Commentary: Rehabilitation for Rural and Remote Residents Following a Traumatic Hand Injury

Abstract

A traumatic hand injury can involve damage to a number of structures including skin, nerves, tendons, muscle bone, and soft tissue. Impairments such as pain or stiffness and loss of range of motion can last for many years and result in a moderate to extreme impact on a person's day-today life. Work, leisure, financial security, and emotional well-being often most affected. This commentary provides an analysis of those factors that inhibit (barriers) and support (enablers) the provision of hand therapy rehabilitation in rural and remote areas. Providing a collaborative and flexible rehabilitation programme to rural and remote residents following a traumatic hand injury can be seen as a challenge due to issues such as a limited access to health care services. Established protocols that work in regional or metropolitan locations are unlikely to be effective and innovative and pragmatic strategies are required. The provision of a collaborative and flexible rehabilitation programme regardless of residential location is an important part of the therapist's intervention plan.

Extension, austerity, and emergence: Themes identified from a global scoping review of non‐urban occupational therapy services

“…Transplantation involved replicating an existing urban service in a non‐urban community. Some examples included providing developmental support (Almomani et al, 2014 ; Bartie et al, 2016 ; Cronin, 2018a , 2018b ; Haring & Lovett, 2010 ; Keightley et al, 2018 ; Maxwell, 2010 ; McGuire et al, 2015 ; Wagner et al, 2017 ), assessment and screening services, workplace rehabilitation (Fontana, 2017 ; Hildebrand, 2015 ; McCauley et al, 2015 ), hand therapy (Bell et al, 2011 ; Kingston, 2017 ; Kingston et al, 2010 ; Kingston & Gray, 2011 ; Kingston, Judd, et al, 2015 ; Kingston, Williams, et al, 2015 ; Maxwell, 2010 ; Worboys et al, 2018 ), rehabilitation (Carter et al, 2017 ; Danzl et al, 2016 , 2013 ; Gauld et al, 2011a , 2011b ; Hunter & Kitzman, 2018 ; Kim et al, 2019 ; Kitzman & Hunter, 2011 ; Sekaran et al, 2010 ), and driving assessments (Churchill, 2016 ). These services aimed to provide some access to services already available to urban clients.…”

“…Lack of access to occupational therapy services in non‐urban spaces was commonly acknowledged across nearly all publications. Non‐urban spaces and populations were frequently identified as having less access to workers, services, and funding (e.g., Bellefontaine et al, 2015 ; Bunning et al, 2014 ; Burgman et al, 2011 ; Danzl et al, 2016 ; Dawad & Jobson, 2011 ; Dew et al, 2013 ; Gardner et al, 2016 ; Haring & Lovett, 2010 ; Johnsson et al, 2019 ; Kingston, 2017 ; MacLachlan, 2010 ; Paul et al, 2016 ; Smith & Cooke, 2017 ). Some publications noted that services were limited to bare minimums to allow the client to leave the urban space and return home and acknowledged limited support or follow‐up in the non‐urban space (e.g., Bunning et al, 2014 ; Danzl et al, 2013 ; Dew et al, 2013 ; Hyett et al, 2011 ; Kingston et al, 2010 ; Kingston, Judd, et al, 2015 ; Miller & Evans, 2013 ; Sekaran et al, 2010 ; White et al, 2016 ).…”

“…The challenges service providers experienced managing the geography and perceived additional cost of servicing non‐urban spaces were often framed as reasons that non‐urban people must compromise on service delivery method, frequency, or type of occupational therapy services received, in ways that were not required of people in urban spaces (e.g., Bellefontaine et al, 2015 ; Cason & Jacobs, 2014 ; Cronin, 2018b ; Fishpool et al, 2011 ; Haring & Lovett, 2010 ; Hickey et al, 2011 ; Hines et al, 2019 ; Johnsson et al, 2019 ; Kingston, 2017 ; Monz et al, 2019 ). Delivering occupational therapy services of the same scope and quality as elsewhere in Canada is difficult.…”

'The hand belongs to someone': a therapist perspective on patient compliance

“…Within the hand rehabilitation literature, functional or occupation-based intervention has been recommended as a therapy-related factor that can be used to improve patient compliance 16 . An occupation-based approach, along with flexibly and collaboratively tailoring protocols, has been recommended for rural hand rehabilitation practice 51 . Although challenges exist to implementing such an approach 22 , a growing body of evidence 52,53 suggests that opportunities be provided for therapists to develop their occupation-based knowledge and skill.…”