Bridget Ellis

A study to compare the reliability of composite finger flexion with goniometry for measurement of range of motion in the hand

Objective: To establish the intra and inter-rater reliability of composite finger flexion (CFF), and to compare this with goniometry. Design: Fifty-one physiotherapists and occupational therapists took part in the study. The hand of a normal subject was splinted in three different positions. Using a goniometer and a ruler alternately, each therapist measured both the proximal interphalangeal joint and CFF of three digits, following a standardized protocol. This process was repeated three times. Setting: Eighteen NHS hospital sites in the UK. Results: The two measurement methods produced different ranges and standard deviations for each digit. The repeatability coef”cient shows that repeated intra-rater goniometric measures fall within 4–5 degrees of each other 95% of the time. Inter-rater goniometric measures fall within 7–9 degrees. Repeated intra-rater CFF measures fall within 5–6 mm of each other, whereas inter-rater fall within 7–9 mm. The in‘uence of occupation, experience in hand therapy, years of practice and routine use were found to have no effect on reliability. Scaling of the two methods of measurement allowed comparison between them to be made. CFF and goniometry are equally reliable when comparing inter-rater reliability, but goniometry displays less variability than composite ”nger ‘exion for intra-rater measurements. Conclusion: In this study involving a subject with normal joints, goniometry is more reliable than CFF when only one measurer is involved. However, CFF may be a useful alternative where multiple joint measures are required, or when goniometry is impracticable.

Joint angle measurement: a comparative study of the reliability of goniometry and wire tracing for the hand

Objectives: To compare the inter- and intra-rater reliability of goniometry and wire tracing in the assessment of finger joint angles: metacarpo-phalangeal (MCPJ), proximal (PIPJ) and distal interphalangeal joints (DIPJ). Design: Twenty occupational therapists and 20 physiotherapists with a range of clinical experience were recruited from nine different centres. Using a masked goniometer and wire tracing they carried out repeated assessments of the MCPJ, PIPJ and DIPJ of a normal subject fixed in two different positions. Results: The two assessment methods did not produce comparable angle measurements. Goniometry showed greater inter- and intra-rater reliability than wire tracing. Regardless of the assessment tool, the repeatability coefficient indicated that DIPJ measurement was less reliable than the other joints. Clinical and specialist experience did not affect reliability. Conclusion: Although both goniometry and wire tracing show limitations as reliable assessment tools, it is recommended that where possible goniometry should be used.

What can handgrip strength tell the therapist about hand function

Power handgrip strength is recorded by clinicians as a quick and viable measure of hand impairment and function that can serve as a useful evaluation of hand status and treatment progress. This paper explores the procedure and reliability of measuring handgrip using different equipment. The extent of usefulness of grip strength as an indicator of structural impairment and ability measures in patient populations is questioned and the relevance of recording grip strength as part of a clinical assessment is summarised.

Role, Training and Job Satisfaction of Physiotherapy Assistants

Summary Physiotherapy assistants form approximately 20% of the work force within physiotherapy departments and yet little is known about them. The purpose of this study was to assess the current role of physiotherapy assistants in one NHS Region via postal questionnaire, identifying tasks performed and levels of responsibility and supervision; assessing the level of satisfaction of physiotherapy assistants; and comparing these findings with a previous study in 1991. A response rate of 85% (424 assistants) was achieved. The results showed that there is indication of increasing responsibility, independence and specialist skills of physiotherapy assistants since 1991. Training is locally determined and varied. Update of national training initiatives is limited. Overall physiotherapy assistants are satisfied with their jobs (91%). Specific areas of dissatisfaction are pay and career development. Satisfaction is associated with levels of supervision, in-service training and age (p

The Developing Role of Hand Therapists within the Hand Surgery and Medicine Services: an Exploration of Doctors' Views

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice. Thirty-five hand therapists were identified as working in this role in Britain, primarily in pre- and post-operative settings. A postal survey of the 31 consultants with whom they worked investigated their views on the nature of this role and service; the facilitating and constraining factors to this development; and on required qualifications, training and supervision. Seventeen consultants, all hand surgeons, replied. They reported that the principle reasons for the development of ESPs were the need to reduce the waiting list and the consultants’ workload. A variety of roles had been created, reflecting the different service needs and the skills of the therapists. Training was largely experiential. Extended scope practitioners had had a significant impact on waiting lists. There was variation in the surgeons’ views regarding further development of these posts. Concerns were identified regarding these posts, such as professional isolation, the transferability of skills, inappropriate extension of the role and the potential for litigation.

An exploration of the developing role of hand therapists as extended scope practitioners

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice. The aims of this study were to identify the number, training and scope of practice of hand therapists working as ESPs. Thirty-five ESPs were identified and sent a questionnaire examining aspects of their practice. Thirty-two ESPs (91%) replied. The findings show that the ESPs worked in four models of practice: own clinic environment, rheumatology, preoperative and post-operative clinics. Their activities included making diagnoses, injections, joint aspirations and wound care. ESPs referred patients for surgery, investigative procedures and therapy. Training was largely experiential and there were unmet training needs. It can be concluded from this study that ESPs are undertaking aspects of care that traditionally have been undertaken by doctors and nurses. The development of ESPs has training implications.

Clinical Assessment of the Hand - A Review of Joint Angle Measures

Measurement of range of motion (ROM) at a joint is regarded by many clinicians as objective and is therefore frequently used as an assessment tool. There are many methods of measurements available to the clinician and the researcher, but information about their reliability may be less accessible. Some techniques of measurement, such as goniometry, have been studied frequently, whereas other popular techniques have little or no published evidence to support their use. The aim of this paper is to summarise the results from the literature surrounding methods of measurement, particularly those concerned with hand assessment.

A Delphi Study of the Role Parameters and Requirements of Extended Scope Practice in Hand Therapy

Physiotherapists and occupational therapists working within hand therapy in the United Kingdom are undertaking roles working beyond their normal professional boundaries. The aim of this study was to reach consensus on the role parameters and required knowledge, training and competencies desirable for such extended roles. A panel of 21 expert stakeholders comprising hand therapy clinicians, educators, doctors, existing extended scope practitioners and a representative from a patient group participated in three survey rounds using the Delphi technique. They examined three groups of parameters with reference to the competencies, knowledge and activities desirable for such extended roles. A prioritised list of parameters was developed. Data were analysed using descriptive statistics. Response rates for each round were consistently 95% or greater. The results showed areas of clear consensus, with prioritisation supporting the development of an independent practitioner working without direct supervision by a medical practitioner. Specific criteria were identified for such practice with regards to knowledge, training and activities, such as the ability to order, understand and interpret clinical investigations. In-house formal training tailored to individual service needs was the favoured approach. The results of this study can inform the development of a national strategy for the implementation of new ways of working while ensuring the provision of a quality health service.

The Use Of Corticosteroid Injections in the Treatment of Stenosing Tendovaginits (Trigger Finger): Three Comparative Case Studies

Stenosing tendinopathy in the hand commonly occurs at the A1 pulley at the metacarpophalangeal joint. It commences with palmar discomfort during movement, progresses to a painful ‘triggering’ as the patient flexes and extends the digit and ultimately may lead to locking of the digit. A number of treatment options are available – splints, corticosteroid injections and surgery being the most commonly offered. This paper reviews the outcome of three patients presenting with this condition and treated with corticosteroid injections, in the extended scope practice clinic run by a hand therapist. Whilst all patients gained some short-term benefit, two required further injections and one was finally referred for a surgical release. Further analysis of these outcomes highlights the implications of presenting signs and the differences in patient requirements.