Abstract
•Despite being trained in more holistic treatment approaches, occupational therapists who are certified hand therapists (CHTs) report that a biomechanical intervention approach is their primary approach to treating clients with upper extremity injuries.•While many occupational therapist CHTs will integrate occupation-based assessment and interventions into their therapy sessions, most do not formally assess for psychosocial dysfunction, and they do so even less with worker's compensation clients.•There is a need for better standardized tools to assess psychosocial factors for hand injured clients.
Occupational therapists address occupations, performance skills, and client factors that interfere with the successful occupational engagement in everyday activities, including psychosocial factors. However, due to the biomechanical model focus within hand therapy clinics, provision of a holistic care plan remains challenging for occupational therapists. If a client's psychosocial functioning is not addressed, progress toward a full recovery may be limited.
The purpose of this study was to identify how occupational therapists who are certified hand therapists (CHTs), address and provide interventions to clients with psychosocial factors that negatively impact function.
Mixed-Method.
CHTs completed an electronic survey (n = 117) followed by a virtual focus group (n = 9). Survey data analysis included descriptive and correlational statistics to highlight frequencies, ranges, and relationships between the participant demographics and the selection of assessment and the intervention approaches. Thematic analysis guided the qualitative coding of the focus group transcripts.
Of the 117 survey respondents, 79% reported frequent use of the biomechanical approach. The most frequently administered assessment included the Quick-Disabilities of the Arm, Shoulder, and Hand (n = 45; 40.9%). Five themes emerged from the focus groups: hand dysfunction impacts roles and routines; client rapport building takes time; CHT hesitation to address psychosocial factors; standardized assessments need to evaluate psychosocial factors that impact client function; and education and communication are critical intervention approaches.
Occupational therapy practitioners primarily utilize the biomechanical approach and are less likely to assess or treat psychosocial factors that impact a client's function. However, participants reported a need for a standardized assessment to identify the psychosocial factors that impact their clients’ functional performance. Further research is warranted to increase the measurement and the use of holistic theoretical models of practice, assessments, and intervention approaches.