Occupational therapy hand assessment practices: Cause for concern?

Abstract

Introduction: Assessment is critical for measuring improvement, or lack thereof, and demonstrating the outcome of intervention. In response to the lack of research in this area, this study aimed to determine the assessment practices of occupational therapists working with clients with hand conditions. Methods: A quantitative cross sectional survey design was used. A convenience sample of occupational therapists was recruited from five provinces. Respondents completed a questionnaire developed for the study that comprised demographic information, assessments used, frequency of use and factors influencing assessment choice. Data were analysed with Statistica version 11. Results: Eighty-one respondents (n=114) completed questionnaires representing a 71% response rate. Goniometry (84.0%), manual muscle testing (76.5%) and testing for flexor tendon function (76.3%) were used most frequently. The most common reasons for not using assessments were lack of availability and unfamiliarity. Conclusion: It is of concern that the assessment practices of participants in this study focussed primarily on the assessment of body function and structure with few therapists using activity and participation measures. This could seriously limit the evidence needed to verify the outcomes achieved through occupational therapy intervention in the treatment of hand conditions.evidence of the interventions provided 5 . If therapists do not assess, they will not be able to produce evidence of the effects of the interventions offered which poses a threat to funding of services. This claim is supported in the Western Cape Department of Health Healthcare 2030 plan 6 that states that there will be an increased move towards outcome based intervention with priority being given to interventions aimed at desirable outcomes. At the time of conducting this study, no research to determine the assessment practices of occupational therapists working with hand conditions within South Africa had been published. Assessment practices are understood to encompass the type of assessment used, the frequency of use and the reasons for non-use within a particular area of practice. This study therefore set out to provide an updated account of these practices by South African occupational therapists working with clients with hand conditions. LITERATURE REVIEWA client-centred approach should be applied in assessment to obtain a "careful understanding" of the individual before starting occupational therapy intervention 7:253 . This type of approach is more likely to ensure that the client is engaged in the occupational therapy process which will encourage greater client cooperation 8 . In a client-centred approach, the client and therapist work together to establish the occupational performance problems and to set goals for the required intervention. Assessment has to take place for this to be possible. Standardised assessment provides quantitative information, useful for tracking the client's progress and demonstrating the outcome of therapy 44United Kingdom the au...

Occupation-based hand therapy in South Africa: challenges and opportunities

“…However, it seems that the primary focus of current occupational therapy assessment and treatment for these clients, remains on body structure and function 1,4 . This is also true in South Africa 9 . Occupational therapy modalities and techniques within a biomechanical approach include splinting and physical agent modalities.…”

“…In the context of client-centred goals, the therapists must ensure that the client contributes meaningfully to prioritising treatment goals. An effort must also be made to apply appropriate adult learning principles 9 . ✥ OBHT must include sound knowledge and understanding of the requirements of an activity, task or occupation.…”

“…Activity analysis contributes to successfully facilitating the transition between the clinical setting (therapy practice) and the client's real-life environment. Meaningful occupations can be used to motivate clients to integrate improvements in body structure and functions at home 9 . In addition, as described by Amini 8 , occupations can be used to assist a client to return to psychosocial well-being while they await improvement in the affected body function or structure.…”

The validity and clinical utility of the Disabilities of the Arm Shoulder and Hand questionnaire for hand injuries in developing country contexts: A systematic review

“…9 In South Africa, the routine use of measures of activity and participation remains low. 10 Therapists offer time constraints and lack of applicability in the practice context as reasons for nonuse of the DASH. 10 Time constraints are a common reason for nonuse of PROMs.…”

“…10 Therapists offer time constraints and lack of applicability in the practice context as reasons for nonuse of the DASH. 10 Time constraints are a common reason for nonuse of PROMs. 6,7,11 In contrast, the quick administration time of the DASH has been reported in some studies.…”