Highlights
- •67% of patients with TD diverted from the SOPD and treated in APHT improved sufficiently to allow discharge from the SOPD without specialist surgical consultation.
- •Only 1.4% of patients discharged from APHT were re-referred for the same condition in the following 12 months.
- •Superior initial Michigan hand questionnaire scores were associated with discharge from APHT without need for surgical review.
- •88% of patients returned to SOPD were booked for surgery demonstrating high levels of agreement between surgeons and APHT regarding need for surgery.
Abstract
Study Design
Prospective cohort design.
Background
Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists
often exceeds clinical recommendations for chronic hand conditions. Diversion to allied
health is an alternative option, however evidence regarding patient and organizational
outcomes in hand therapy is lacking.
Purpose of the Study
To evaluate clinical and organizational efficacy, patient outcomes and satisfaction
of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists
to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals.
Methods
Data was collected from eligible patients with TD through chart reviews and telephone
satisfaction surveys. Data included number of patients requiring SOPD review, repeat
referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes,
satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann
Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis
were performed.
Results
104 patients completed APHT treatment. Seventy patients (67%) did not require return
to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred
for only 1 patient. Patients requiring SOPD review after APHT treatment were seen
within target time frames and demonstrated 88% conversion to surgery-rates. Michigan
Hand Outcome Questionnaire scores showed greater improvement in those not requiring
SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between
initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge
outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service.
Conclusion
Diversion of referrals for TD from SOPD to APHT is an effective waitlist management
strategy, with the propensity to reduce waiting times, improve patient flow, whilst
resulting in favorable clinical and patient-rated outcomes and satisfaction.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Factors causing prolonged postoperative symptoms despite absence of complications after A1 pulley release for trigger finger.J Hand Surg Am. 2019; 44 (e1- e6): 338
- Management of diabetic trigger finger.J Hand Surg Am. 2019; 44: 150-153
- Trigger finger: etiology, evaluation, and treatment.Curr Rev Musculoskelet Med. 2008; 1: 92-96
- Conservative management of trigger finger: a systematic review.J Hand Ther. 2019; 32: 212-221
- Long-term functional outcome of trigger finger.Disabil Rehabil. 2018; 40: 90-95
- Multidisciplinary consensus guideline for managing trigger finger: results from the European HANDGUIDE Study.Phys Ther. 2014; 94: 1421-1433
- Open surgery versus ultrasound-guided corticosteroid injection for trigger finger: a randomized controlled trial with 1-year follow-up.J Hand Surg Am. 2017; 42: 359-366
- Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery.Rheumatology (Oxford). 2012; 51: 93-99
- Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial.J Hand Ther. 2019; 32: 444-451
- The impact of a hand therapy screening and management clinic for patients referred for surgical opinion in an Australian public hospital.J Hand Ther. 2013; 26 (quiz 22): 318-322
- A retrospective review to determine the long-term efficacy of orthotic devices for trigger finger.J Hand Ther. 2012; 25 (quiz 6): 89-95
State of Queensland (Queensland Health). Wait times strategy statewide consultation handbook. In: Healthcare Improvement Unit DoH, editor. Brisbane QLD 4001: State of Queensland (Queensland Health); 2015.
State of Queensland (Queensland Health). Clinical Prioritisation Criteria, Orthopaedics, Stenosing tenosynovitis Brisbane: State of Queensland (Queensland Health); 2019 [19/03/2020]. Available from: https://cpc.health.qld.gov.au/Condition/47/stenosing-tenosynovitis 19/03/2020.
State of Queensland (Queensland Health). Allied health expanded scope strategy 2016-2021. In: Clinical Excellence Division DoH, editor. Brisbane QLD 4001 2016.
- The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing.Appl Health Econ Health Policy. 2016; 14: 479-491
- Extended roles for allied health professionals: an updated systematic review of the evidence.J Multidiscip Healthc. 2014; 7: 479-488
Stute M, Moretto N, Raymer M, Banks M, Buttrum P, Sam S, et al. Process to establish 11 primary contact allied health pathways in a public health service. Aust Health Rev. 2018 Jun;42(3):258–265.
- Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?.Aust Health Rev. 2018; 42: 334-339
- Evaluation of occupational therapy-led advanced practice hand therapy clinics for patients on surgical outpatient waiting lists at eight Australian public hospitals.J Hand Ther. Jul-Sep 2020; 33: 320-328
- A cohort investigation of patient-reported function and satisfaction after the implementation of advanced practice occupational therapy-led care for patients with chronic hand conditions at eight Australian public hospitals.J Hand Ther. Oct-Dec 2020; 33: 445-454
- Audit of a therapist-led clinic for carpal tunnel syndrome in primary care.Br J Hand Ther. 2008; 13: 72-78
- Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial.Am J Occup Ther. 2013; 67: 448-459
- Development and implementation of a hand therapy extended scope diagnostic clinic for both elective and trauma hand conditions to enhance patient care.J Hand Ther. 2010; 23 (e25-e)
- Hand therapist carpal tunnel clinic.Br J Hand Ther. 2004; 9: 23-26
- Flexor tendon entrapment of the digits (trigger finger and trigger thumb).J Occup Environ Med. 2000; 42: 526-545
State of Queensland (Queensland Health). Primary contact occupational therapy hands statewide toolkit. in: allied health profession's office of Queensland DoH, editor. Brisbane QLD: State of Queensland (Queensland Health); 2016.
Australian Physiotherapy Association. Position statement: scope of practice 2009 [Available from: https://australian.physio/sites/default/files/RESOURCES/Advocacy_Position_Scope_of_Practice_2009.pdf 25/03/2020.
Occupational Therapy Australia. POSITION PAPER: occupational therapy scope of practice framework Fitzroy VIC: occupational therapy Australia; 2017
- Global rating of change: perspectives of patients with lumbar impairments and of their physical therapists.Physiother Theory Pract. 2019; 35: 851-859
- Global rating of change scales: a review of strengths and weaknesses and considerations for design.J Man Manip Ther. 2009; 17: 163-170
- Which questionnaire is best? The reliability, validity and ease of use of the patient evaluation measure, the disabilities of the arm, shoulder and hand and the Michigan hand outcome measure.J Hand Surg Eur Vol. 2008; 33: 9-17
- Determining the Michigan hand outcomes questionnaire minimal clinically important difference by means of three methods.Plast Reconstr Surg. 2014; 133: 616-625
- The Michigan hand outcomes questionnaire after 15 years of field trial.Plast Reconstr Surg. 2013; 131 (779e-87e)
- Normative values of the michigan hand outcomes questionnaire for patients with and without hand conditions.Plast Reconstr Surg. 2017; 140 (425e-33e)
Australian Bureau of Statistics (ABS). Socio-economic indexes for areas 2018 [Available from: https://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa 15/04/2020.
Cornell Statistical Consulting Unit. Adjusted standardized residuals for interpreting contingency tables 2018 [Available from: https://www.cscu.cornell.edu/news/statnews/stnews95.pdf 09/07/2019.
- Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomised placebo controlled trial.Ann Rheum Dis. 2008; 67: 1262-1266
- Establishing an efficient care paradigm for trigger finger.J Hand Surg Asian Pac Vol. 2018; 23: 356-359
- Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial.J Hand Surg Eur Vol. 2010; 36: 53-56
- Long-term outcomes following a single corticosteroid injection for trigger finger.J Bone Joint Surg Am. 2014; 96: 1849-1854
Clay FJ, C. Melder, A. Best practice for managing outpatient bookings: evidence review Melbourne, Australia: Monash Health; 2018 [Available from: https://monashhealth.org/wp-content/uploads/2019/01/Scheduling_RapidReview-29102018-final.pdf 24/04/2020.
JHT Read for Credit
Quiz: # 879
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.RCTs
- b.case series
- c.qualitative
- d.prospective cohort
- a.
- # 2.In Australia
- a.essentially all hand problems are initially treated in surgical outpatient clinics
- b.essentially all chronic hand conditions are initially evaluated by hand therapists before being evaluated in surgical outpatient facilities
- c.hand therapy practices often see patients with chronic conditions before being evaluated in surgical outpatient clinics
- d.hand therapists are not permitted by law to evaluate patients prior to being evaluated by a physician
- a.
- # 3.The patient sample was
- a.trigger finger patients
- b.all patients seen in hand therapy from SOPD waitlists
- c.Dupuytren's contracture patients
- d.carpal boss patients diverted from SOPD waitlists
- a.
- # 4.Following APHD
- a.all patients returned to their SOPD
- b.approximately 2/3 did not return to their SOPD
- c.approximately 50% required surgical release of the A2 pulley
- d.approximately 50% were satisfied with their outcome
- a.
- # 5.Diversion from waitlists to hand therapy was shown to be an effective patient management strategy in patients with chronic hand complaints
- 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
Published online: June 23, 2021
Accepted:
June 17,
2021
Received in revised form:
May 11,
2021
Received:
September 16,
2020
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Inc. All rights reserved.
