Alice Ørts Hansen

Client-centred practice from the perspective of Danish patients with hand-related disorders.

Abstract Purpose: The objectives of this study were to investigate perceptions of client-centred practice among Danish patients with hand-related disorders engaged in rehabilitation at outpatient clinics, and to decide on domains to serve as a conceptual foundation for item generation in the development of a new, standardized questionnaire to evaluate the experience of client-centredness among patients with hand-related disorders. Method: Focus group interviews were held with 25 patients with hand-related disorders from six outpatient hand clinics in Denmark. Deductive content analysis was used to decide on domains for item generation. Results: Patients found that information was paramount in understanding their situation and to feel empowered and motivated. They attached importance to participation in decision making so that rehabilitation was considered meaningful. Moreover, they thought rehabilitation should be individualized by taking their life situations and personalities into account. Six domains were found to be central to client-centred practice: patient participation in decision making, client-centred education, evaluation of outcomes from patient’s perspective, emotional support, cooperation and coordination, and enabling occupation. Conclusions: The domains can be used in the further development of a Danish questionnaire to evaluate the experiences of client-centredness among patients engaged in rehabilitation at outpatient clinics for hand-related disorders. Implications for rehabilitation Patients with hand-related disorders wish for rehabilitation to be tailored to individual needs. The patient’s life situation and personality, including coping ability, are important factors to consider in rehabilitation planning, interventions, and evaluations. Patients with hand-related disorders attach importance to information and require health professionals’ support to manage their activities of everyday life. Patients with hand-related disorders ask for participation and shared decision making in rehabilitation planning.

Test–retest reliability of Antonovsky’s 13-item sense of coherence scale in patients with hand-related disorders

Abstract Purpose: To report on the distribution and test-retest reliability of Antonovsky’s 13-item Sense of Coherence (SOC-13) Scale in patients with hand-related disorders (HRD). Links between the SOC-13 score and factors such as age, number of days between date of injury and start of rehabilitation, gender and educational level were explored. Method: Survey with test–retest, using self-administered questionnaire. SOC-13 was completed before starting rehabilitation at an outpatient clinic after 14 days and three months. Adult patients with HRD were included. Results: A total of 170 participants completed the SOC-13 at baseline (median SOC 71, range 30–91). The Intra-class Correlation Coefficient between baseline and 14 days was 0.84 (n = 151), and baseline and three months was 0.79 (n = 113). Weak correlations were found between SOC and age rs = 0.17, p < 0.03. No correlation was found between SOC and number of days since injury rs = 0.01, p > 0.92. No difference was found in SOC score related to gender or educational level. Conclusions: The SOC-13 scale showed reliability for patients with HRD. There was a weak connection between age and SOC without clinical relevance. SOC-13 has the potential to be a powerful tool to measure the ICF component personal factors, which could have an impact on patients’ rehabilitation outcomes. Implications for rehabilitation Antonovsky’s SOC-13 scale showed test-retest reliability for patients with hand-related disorders. The SOC-13 scale could be a suitable tool to help measure personal factors.

The effect of an occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale: Study protocol

Introduction High-quality rehabilitation is required if patients with hand-related disorders are to achieve high levels of functioning. Occupation-based interventions are effective in stroke, hip fractures, and for elderly people, but there is limited knowledge of their effect in hand therapy. Sense of coherence may affect rehabilitation outcome, since patients with weak sense of coherence experience lower functioning, are less satisfied with their occupational performance, have inferior quality of life and more pain compared to patients with stronger sense of coherence . Method Following SPIRIT guidelines, we present a randomized, controlled, parallel-grouped trial. It investigates the effect of an occupation-based intervention for outpatients with hand-related disorders and whether sense of coherence influences the outcomes. Patients are stratified into three groups (weak, medium and strong sense of coherence) and randomized to occupation-based or exercise-based hand therapy. Sample size calculation indicates that 70 patients are required in each intervention in each separate sense of coherence group. With an expected drop-out of 20%, a total of 504 participants will be randomized. Primary analysis is score change in functioning measured by the Disabilities of the Arm, Shoulder and Hand from start of rehabilitation to three months’ follow-up. Secondary outcomes are self-evaluated occupational performance and satisfaction with occupational performance. Conclusion This study will add valuable knowledge to the field of hand therapy regarding the therapeutic use of occupations that patients find meaningful. Moreover, it may show which patients will benefit the most from an occupation-based intervention in relation to their sense of coherence.

Occupational performance problems identified by 507 patients: An insight that can guide occupation-based hand therapy

Introduction Several barriers challenge the use of occupation-based interventions in hand therapy. An outpatient clinical setting can be prepared in such a way as to address the most common occupational performance problems which might promote an occupation-based intervention. To this end, more knowledge is needed about which problems patients with hand-related disorders consider most important. Methods Interviews using the Canadian Occupational Performance Measure (COPM)were conducted with 507 patients. Data were entered into Microsoft Excel in the COPM categories: Self-care, productivity and leisure and analysed using descriptive statistics. Data concerning main problem areas were categorized according to the Taxonomic Code of Occupational Performance (TCOP). The analysis included the number of prioritized occupational performance problems (NPOPP) in each COPM category/subcategory; the NPOPP in each category is relative to gender and age and the most frequent problems. Results The total NPOPP was 2384. Problems within productivity and self-care constituted the largest proportion, respectively, 46% and 40%. Gender or age affected the NPOPP in each category to a limited extend. Problems were expressed at all levels in the TCOP, except the lowest level. The most frequently expressed problem was use of utensils when eating. Conclusion The problems mostly concern productivity and self-care, regardless of gender or age. Patients consider problems at the levels of occupation, activities, tasks and actions to be important and meaningful to address in their intervention. This study provides useful knowledge that can be applied when preparing a setting to address the most common problems, which could lead to the promotion of occupation-based interventions.

Danish version of the Patient-Rated Wrist/Hand Evaluation questionnaire: Translation, cross-cultural adaptation, test–retest reliability and construct validity

Introduction In Denmark, there is a growing need for valid, reliable and standardized patient-rated outcome measures for use in clinical practice and research. The Patient-Rated Wrist/Hand Evaluation (PRWHE) is a self-reported assessment of hand-related disorders that measures pain and functional difficulties in activities of daily living. The purpose of this study was to: (1) translate and cross-culturally adapt the PRWHE into Danish and (2) assess the reliability and construct validity of the Danish version in patients with hand-related disorders. Methods The PRWHE was translated and cross-culturally adapted into Danish using the dual-panel approach. A total of 97 patients with diverse hand-related disorders and a mean age of 52.6 years (SD 15.2) participated in the psychometric testing. They were assessed on two occasions. Test–retest reliability was assessed using the Intraclass Correlation Coefficient (ICC2.1) to assess test–retest, Cronbach’s alpha to assess internal consistency and a Bland–Altman plot to estimate measurement error. Construct validity was investigated by evaluating the relationship between the Danish PRWHE (PRWHE-DK) and the Danish validated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Results Psychometric testing demonstrated an excellent test–retest reliability (ICC2.1 = 0.94) and internal consistency (alpha = 0.96). A systematic error of 1.5 and a measurement error of ± 16.1 were found. Furthermore, a strong correlation was found between PRWHE-DK and DASH (r = 0.71). Conclusions The PRWHE-DK is a reliable, valid instrument for patients with different kinds of hand-related disorders, and can be used in clinical practice and multi-cultural research studies to measure pain and functional disability.

Increased use of the affected hand one and a half years after surgical correction for cerebral palsy and subsequent intensive hand therapy

Introduction Good hand function is essential for carrying out daily activities. People with unilateral cerebral palsy often have spasticity in their affected hand and arm, which makes it difficult to perform bimanual tasks. The aim of this study was to measure changes in grip span, strength and functional use of the affected hand when assisting in two-handed activities after surgical correction for cerebral palsy and subsequent intensive hand therapy. Methods Since 1999, we have been evaluating all patients with unilateral cerebral palsy who had the potential for surgical correction of their forearm and hand, followed by intensive hand therapy at our university hospital. We tested their grip span, strength and use in two-handed activities preoperatively and six and 18 months postoperatively. Results Between 1999 and 2011, 39 patients have had a corrective operation with tendon transfer to correct a deformity of the wrist and most have had a correction of the thumb as well. All received subsequent hand therapy until six months after the operation. Grip span, strength and changes in the functional use of the affected hand when assisting in two-handed activities all increased significantly (p<0.01), six and 18 months postoperatively. Discussion Patients demonstrated a more useful affected hand in everyday activities and results persisted after the rehabilitation ceased at six months. Our findings support surgical correction for cerebral palsy followed by intensive hand therapy improves hand position and hand function.