Abstract
This research examined how client and healthcare factors affected UE outcomes. A quantitative study was conducted with consecutive sampling of more than 500 participants with UE conditions over an 18-month period. UE therapy outcomes were assessed every four weeks using GROC and QuickDASH scores, both of which improved significantly. This study can inform OT’s working with UE conditions about factors that can impact decisions regarding treatment planning and implementation.
Primary Author and Speaker: Cynthia Hayden
Occupational therapists often work with clients with upper extremity conditions. It is important to know what client and healthcare factors influence clients’ progress in upper extremity rehabilitation. This research will provide practitioners with knowledge that can impact decisions regarding treatment planning and implementation based on the association of client and healthcare factors with upper extremity therapy outcomes.
A quantitative study was conducted with clients who received hand therapy treatment in an orthopedic outpatient clinic in the southeastern United States. During an 18-month period, data was collected from consecutive sampling of 500+ participants with upper extremity conditions. Data collected included demographic information, client factors, healthcare factors, and results from two self-reported outcome questionnaires. Client factors included age, gender, extremity treated, and location of injury. Health care factors were surgery vs non-surgery, total number of visits, type of insurance coverage, and received treatment from OT, PT, or Level II OT student. Hand therapy outcomes were determined by Global Rate of Change Score (GROC) and QuickDASH scores, obtained at initial evaluation, at 4, 8, 12, 16, 20, and 24 weeks, and at discharge. The GROC was used to measure client reported improvements after treatment (Kamper, Maher, & Mackay, 2009). The QuickDASH, an 11-item questionnaire, was used to measure physical function and symptoms in people with musculoskeletal disorders of the upper limb (Southan, Driessens, Burton, Pope, & Thurnwald, 2016).
Forty percent of the data has been deidentified, coded, and analyzed using statistical methods in SPSS version 24. Paired t-tests were used to compare GROC and QDash scores at all intervals. Repeated one-way ANOVAs were conducted to examine the relationships between client and healthcare factors and hand therapy outcomes based on the GROC and QuickDASH scores.
The study findings are summarized. The majority of clients received 1-15 hand therapy visits. Clients with shoulder, wrist, and finger injuries were more predominant than clients with elbow and thumb injuries. Working age adults were seen most frequently for upper extremity conditions, with those 40 and over receiving therapy twice as much as those under 40. Eighty percent of men received surgery, compared to 33% of women. Females were more likely to adhere to therapy and have more therapy visits. Those clients with third party insurance improved QuickDASH scores more than those with Medicaid, Medicare, or Workers’ Compensation. Using two-tailed t-tests, GROC and QuickDash score increases were statistically significant (p ≤ 0.05) for all time comparisons, except for GROC scores between week 8 to week 12. On a percentage scale of 0-100, QuickDASH scores increased significantly with an average of 32.29%, twice the change for clinical significance.
Therapy for UE conditions improved clients’ perceptions of making progress due to therapy (GROC score changes) and improved function with less limitations (QuickDASH score changes). Although there were no significant relationships found for client or health care factors in improving GROC scores, the health care factors of having surgery, who was the therapist (OT, PT, Level II student), type of insurance, and total visits were statistically significant (p ≤ 0.05) for QuickDASH score improvements.
Hand therapy improved clients’ functional outcomes as measured by Global Rate Of Change and QuickDASH scores. Client and healthcare factors of being female, over 40, and having surgery required more total therapy visits. Healthcare factors influenced QuickDash outcomes more than client factors.
Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. (2009). The Journal of Manual & Manipulative Therapy. 17(3):163–170. doi: 10.1179/jmt.2009.17.3.163.
Southan, M., Driessens, S., Burton, C., Pope, R., & Thurnwald, P. (2016). A retrospective study of QuickDASH scores for common acute trauma conditions presenting for hand therapy. Journal of Hand Therapy, 30(1), 41-48. doi:http://dx.doi.org/10.1016/j.jht.2016.07.004