Date Presented 03/27/20
The goal of the study was to examine the implications of a variety of hand-related diagnoses using the broad prospective of the International Classification of Functioning. The hand-condition group reported significantly (p < .05) lower perceived QOL, higher levels of disability, and reduced hand strength and dexterity in comparison to a healthy control group. Personal factors, hand function, and pain explained 29% of the variance in QOL. The results support the application of a broader biopsychosocial approach in hand-therapy practice.
Primary Author and Speaker: Danit Langer
Contributing Authors: Avigayil Horwitz, Hanna Melchior, Adina Maeir
PURPOSE: A survey of the literature shows that most of the research in hand therapy relates to a remedial model targeting structural impairments (Rudolf, Kus, Chung, Johnston, LeBlanc & Cieza, 2012). Considering the persistence of many hand health conditions (HC), this study attempted to broaden this perspective and to describe a range of HC in terms of quality of life (QOL), activity and participation (A&P), and hand function.
DESIGN: This is a descriptive, correlative predictive study, which examines relationships between hand function, A&P and QOL in people with HC compared to healthy controls. Participants were recruited from two hand clinics between February 2015 and October 2018. Seventy patients with chronic and acute hand conditions agreed to participate in the study. Criteria for inclusion in this study were that patients be adults (age 18 years or older) with a diagnosis of HC, who were referred for treatment by an orthopedic surgeon. Individuals with additional major health conditions that impact functioning and quality of life, documented in medical record or self- report, were excluded from the study.
METHODS: Participants were recruited from two hand clinics. The research group was matched with healthy participants. Assessments were administered to participants in their first visit to the hand clinic. Healthy participants were administered the same assessment protocol. QOL was measured with the World Health Organization Quality of Life questionnaire; A&P with the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire; pain with the Patient-Rated Wrist/Hand Evaluation; hand function with The Functional Dexterity Test, Jamar Dynamometer and Pinch Gauge.
RESULTS: Seventy-seven patients with chronic and acute hand conditions (HC) agreed to participate in the study (Mean age=43.70 SD=17.56; 47 males and 30 females). The study group reported significantly (p<.05) lower perceived QOL, higher levels of disability, reduced hand strength and dexterity in comparison to the control group. A hierarchical stepwise analysis was used to calculate the explanatory power of the personal factors (age and gender), hand function (strength and dexterity), and pain on A&P and QOL. Taken together, personal factors, hand function, and pain explained 28.9% of the variance in QOL (Overall F= 12.368, p=.010). Pain was the only significant contributing factor to the R-square change (20.6%). Regarding A&P, taken together, personal factors, hand function, and pain explained 61.4% of the variance in A&P (Overall F= 37, p=.001). Both hand function and pain significantly contributed to the R-square change.
CONCLUSION: The present study evaluated the consequences of a wide range of HC in light of the ICF model. The results of the study demonstrate that limitations in hand function are not the only- or even, the most important- factor affecting people with HC. Nonetheless, hand function is the element most frequently addressed in research and clinical work to the exclusion of elements like QOL and A&P. Participants in the present study reported reduced QOL in comparison to a healthy control group. This finding is noteworthy since there is a dearth of research regarding QOL in HC population. Pain was found to explain the largest percent of the variance in both QOL and A&P.
CLINICAL IMPLICATIONS: Clinicians should include assessments of A&P and QOL outcomes in the treatment of individuals with HC. Pain appears to have a large impact on QOL and disability, and should therefore be comprehensively addressed when treating HC. Treatment efficacy should be evaluated with International Classification of Functioning outcomes, and not limited to isolated hand functions
References
Rudolf, K. D., Kus, S., Chung, K. C., Johnston, M., LeBlanc, M., & Cieza, A. (2012). Development of the International Classification of Functioning, Disability and Health core sets for hand conditions–results of the World Health Organization International Consensus process. Disability and rehabilitation, 34(8), 681-693. https://doi.org/10.3109/09638288.2011.613514
Lesher, D. A.-M., Mulcahey, M. J., Hershey, P., Stanton, D. B., & Tiedgen, A. C. (2017). Alignment of outcome instruments used in hand therapy with the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health: A scoping review. American Journal of Occupational Therapy, 71, 7101190060. https://doi.org/10.5014/ajot.2017.016741
