Highlights
- •Two case studies have been presented in which the participants received an orthosis and joint protection education using a client-centered approach that was facilitated by the utilization of the Canadian Occupational Performance Measure.
- •Both participants showed improvement in pain, activity, and participation.
- •Focusing our rehabilitation strategies on that which is most important to the client should be considered to optimize their occupational performance by tailoring treatment interventions to their identified occupational performance issues.
Abstract
Design
Case study.
Introduction
Hand therapists are often called upon to provide treatment for thumb carpometacarpal
joint osteoarthritis.
Purpose
These 2 case studies present a client-centered approach in the selection of orthoses
and joint protection strategies for patients with thumb carpometacarpal joint osteoarthritis.
At baseline, the participants presented with pain, decreased active range of motion,
decreased pinch strength, and limitations in activity and participation.
Methods
The outcome measures utilized at study entry and 6 weeks included the pain Visual
Analog Scale, the Australian Canadian Osteoarthritis Hand Index, the Disabilities
of the Arm, Shoulder and Hand questionnaire, the Canadian Occupational Performance
Measure, active range of motion measured with goniometry, and pinch strength measured
with a pinch gauge. The Canadian Occupational Performance Measure facilitated the
client-centered approach by identifying occupational performance issues and rating
the participant's performance and satisfaction for each. Each participant was prescribed
a different orthotic design, received client-centered joint protection instruction,
and evidence-based exercises.
Results
After 6 weeks, both clients had decreased pain and improvement in their activities,
participation, and satisfaction.
Discussion
Using a client-centered approach can help therapists to carefully consider a patient's
occupational needs when designing and fabricating orthoses and customizing their joint
protection education for carpometacarpal joint osteoarthritis.
Conclusion
Focusing rehabilitation strategies on that which is most important to the client should
be considered to optimize their occupational performance.
Keywords
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References
- Treatment of thumb metacarpophalangeal and interphalangeal joint arthritis.Hand Clin. 2008; 24: 251-261
- Effectiveness of physical and occupational therapy on pain, function and quality of life in patients with trapeziometacarpal osteoarthritis-A systematic review and meta-analysis.Hand Ther. 2016; 21: 5-15
- Splinting for osteoarthritis of the carpometacarpal joint: a review of the evidence.Am J Occup Ther. 2007; 61: 70-78
- Conservative treatment of thumb base osteoarthritis: a systematic review.J Hand Surg Am. 2015; 40: 16-21
- Systematic Review of design and effects of splints and exercise programs in hand osteoarthritis.Arthritis Care Res. 2011; 63: 834-848
- Orthoses as enablers of occupation: client-centred splinting for better outcomes.Can J Occup Ther. 2004; 71: 306-314
- Effects of client-centered multimodal treatment on impairment function and satisfaction of people with thumb carpometacarpal osteoarthritis.J Hand Ther. 2017; 30: 307-313
- The Canadian occupational performance measure: an outcome measure for occupational therapy.Can J Occup Ther. 1990; 57: 82-87
- A critical review of visual analog scales in the measurement of clinical phenomena.Res Nurs Health. 1990; 13: 227-236
- Clinimetric properties of the AUSCAN osteoarthritis hand index: an evaluation of reliability, validity and responsiveness.Osteoarthritis Cartilage. 2002; 10: 863-869
- The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now?.Br J Hand Ther. 2001; 6: 109-118
- Practical Handbook for Goniometry and Manual Muscle Testing.McGill University, Montreal2015
- Clinical Assessment Recommendations.2nd ed. American Society of Hand Therapists, Chicago, Illinois1992
- Occupational Therapy for Physical Dysfunction.7th ed. Wolters Kluwer Lippincott Williams &Williams, Philadelphia, PA2014
- The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.J Hand Ther. 2000; 13: 228-235
- Successful Orthotic Interventions for Osteoarthritis of the Thumb CMC Joint.(Canadian Association of Occupational Therapists Conference)2009
- Influence of metacarpophalangeal joint position on basal joint loading in the thumb.J Bone Joint Surg Am. 2001; 83A: 709-716
- Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: a retrospective study.J Hand Ther. 2013; 26: 44-52
JHT Read for Credit
Quiz: #540
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The study design is
- a.qualitative
- b.an RCT
- c.case report
- d.prospective cohort
- a.
- #2.Results were assessed at
- a.6 weeks after treatment was started
- b.6 months after treatment was started
- c.2 months after treatment was started
- d.1 year after treatment was started
- a.
- #3.Evaluation measures included
- a.ROM & pinch strength
- b.the DASH
- c.the Canadian Occupational Performance Measure
- d.all of the above
- a.
- #4.A key feature of patient management was
- a.ultrasound and massage
- b.manual joint mobilization
- c.a static orthosis
- d.a dynamic orthosis
- a.
- #5.The authors refer to their intervention strategy as a “Client-centered approach”
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Accepted:
January 9,
2018
Received in revised form:
January 4,
2018
Received:
October 1,
2017
Identification
Copyright
© 2018 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
