Active Research
Mind-Body Interventions in Hand Therapy

Background. Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.

Objective. To explore therapists’ perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.

Methods. Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.

Results. SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.

Conclusion. In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Keywords. Qualitative research, occupational therapy, musculoskeletal diseases, return to work

Study Design. This study was a scoping review.

Background. Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment.

Purpose of the Study. This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility.

Methods. Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility.

Results. Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians.

Conclusion. Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.

Keywords. Ultrasound imaging; Sonography; Upper extremity; Musculoskeletal; Scoping review

Importance. Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. Objective: To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function.

Design. Retrospective cohort study using a chart review method.

Setting. Outpatient clinic.

Participants. Twenty-one adults with fibromyalgia (M age = 54 yr).

Intervention. A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach.

Outcomes and Measures. The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program.

Results. Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures.

Conclusions and Relevance. The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia.

Keywords. fibromyalgia, pain, clients, personal satisfaction, self efficacy, life style, depressive disorders

Background. Arthritis is the leading cause of disability in adults, and research shows that people living with arthritis experience work instability, loss of independence, financial difficulties, and overall decreased quality of life. Current nonpharmacological treatments can be beneficial for short term relief; however, the evidence on these long-term treatments is limited. Ergonomic modifications have been used in the workplace to address musculoskeletal conditions to ensure proper fit of one's environment, and research shows that these modifications can decrease pain and injury and increase work productivity. A broader perspective on ergonomic approaches may be important to supporting individuals with arthritis within hand therapy.

Purpose of the Study. This review proposes an expanded perspective on ergonomic approaches within hand therapy and explores published literature to identify potential benefits of applying ergonomic approaches for individuals with upper extremity arthritis.

Methods. A systematic search and screening process was conducted to identify articles that implemented an ergonomic approach for the support of individuals with upper extremity osteoarthritis or rheumatoid arthritis.

Results. A total of 34 articles described interventions that employed ergonomics including task-based or general ergonomics (n = 17), contextualized supports (n = 8), or holistic, lifestyle approaches (n = 9). Only one study focused solely on individuals with osteoarthritis, whereas interventions for individuals with rheumatoid arthritis showed positive outcomes across these categories. Situational learning, building of patient self-efficacy, and development of new habits and routines are vital for carryover and implementation to support performance in daily life.

Conclusion. There is an opportunity for hand therapists to extend the scope of interventions provided as part of an ergonomic approach to supporting patients. Specifically, therapists can consider use of emerging technologies and telehealth that promote contextualization and follow-up for long-term outcomes.

Keywords. Ergonomics, Osteoarthritis, Rheumatoid arthritis

This multimethod study identified four themes within the therapist-patient relationship that affect the provision of holistic and collaborative care. Therapists developed a complex relationship with their patients, leading to high scores on measures of adherence and engagement. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care to produce effective outcomes.

Purpose. Holistic and collaborative treatment planning and patient care are essential components of best practice occupational therapy (OT). This approach to care must consider patient factors and therapeutic techniques, but success will also be dependent on the therapist-patient relationship itself. There has been limited examination of this relationship within OT settings, particularly related to core concepts such as engagement and adherence. This study identified factors within the therapist-patient relationship that impacted the provision of holistic and collaborative services within an outpatient setting.

Design. A multi-method study design was used to obtain quantitative and qualitative data to describe therapists’ perspectives of their patients’ adherence and engagement, and the relative role of therapist-patient relationship. The study participants were a convenience sample of four OTs working at a hospital-based outpatient upper extremity rehabilitation clinic.

Method. Data were collected over three months. A series of weekly group interviews (n = 13) were conducted using a semi-structured guide. Interviews explored the interaction between therapist and patient roles within the therapeutic environment, including balances of power and barriers/facilitators to therapeutic engagement and adherence. Therapists completed surveys following visits from a sub-sample of patients receiving treatment during the study period (n = 16). Specifically, the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) were used to assess therapists’ perspectives of patient adherence and engagement. Descriptive statistics were generated from the survey data. Principles of constructivist grounded theory were used to analyze interview transcripts through an iterative process of initial and focused coding until saturation was reached. Themes connecting the codes were created by the primary coder. Two additional researchers who conceptualized the study and conducted the interviews engaged with the coder in iterative discussions to refine the qualitative themes and situate these findings within the context described by the quantitative results.

Results. Therapists consistently rated their patients highly on SIRAS and RTES measures. SIRAS scores averaged 14.4/15 (SD: 1.0, range: 10-15) and RTES scores averaged 42.5/45 (SD: 3.4, range: 23-45). These high scores may have been facilitated by complex and dynamic interactions across multiple factors within the therapist-patient relationship. Four themes emerged from therapist interviews: (1) Power within the therapist-patient relationship was fluid, often impacted by patient preference, personal contexts, and medical environment restrictions; (2) engagement was reciprocal and co-constructed between the therapist and patient; (3) therapist-patient interaction modulated emotional states to influence mutual engagement; and (4) the therapist-patient relationship is defined by different spatial and temporal contexts within the therapy process.

Conclusion. This study found that, in a highly engaged and adherent treatment setting, the therapist-patient relationships were complex, intimate, and dynamic, and extended beyond patient education and physical interventions. Careful management of this relationship was central to facilitating active patient participation and engagement.

Keywords. arm, outpatients, rehabilitation

Background. Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area.

Purpose. This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation.

Methods. The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness.

Findings. Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested (p = .044).

Implications. Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest.

Introduction. Translational evidence for mind–body interventions in hand therapy is limited. This pilot study aimed to determine potential benefits of including a mindful body scan or sonographic biofeedback at the outset of a hand therapy session on key psychological states.

Methods. A randomized, repeated-measures, cross-over design was used to evaluate a mindful body scan and sonographic biofeedback at the outset of a hand therapy session. Measures of pain, anxiety, and stress (i.e. salivary cortisol) were obtained from 21 hand therapy patients at the start, after 20 min, and at the end of each of three 60-min treatments. Trends were examined, and mixed-effects regression compared effects across time within and across the sessions for each of the outcome measures.

Results. For all intervention types, anxiety and stress decreased across the treatment session (p < 0.001); no statistically significant changes were noted in pain. Using either mind–body intervention before standard care resulted in a meaningful decrease and statistical trend toward improvement in stress. The use of a mindful body scan produced an immediate, statistically significant reduction in anxiety (β = − 0.14, p = 0.03), a lowered level that was maintained throughout the therapy session.

Discussion. These data provide preliminary support for integrating mind–body interventions as preparatory activities in hand therapy. Mindful body scans may prepare patients for therapeutic interventions by more quickly reducing anxiety, and the use of either intervention may reduce patient stress more than would occur during a standard care session. These effects should be evaluated in an adequately powered clinical trial.

Keywords. Therapeutics, integrative health, sonography, mindfulness.

Mind–body interventions are a viable holistic approach to rehabilitation; however, evidence for mind–body approaches in hand therapy is lacking. This study explored the experiences of clients with musculoskeletal disorders undergoing two mind–body interventions within hand therapy. Qualitative data were obtained from clients who received mindfulness meditation and sonographic biofeedback as part of hand therapy. Semi-structured interviews conducted after four therapy sessions elicited participants’ experiences and acceptability. Emergent themes were identified through an iterative, qualitative descriptive process. The following three themes emerged as results: insight on the body, relaxation and relief, and I am in control. A fourth theme was identified in the acceptability data, that is, mindfulness as a meaningful activity. At least one of the interventions was acceptable to each participant. Positive participant experiences support further consideration of mind–body interventions as a useful holistic approach in hand therapy to support wellness, quality of care, and participation in recovery.

Keywords. therapeutics, hand therapy, integrative medicine, mindfulness, biofeedback

A scoping review was conducted to describe how mindfulness is used in physical rehabilitation, identify implications for occupational therapy practice, and guide future research on clinical mindfulness interventions. A systematic search of four literature databases produced 1,524 original abstracts, of which 16 articles were included. Although only 3 Level I or II studies were identified, the literature included suggests that mindfulness interventions are helpful for patients with musculoskeletal and chronic pain disorders and demonstrate trends toward outcome improvements for patients with neurocognitive and neuromotor disorders. Only 2 studies included an occupational therapist as the primary mindfulness provider, but all mindfulness interventions in the selected studies fit within the occupational therapy scope of practice according to the American Occupational Therapy Association's Occupational Therapy Practice Framework: Domain and Process. Higher-level research is needed to evaluate the effects of mindfulness interventions in physical rehabilitation and to determine best practices for the use of mindfulness by occupational therapy practitioners.

Objective. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.

Method. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.

Results. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.

Conclusion. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.

Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession's foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.