ASSIGNMENT
Rewrite the literature review below, create themes based on the articles that was found and synthesize the results based on themes identified, providing substantial evidence.
Literature Review
Introduction
An extensive literature review was guided using search terms applicable to the purpose of this study. Collaboration with a medical research librarian led to the use of the following databases: PubMed, Cochrane Library, ScienceDirect, National Rehabilitation Information Center, Psychinfo, CINAHL, and Google Scholar. Aside from traditional search engines, other data resources, such as Networks, Organizations, and Conferences were used which included the American Journal of Occupational Therapy. Reference lists from articles included in the study were reviewed for feasible articles, and additional selected articles were hand searched. The search terms included the following: (1) orthopedic hand impairment conditions AND occupation-based interventions; (2) hand therapy AND adults AND occupation-based; (3) occupation-based interventions AND hand therapy; (4) hand therapy OR upper extremity rehabilitation AND occupation based; (5) biomechanical approach AND occupation based. The searches contained filters that were limited to advanced search, full-text review, and peer reviewed articles from 2012 to 2022.
In 2016, Robinson, Brown, and O’Brien reported that hand therapy professionals had been inclined to follow a reductionist biomechanical approach to clinical practice, which emphasizes body structure and function. Robinson, Brown, and O’Brien (2016) suggest the use of the Canadian Model of Occupational Performance and Engagement (CMOP-E) in occupational therapy-hand therapy settings, as it diverges from the more common biomechanical approach and focuses on the relevance of everyday life tasks or the occupations of a therapist’s client (Robinson et al., 2016). The CMOP-E reasons that occupational performance is the outcome of the dynamic, continuing relationship between a person (e.g., physical, cognitive, affective domains) with spirituality at its root; the individual’s occupations (e.g., self-care, productivity, leisure); and the individual’s environment (e.g., physical, social, cultural, institutional) in which they live, work, travel, and play (Robinson et al., 2016). It asserts that occupational therapy, through an occupation-based approach, can enable clients to connect to imperative roles, responsibilities, patterns, and daily activities, influencing the client’s outcomes (Robinson et al., 2016). In the review, one randomized control trial (RCT), participants randomly assigned into a group, analyzed the effectiveness of OBI vs. traditional therapeutic exercises in hand injuries; the results revealed that using occupation-based interventions produced substantially more significant improvement in patient outcomes in chronic and acute hand injuries (Robinson et al., 2016). The lack of research discovered by Robinson, Brown, and O’Brien (2016) led the authors to advocate for occupational therapy specialists in hand therapy, suggesting that they should collaborate with those already integrating occupation-based interventions.
Occupational therapists with a minimum of five years of experience in hand therapy were recruited for a study that evaluated their experience delivering occupation-based interventions in the workplace (Colaianni et al., 2015). The ten participants discussed their experiences of providing occupation-based interventions based on the perceptions of influences, psychosocial benefits, procedural components of practice, and challenges (Colaianni et al., 2015). The participants’ perceptions were explained by the participants: academic environment and knowledge, patients’ motivation level when occupation-based is implemented in treatment, and occupation being focused as the end goal (Colaianni et al., 2015). The challenges in the study described are related to time, environment, and reimbursement measures (Colaianni et al., 2015). In order to develop a more occupation-based intervention program, occupational therapists can apply the conclusions of this study to resolve the tension between a holistic, occupation-focused approach and the biomechanical model (Colaianni et al., 2015).
A mixed-methods study reported that the use of occupation-based interventions in hand therapy is expanding (Colaianni et al., 2022). The study contained quantitative and qualitative data representing the routine use of OBI among 27 occupational therapists working in hand therapy clinics as CHTs (Colaianni et al., 2022). The CHTs narrated common themes of occupation-based interventions that were implemented in their daily practice 75% of the time, including meal preparation, clean-up, dressing, leisure, social participation, personal hygiene, grooming, pet care, care of others, and exploration (Colaianni et al., 2020). The CHTs noted that the interventions implemented were reflected in the OTPF (Colaianni et al., 2020). This study explains that a barrier is the lack of equipment in clinics and knowledge; encouragement of OBIs in practice entails support from facilities and the core motivation of CHTs (Colaianni et al., 2020). Most significantly, it distinguishes the importance of using OBIs and that occupational therapy practitioners and educators have a role to play in overcoming the barriers to occupation-based hand therapy (Colaianni et al., 2022).
According to Bauer and Maher (2022), occupational therapy students need a more durable understanding of the use of occupation-based interventions in hand therapy. The study recognizes the developing movement of occupational therapists deserting their occupation-based origins and applying more biomechanical approaches in hand therapy treatment (Bauer & Maher, 2022). Twenty-seven occupational therapy students who were enrolled in a professional/graduate program or obtained a master’s or doctorate in occupational therapy were included in this mixed-methods survey; the goal was to determine if there is a need for an increase in education in the OT curriculum regarding OBI and hand therapy (Bauer & Maher, 2022). The students display a detachment between their comprehension of occupations as they relate to hand therapy (Bauer & Maher, 2022). Bauer and Maher (2022) found that most OT students, 81.48%, expressed limited education about OBIs in hand therapy content within their program; students reported primarily biomechanical instruction. The quantitative and qualitative data analysis formed a hypothesis on the cause-and-effect relationship between the student’s knowledge and perceptions of using occupation-based interventions (Bauer & Maher, 2022). The matter originates at the education level, and a change in occupational therapy curriculum should reflect the core of the profession; the root of occupation needs to be brought back to the forefront to ensure hand therapy remains within the scope of occupational therapy practice in hand therapy. (Bauer and Maher (2022).
A case report shared that using occupation-based interventions in combination with therapeutic exercises showed improved outcomes in hand rehabilitation (Young et al., 2020). A 22-year-old male was referred to an inpatient facility and was treated by three OTs six days after surgery (Young et al., 2020). The occupational therapist implemented a series of various therapeutic exercises; the hand therapist implemented occupation-based interventions such as graded, meaningful craft activities to improve mobility and increase hand function (Young et al., 2020). The third therapist maintained detailed reports and often collaborated throughout the required treatment sessions (Young et al., 2020). They also utilized multiple assessments that included goniometric evaluations, monofilaments, disk-criminator, dynamometer, MMT, Nine Hole Peg Test, and Jebson-Taylor Hand Function Test to measure ROM, sensation, and strength, and hand function (Young et al., 2020). Young, Daya, and Govender (2020) also reported using the DASH, and a patient interview was administered to measure the male patient’s satisfaction and return to leisure, household, and work tasks. After 65 treatment sessions, the patient accomplished approximately total AROM in his digits, intrinsic hand function, thirty seconds on Nine-Hole Peg Test, and the capability to return to work minus other reconstructive procedures (Young et al., 2020).
A randomized controlled trial examined the effectiveness of a combination of occupation-based interventions (OBI), and therapeutic exercise (TE) compared to patients receiving therapeutic exercise alone for the treatment of hand injuries (Che Daud et al., 2016). Forty adult patients with hand injuries from an OT clinic gave full consent to partake and were randomly distributed to either the OBI + TE group or the TE group. The primary outcome measure used by the two groups was the DASH; the secondary outcome measures were the Purdue Ppegboard Ddexterity Ttest, Total Active Motion (TAM), grip strength, pinch strength, neuropathic pain, and Canadian Occupational Performance Measure (COPM) (Che Daud et al., 2016). Che Daud, Yau, Barnett, and Jones determined that the group with the combination of OBI + TE received more successful outcomes and better recovery than the patients in the TE-only group in hand. The OBI + TE group also substantially improved COPM performance and satisfaction after receiving therapy (Che Daud et al., 2016). Overall, the study recognized that the patients in the OBI + TE group were more satisfied and had superior occupational performance than the patients in the TE group (Che Daud et al., 2016).
An occupational therapist for 34 years and a certified hand therapist for 23 years conducted an online ten-question survey with a total of 594 members of the American Society of Hand Therapy (ASHT) completing an online survey via email (Grice, 2015). The descriptive analysis found that answers were acknowledged by 22% of those surveyed (Grice, 2015). Findings show that over half use daily occupation-based assessments; most are associated with Activities of Daily Living (ADL) function and used to improve goals (Grice, 2015). According to Grice (2015), the explanations for not using either occupation-based or impairment-based assessment were the same: time restrictions, accessibility of, and understanding of the assessments being used. The insights of the applicants signify that the majority think they are utilizing occupation-based interventions in practice; OBIs lead to better functional outcomes in patients, and occupation-based is the heart of OT. They believe people are more determined if they have a goal to achieve by using occupation-based interventions (Grice, 2015).
A similar cross-sectional web-based survey was utilized to measure hand therapists’ use of OBI in clinical practice (Valdes et al., 2021). The survey consisted of 311 hand therapists’ members of the American Society of Hand Therapists (ASHA) who responded to the sixteen-item survey (Valdes et al., 2011). The author found that hand therapists use numerous OBIs during practice, and most believe they are very significant (Valdes et al., 2011). Although, the author reveals in the study that integrating an occupation-based assessment in alignment with or in place of an assessment of body function and body structures is not completed on a routine basis, with evidence of 125 participants reported using OBIs with patients (Valdes et al., 2011). The three primary OBI interventions hand therapists utilize are dressing tasks, cooking and meal preparation, and in-hand manipulation of medications and coins (Valdes et al., 2011). Valdes, Naughton, Téllez, and Szekeres (2011) acknowledged OBIs as resourceful and valuable when identifying functional constraints in patients. By the end of the study, it is demonstrated that occupation-based interventions have proven to show positive effects on satisfaction, sense of autonomy, motivation, and control over an individual’s life (Valdes et al., 2011). The individuals in Valdes, Naughton, Téllez, and Szekeres (2011) study, obtained the belief that occupation-based interventions are essential in hand therapy and should be implemented to enable patients to perform and participate in components of a rehabilitation program at home.
A single-blinded randomized controlled trial consisting of 36 outpatient participants between the ages of 16-60 was distributed into three groups: an occupation-based group, a rote-exercise-based group, and the control group (Rostami et al., 2017). The Canadian Occupational Performance Measure, Box and Block, static two-point discrimination, disabilities of the arm, shoulder and hand (DASH), and self-assessment manikin, was utilized randomly across sessions three times as a pretest, posttest, and follow-up (Rostami et al., 2017). According to Rostami, Akbarfahimi, Mehraban, Akbarinia, and Susmani (2017), the findings demonstrated significantly higher levels of improvement in the occupation-based group than in the rote-exercise group at both posttest and follow-up sessions. Participants in the occupation-based group had overall superior scores for their awareness level of satisfaction and performance, upper limb functional ability in their ADLs, and a higher level of motivation than the rote exercise-based group (Rostami et al., 2017). The study concluded that participants in the occupation-based group were determined to utilize their affected hands more and more during different ADLs (Rostami et al., 2017).
One hundred and eight members of the American Occupational Therapy Association (AOTA) who practiced in a hand therapy setting were recruited by the AOTA president for a mixed-method design survey (Phillips et al., 2019). Participants were asked if there are benefits to using OBIs within the hand therapy setting, if they could successfully integrate OBIs within their treatment process, and if they were asked to indicate barriers to using OBI (Phillips et al., 2019). In response to the AOTA president, results indicated 88% of participants agreed or strongly agreed there are benefits to using occupation-based interventions within the hand therapy setting, 72.2% agreed or strongly agreed their occupations as treatment facilitated client recovery, and 55.6% agreed or strongly agreed they felt they were able to successfully incorporate occupation-based interventions within their treatment process (Phillips et al., 2019). The top three barriers reported were lack of time, an unsupportive environment, and equipment needs (Phillips et al., 2019). The importance of this study can shape future practice and help deliver knowledge concerning the value of using occupation-based treatment in hand therapy clinics (Phillips et al., 2019).
A small case series had three participants who were 18 years of age recruited from two outpatient orthopedic hand therapy clinics with thumb carpometacarpal (CMC) joint osteoarthritis, two female and one male (Naughton & Algar, 2022). The evaluation and treatment were conducted by two occupational therapists certified in hand therapy credentials and clinical doctors in occupational therapy; they were asked to complete the four following functional tasks while receiving skilled treatment in the clinic: washing, rinsing, and drying dishes, manipulating a laundry basket, lifting, and moving pots and pans, and pouring water from a pitcher (Naughton & Algar, 2022). The three participants were satisfied with the addition of occupation-based intervention in their treatment and experienced a reduction in pain and an increase in clinically significant function (Naughton & Algar, 2022). This descriptive study found a growth in interventions at the occupation level and a loss in biomechanical interventions with the use of occupation-based kits (Naughton & Algar, 2022).
