Abstract
This research examined how client and health care factors affected OT outcomes for clients. A quantitative study was conducted with consecutive sampling of more than 200 participants with upper extremity (UE) conditions over an 18-month period. UE therapy outcomes were assessed every 4 weeks using Global Rate of Change (GROC) and QuickDASH scores, which both improved significantly. This study can inform OTs working with outpatient clients about factors that can affect decisions regarding treatment implementation.
Primary Author and Speaker: Cindy 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 total visits and change in Global Rate of Change (GROC) and QuickDASH scores. 1. Determine if hand therapy improved clients’ functional outcomes as measured by Global Rate Of Change and QuickDASH scores. 2. Determine what client factors (age range, gender, left/right upper extremity affected or both, and location of injury such as shoulder, elbow, wrist, fingers, or thumb) affected hand therapy outcomes for upper extremity clients. 3. Determine what healthcare factors (surgery vs non-surgery, total number of visits, referral source, type of insurance coverage, receiving treatment from OT/PT/CHT, and type of discharge affected hand therapy outcomes for upper extremity clients. A quantitative study was conducted with clients who received occupational therapy treatment in an orthopedic outpatient clinic. During an 18-month period, data was collected from a convenience sample of 200+ participants with upper extremity conditions.The Global Rate of Change Score (GROC) was used to measure client reported improvements after treatment. The QuickDASH, an 11 item questionnaire, was used to measure physical function and symptoms in people with musculoskeletal disorders of the upper limb. Demographic and outcome data was collected over an 18-month period by an occupational therapist in the upper extremity practice. The data was deidentified, coded, and analyzed using statistical methods in SPSS version 26. Paired t-tests were used to compare GROC and QuickDash scores at timed intervals. Repeated one-way ANOVA’s were conducted to examine the relationships between client and healthcare factors and outcomes. 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 elbow and thumb injuries. Working age adults were seen most frequently for upper extremity conditions, with those 40 and over receiving therapy twice as often 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 or Medicare. Using two-tailed t-tests, GROC and QuickDash score increases were statistically significant for all time comparisons. On a percentage scale of 0-100, QuickDASH scores increased significantly with an average of 32.29%, twice the change of 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, CHT), the referral source, type of insurance, and total visits were statistically significant 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, S. J., Maher, C. G., 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. https://doi.org/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. https://doi.org/10.1016/j.jht.2016.07.004