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Effective long-term management of brachial plexus injury following surgery: What is needed from hand therapists’ perspectives

Published:March 02, 2022DOI:https://doi.org/10.1016/j.jht.2022.01.006

      Highlights

      • Given the long-term recovery following BPI, consideration should be given to relevance of slow stream rehab and interdisciplinary care.
      • Consider upskilling or an interdisciplinary care model to assist hand therapists and the provision of pain management and psychological support.
      • Increased dissemination of resources to support hand therapists working with individuals following BPI and enhanced communication opportunities to develop networks both nationally and internationally.

      Abstract

      Introduction

      Traumatic, brachial plexus injuries (BPI) result represent a significant cost to the individual and society. Recovery involves multiple surgeries, takes years, and often results in permanent physical dysfunction. While the last couple of decades have seen advancements in surgical management, the BPI rehabilitation literature has not kept pace with these developments.

      Purpose

      We aim to explore the experience of public and privately employed hand therapists’ in delivering effective long-term rehabilitation services to inviduals with BPI in Australia.

      Methods

      An interpretative qualitative study. Two focus groups were conducted with Australian hand therapists’ (n = 10). Data were analyzed using an inductive thematic approach.

      Results

      Three key themes were generated from the data. The first theme ‘Falling through the gaps: overlooked components of therapy for BPI’ captures participants’ thoughts on postinjury health care and rehabilitation services. The second ‘Developing a therapeutic alliance: underpinned by time and trust’ relates to the relationship building challenges and opportunities following trauma that will withstand the long-term recovery of individuals following BPI. The last theme, ‘Factors required for professional development: knowledge and support,’ considers the variation seen with these clients in relation to therapy needs and outcomes.

      Conclusions

      The findings of this study highlight the need to better equip hand therapists’ skills and knowledge in responding to pain and psychological management post BPI. Our results reinforce the benefit of interdisciplinary models of care in the management of individuals with BPI.

      Keywords

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      JHT Read for Credit

      Quiz: # 852

      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 was
        • a.
          prospective cohort
        • b.
          case series
        • c.
          qualitative
        • d.
          RCTs
      • # 2.
        The authors expressed concern that
        • a.
          therapy interventions had not kept pace with surgical advancements
        • b.
          the cost of therapy was prohibitive
        • c.
          too many patients were non-compliant
        • d.
          orthotic fabrication was too difficult
      • # 3.
        Falling through the gap was frequently the result of
        • a.
          insurance restrictions
        • b.
          parental resistance
        • c.
          physician distrust of therapy
        • d.
          concomitant injury
      • # 4.
        One therapist characterized the initial experience as
        • a.
          disturbing
        • b.
          manageable
        • c.
          overwhelming
        • d.
          exhilarating
      • # 5.
        The authors suggest that therapists need to gain a better understanding of the psychological issues and pain components of the BPI patient population
        • a.
          false
        • b.
          true
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.