Hand therapy and responding to change in a pandemic

The rapid emergence of COVID-19 reinforces our need to think globally and act locally. It has highlighted some gaps and flaws in our medical and social systems; and communications between jurisdictions to act quickly when a new infectious agent arises. The impact is worldwide. I have spoken to hand therapy colleagues around the world who have been affected on a professional level by being seconded to different duties, usually higher risk, duties for example COVID-screening, or having their practices entirely shut down with devastating financial consequences. I have talked to hand therapists and others who have been impacted on a personal level by losing friends and family, or suffering from social isolation. Others have had to take on major caregiving roles for family members as services became restricted or withdrawn; and adapt to balancing work and home life at home. Life is not “normal” for most people right now.

As I write this editorial our clinical center is struggling to provide telemedicine in new ways and figuring out how we can safely return to operating and seeing patients in person. Many of you will be in the process of a graded transition to normalcy, and as I write this, we have no idea how that transition will go. Looming ahead of us are potential 2nd waves. Perhaps we will never return to the same level of working without enhanced protection since we how are now painfully aware of how quickly a virus can emerge and spread.

What does this mean for hand therapy? There are widespread implications for how we educate our students, how we conduct our practices, our preparedness to be reallocated to new roles, and the research needed to support best practice in the future. Hand therapists have always been educators who have provided skills for patients to become better at self-management and have promoted adherence through strong therapeutic alliance. These skills will be increasingly important in the future, but we will have to be able to translate our best practices into new remote formats. Many of us had to quickly start providing services in remote formats due to COVID-19. However, it is unlikely that we were able to achieve optimal design strategies. Our goal was really to get something together quickly to meet immediate patient needs. Over the next few years research that informs how we can best provide practice in remote formats will be important. What are the health literacy issues? What strategies promote adherence in an online environment? How do we dose feedback and personal connection; and customize it to the individual to meet varying needs? How can we measure physical impairments like strength and motion remotely? What are the innovations that will support remote assessment? With so many technology options like wearable sensors, smart fabrics, artificial intelligence, virtual reality devices, augmented reality devices, smart phone applications etc, how do we choose the best technology? It is likely that we will need many variations to suit different patient populations, ages, levels of education and comfort with technology.

There is likely to be great transition in the next year as individuals and practices struggle to define their new reality. Systems that were reluctant to reimburse for remote treatments such as telemedicine will also have to adapt. While some people may adapt easily to remote treatment others may be left behind. We will have to be vigilant to identify potential gaps in new systems that are created. Sharing of resources and best practices can lighten the load for individuals or centers as we all struggle to provide best practice. This was certainly clear in the pandemic and will be important as we move forward in providing upper extremity surgery and rehabilitation in new ways.