Embracing an occupational perspective: Occupation‐based interventions in hand therapy practice

Abstract

KEY WORDS client-centred practice, information gathering and collaborative goal setting, musculoskeletal/hand therapy, occupational performance, occupational therapy theory and models.

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective

“…Analysis of the interviews, observations and progress notes indicated that the occupational therapists in this study utilised bottom‐up reasoning processes, assuming that improvements in physical components of the body would result in improved occupational performance and engagement. It has been recognised in the literature that a bottom‐up approach dominates hand therapy research and practice (Fitzpatrick & Presnell, ; Robinson, Brown & O'Brien, ; Winthrop Rose, Kasch, Aaron & Stegink‐Jansen, ). It appeared in this study that the biomedical culture pushed occupational therapists into this way of thinking about body functions and components.…”

“…These informal discussions usually centred on patients’ work and hobbies, which aligns with findings from other studies of hand therapists’ assessment and evaluation practices (Grice, ; Kaskutas & Powell, ; Powell & Von Der Heyde, ). Informal discussion as a way of gathering information may mean patients have difficulty understanding both what information is important to tell the occupational therapist and, the scope of potential areas for intervention (Fitzpatrick & Presnell, ; Robinson et al ., ; Weinstock‐Zlotnick & Bear‐Lehman, ). Occupational issues, including self‐care, may be overlooked during the informal discussion where more obvious leisure or work issues take the forefront, as was for the case for patients following flexor tendon repair in a study by Kaskutas and Powell.…”

“…Occupational therapists specialising in primary contact models in hand therapy could perhaps reflect critically on how their knowledge of the range of physical, cognitive and affective factors impacting on occupation could be utilised to provide more person-centred, theory driven care. Fisher (2013) wrote that occupational therapists can relinquish a bottom-up focus and adopt an occupational lens by utilising one or more models of practice, such as the Canadian Model of Occupational Performance and Engagement (CMOP-E; Polatajko et al, 2013), which was echoed by Robinson et al (2016). Occupational therapists working in the PCOTH clinic, who are pushed by the biomedical context of the medical substitution role, could use conceptual practice models to more explicitly link these parts of the role to the philosophical tenets of occupational therapy (Fisher).…”

“…More research needs to explore the professional identity of occupational therapists in advanced scope roles that also incorporates the perspectives of consumers, the multidisciplinary team and managers. Occupational therapists may also benefit from professional development events that focus on core theoretical and philosophical tenets of the profession (Gillen & Greber, 2014;Robinson et al, 2016).…”

Hand health for all: Do undergraduate occupational therapy hand curricula respond to the call?

“…Preparing graduates to practice within a PHC framework thus suggests that hand curricula be positioned within a vision of hand health for all. In addition an occupational perspective would ensure that students consider the total being in his or her lived reality 24 .…”