Hand Therapy Outcomes: Therapists’ Perceptions Of Occupation-Based Interventions In Practice

Purpose: It is well known that hand therapists frequently use biomechanical-based interventions in their treatment of upper extremity injuries and pathologies. There is a push to return to the occupational therapy profession’s roots of occupation-based practice, which has recently been further reinforced with the introduction of the American Occupational Therapy’s (AOTA) Choosing WiselyⓇ Initiative (Gillen et al., 2019). Hand therapy is one area in which occupation-based practice could become more prevalent. This study will enhance the existing research on occupation-based hand therapy through the use of focus group interviews with occupational therapists who have a majority of their caseload classified as hand therapy. The purpose of this study is to examine hand therapists’ perceptions of occupation-based hand therapy to develop an improved understanding of the connection between hand therapy and the overarching field of occupational therapy. Methodology: This study was approved by the Institutional Review Board (IRB) at the University of North Dakota in Grand Forks, ND. A phenomenological approach was used to guide this study. Convenience and snowball sampling were used to gather participants. Participants were primarily recruited through the use of the University of North Dakota Occupational Therapy Fieldwork Database. Participants received an email invitation and then were asked to attend one of two focus group sessions. Data was audio recorded and then transcribed verbatim. Results: Data from the two focus groups was used to create a total of four categories and 13 themes. The data was analyzed using a phenomenological theoretical framework. Three assertions were developed. Results suggest that hand therapists have a tendency of using a top-to-bottom-up approach (Fisher & Jones, 2017) throughout the therapeutic process; however, the end goal of occupational performance drives intervention. It was found that hand therapists do keep occupation at the forefront of practice, despite the misconceptions that exist. The participants did not feel that the benefits of maintaining an AOTA membership justified that annual cost; thus, there is potential for a disconnect and lack of communication between hand therapists and the profession of occupational therapy. Conclusion: The lack of hand therapist membership in AOTA creates challenges for the entire profession because there is potential for a disconnect between occupational therapists practicing as hand therapists and the field of occupational therapy as a whole. It serves as a barrier for dissemination of information crucial to occupational therapy practice, such as research, best practice standards, and mandates from legislation or third-party payers. It also contributes to the lack of understanding of hand therapists’ use of occupation-based practice