with the shock of pain, disability and the double trauma of surgery and rehabilitation. The challenge also involves an emotional and social struggle as personal relationships are disrupted. Three types of phenomenological analyses*narrative, lifeworld and thematic*are presented as iterative, deepening elaborations. Together they offer a more holistic, if still tentative, picture highlighting the relevance of attending to peoples' personal, social and practical responses beyond simply focusing in reductionist ways on physical function.
Occupational therapists working in the field of hand therapy tend to follow a reductionist biomedical approach in their practice. This emphasis means that there is the potential to lose the occupational focus in interventions with this client group. The International Classification of Functioning, Disability and Health (World Health Organisation 2001) could be used as a framework to examine the consequences of hand injuries. By taking all four conceptual domains into account when treating this client group, it may be possible not only to examine, for example, range of movement and tendon glide but also to start looking at the occupational impact on people's activity performance and social participation following hand impairment, as well as to explore the variations of the occupational impact that these injuries have on people's lives.
Junior therapists starting a six-month rotation in hand therapy soon realise that protocols or guidelines of care do not cover every eventuality presented in the workplace, nor do they provide a failsafe pathway through their rotation. Selfperceived lack of knowledge was reportedly reducing proficient junior therapists to novice practitioners. To help them through this maze of new ideas and treatment concepts, 'islandsof-learning' formulated from 12 stand-alone modules have been developed in consultation with junior therapists, that focus on various learning needs to provide a structured learning pathway through their rotation. These 'islands' are undertaken biweekly and are designed to enable junior therapists to gain a broad grounding in each subject matter. This method has allowed therapists a sense of control over their own learning and reduced the feeling of being overwhelmed by the amount of new information they must acquire. By the end of their rotations, they have developed their own resource pack. This idea has proved successful within the hand therapy department and subsequently other departments within the trust have developed similar training courses for staff during their basic grade rotations.
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