An occupational perspective in hand therapy: A scoping review

Abstract

Introduction: There have been calls for the occupational therapy profession to realign with its values around occupation. However, the profession faces challenges in practice areas that have historically been underpinned by a biomechanical approach, such as hand therapy. The aim of this scoping review was to describe what is known about an occupational perspective in the hand therapy literature. Method: This scoping review utilised a recognised five-step approach. A search was conducted in four databases for papers published between 2005 and 2016. Numerical and thematic analyses were employed, using the Canadian Practice Process Framework as a theoretical framework. Results: Fifty papers were included in the scoping review. Six themes were identified: the centrality of occupation; inconsistencies in terminology; where in the occupational therapy process?; informal discussion as a key occupational strategy; occupational therapists' expectations of patients; and a bottom-up approach focusing on biomechanical strategies to implementing the plan. Conclusion: Whilst there has been some integration of an occupational perspective into hand therapy literature, there are still challenges. Inconsistent terminology, the lack of an occupational perspective throughout the occupational therapy process and a bottom-up approach to interventions all demonstrate the continuing tensions between the biomechanical approach and an occupational perspective.

Occupational Therapy’s Unique Contribution to Chronic Pain Management: A Scoping Review

“…Indeed, in 2011, Robinson et al [ 67 ] warned the scientific community that the influence of the biomedical model of health on OT limited the integration of occupation-based practice for people with CP, the latter being the central value of OT. More recently, Burley et al [ 84 ] also witnessed two competing perspectives, biomechanical and occupational, that are present in OT services in the hand therapy literature. They noticed that whilst there has been some integration of an occupational perspective, a bottom-up approach, an inconsistent use of terminology to describe what could be framed as occupations, and a lack of an occupation-based performance perspective persist throughout the OT clinical process.…”

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

“…A recent scoping review (Burley, Di Tommaso, Cox & Molineux, 2018) revealed that patients with hand injuries experienced occupational issues and found rehabilitation informed by an occupational perspective to be motivating (Bamford & Walker, 2010;Cheung, Clemson, O'Loughlin & Shuttleworth, 2016;Engstrand, Krevers & Kvist, 2015). Other themes from the scoping review included: the assumption that a bottom-up, biomechanical approach would improve occupational performance; a high focus placed on occupational outcome measures; and the use of informal discussion as an occupational strategy (Powell & Von Der Heyde, 2014;Weinstock-Zlotnick & Bear-Lehman, 2015).…”

Psychometric properties of the Assessment of Motor and Process Skills in patients undergoing rehabilitation following hand-related disorders

“…The degree to which patients are affected in their activities of daily living (ADL) following a disorder differs, but as we use our hands in almost all ADL, a hand-related disorder often causes impaired functioning even after years. [2][3][4] Although illness perception has gradually changed over recent decades from a narrow biomedical approach to a broader and more dynamic perception, the biomedical approach remains dominant for most health professionals. 5 This also applies to hand therapy where successful treatment is often judged by improvements of range of motion (ROM) and handgrip strength rather than achieving client-centered and occupation-focused goals.…”

“…5 This also applies to hand therapy where successful treatment is often judged by improvements of range of motion (ROM) and handgrip strength rather than achieving client-centered and occupation-focused goals. 4,6,7 Studies exploring patients' recovery found that patients valued occupational performance as a more important outcome than improvements in objective measures, e.g. ROM and handgrip strength, 4 and further, that a focus on occupation improved client motivation.…”

“…4,6,7 Studies exploring patients' recovery found that patients valued occupational performance as a more important outcome than improvements in objective measures, e.g. ROM and handgrip strength, 4 and further, that a focus on occupation improved client motivation. 4,8,9 In order to assess functioning, the International Classification of Functioning, Disability, and Health (ICF) recommend that body functions and structures, activities and participation are assessed.…”