The Southampton Dupuytren's Clinic: audit of an effective multidisciplinary model

Abstract

Introduction. The Southampton Dupuytren's Clinic (SDC) was preceded by a four-month period when the therapist accompanied the surgeon in Clinic to learn about Dupuytren's Disease (DD) and to develop a specific proforma to collect details of the patient, the condition and the planned treatment. Methods. A special clinic was set up for general practitioner referrals for patients with DD. Each patient was seen by the therapist. A detailed history and examination were recorded on the proforma. Treatment options to include the outcome, risks and benefits of surgery were clearly explained, supported by a handout. The patient was then seen by the surgeon to arrange management. Results. One hundred and ninety-four patients were allocated to the SDC. In all, 5% failed to attend; 8% had an alternative diagnosis made; and 16% with DD were discharged as the disease was not advanced enough for intervention or the patient decided not to have surgery. The therapist then allocated 71% for surgical assessment. The surgeon, to efficiently allocate personnel and theatre resources, listed 22% for skin graft, 8% for fasciotomy, 70% for fasciectomy, 35% for consultant to perform, 35% for fellow/registrar to perform, and 30% for the consultant to train the registrar. Conclusions. We consider that triage and assessment of patients with DD is improved by a multidisciplinary approach: a hand therapist, to quantify deformity and functional deficit, and explain the purpose, risks and outcome of surgery; and a hand surgeon, to decide the type and duration of surgery and the appropriate grade of surgeon.

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

“…Emerging evidence suggests that allied health professionals working in primary contact roles can be costeffective, reduce waiting times and waiting lists, and improve patient flow and patient satisfaction while maintaining the quality and safety of services (Burn & Beeson, 2014;Dawson & Ghazi, 2004;Oldmeadow et al, 2007;Saxon, Gray & Oprescu, 2014;Warwick, Belward, Vadher & Setty, 2010). O'Brien, Hardman and Goldby (2013) found that a statistically significant predictor for not requiring surgery was when patients received nonoperative treatment by an occupational therapist.…”

The lived experience and occupational impact of individuals with Dupuytren's disease: a scoping review

“…Given that Dupuytren's disease is progressive, and recurrence is common after intervention, it is essential that a deeper understanding of the patient journey over time is developed so that patients can be supported to make informed decisions regarding their treatment options. The growing role of occupational therapists in primary contact positions, where they perform extended scope screening and treatment planning roles (Warwick et al, 2010;Cox et al, 2020;Glasgow et al, 2020), means that this knowledge is important for the profession. Further longitudinal research would be beneficial to explore this aspect, as well as to gain a deeper understanding of the ways in which individuals adapt to the condition.…”