Research Article|Articles in Press

Psychosocial factors addressed by occupational therapists in hand therapy: A mixed-methods study

Published:September 18, 2022DOI:


      • Despite being trained in more holistic treatment approaches, occupational therapists who are certified hand therapists (CHTs) report that a biomechanical intervention approach is their primary approach to treating clients with upper extremity injuries.
      • While many occupational therapist CHTs will integrate occupation-based assessment and interventions into their therapy sessions, most do not formally assess for psychosocial dysfunction, and they do so even less with worker's compensation clients.
      • There is a need for better standardized tools to assess psychosocial factors for hand injured clients.



      Occupational therapists address occupations, performance skills, and client factors that interfere with the successful occupational engagement in everyday activities, including psychosocial factors. However, due to the biomechanical model focus within hand therapy clinics, provision of a holistic care plan remains challenging for occupational therapists. If a client's psychosocial functioning is not addressed, progress toward a full recovery may be limited.


      The purpose of this study was to identify how occupational therapists who are certified hand therapists (CHTs), address and provide interventions to clients with psychosocial factors that negatively impact function.

      Study Design



      CHTs completed an electronic survey (n = 117) followed by a virtual focus group (n = 9). Survey data analysis included descriptive and correlational statistics to highlight frequencies, ranges, and relationships between the participant demographics and the selection of assessment and the intervention approaches. Thematic analysis guided the qualitative coding of the focus group transcripts.


      Of the 117 survey respondents, 79% reported frequent use of the biomechanical approach. The most frequently administered assessment included the Quick-Disabilities of the Arm, Shoulder, and Hand (n = 45; 40.9%). Five themes emerged from the focus groups: hand dysfunction impacts roles and routines; client rapport building takes time; CHT hesitation to address psychosocial factors; standardized assessments need to evaluate psychosocial factors that impact client function; and education and communication are critical intervention approaches.


      Occupational therapy practitioners primarily utilize the biomechanical approach and are less likely to assess or treat psychosocial factors that impact a client's function. However, participants reported a need for a standardized assessment to identify the psychosocial factors that impact their clients’ functional performance. Further research is warranted to increase the measurement and the use of holistic theoretical models of practice, assessments, and intervention approaches.


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        • Ladds E
        • Redgrave N
        • Hotton M
        • Lamyman M.
        Systematic review: predicting adverse psychological outcomes after hand trauma.
        J Hand Ther. 2017; 30: 407-419
        • Bates E
        • Mason R.
        Coping strategies used by people with a major hand injury: a review of the literature.
        Br J Occup Ther. 2014; 77: 289-295
        • Dogu B.
        • Kuran B.
        • Sirzai H.
        • Sag S.
        • Akkaya N.
        • Sahin F.
        The relationship between hand function, depression, and the psychological impact of trauma in patients with traumatic hand injury.
        Int J Rehabil Res. 2014; 37: 105-109
        • Hannah SD.
        Psychosocial issues after a traumatic hand injury: Facilitating adjustment.
        J Hand Ther. 2011; 24: 95-103
        • Buchanan H
        • Van Niekerk L
        • Grimmer K.
        Work transition after hand injury: a scoping review.
        J Hand Ther. 2020; (S0894-1130(20)30186-1): 1-12
        • Gerg MJ
        • Hazak KM
        • Carrie B
        • Melendez N
        • Jewell VD
        Non-physical factors that impact return to work in individuals with upper extremity injuries: a scoping review.
        Work. 2022; 73
        • Gustafsson M.
        • Windahl J.
        • Blomberg K.
        Ten years follow-up of trauma-related psychological distress in a cohort of patients with acute traumatic hand injury.
        Int J Orthop Trauma Nurs. 2012; 16: 128-135
        • Roh YH
        • Lee BK
        • Noh JH
        • Oh JH
        • Gong HS
        • Baek GH.
        Effect of anxiety and catastrophic pain ideation on early recovery after surgery for distal radius fractures.
        J Hand Ther. 2014; 39: 2258-2264
        • Vranceanu A-M
        • Jupiter JB
        • Mudgal CS
        • Ring D.
        Predictors of pain intensity and disability after mind hand surgery.
        J Hand Surg. 2010; 35: 956-960
        • MacDermid JC
        • Valdes K
        • Szekeres M
        • Naughton N
        • Algar L.
        The assessment of psychological factors on upper extremity disability: a scoping review.
        J Hand Ther. 2017; 31: 511-523
        • American Occupational Therapy Association
        Occupational therapy practice framework: Domain and process (4th ed.).
        Am J Occup Ther. 2020; 74: p1-p87
        • Keller JL
        • Caro CM
        • Dimick MP
        • Landrieu K
        • Fullenwider L
        • Walsh JM.
        Thirty years of hand therapy: The 2014 practice analysis.
        J Hand Ther. 2016; 29: 222-234
        • Finlay L.
        Holism in occupational therapy: elusive fiction and ambivalent struggle.
        Am J Occup Ther. 2001; 55: 268-276
        • Dale LM
        • Fabrizio AJ
        • Adhlaka P
        • et al.
        Occupational therapists working in hand therapy: the practice of holism in a cost containment environment.
        Work. 2002; 19: 35-45
        • Grice KO.
        The use of occupation-based assessments and intervention in the hand therapy setting-A survey.
        J Hand Ther. 2015; 28: 300-306
        • Burley S
        • Di Tommaso A
        • Cox R
        • Molineux M.
        An occupational perspective in hand therapy: a scoping review.
        Br J Occup Ther. 2018; 81: 299-318
        • Colaianni D
        • Provident I.
        The benefits and challenges to the use of occupation in hand therapy.
        Occup Ther Health Care. 2010; 24: 130-146
        • Takata SC
        • Wade ET
        • Roll SC.
        Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice.
        J Hand Ther. 2017;
      1. McMillan IR. The biomechanical frame of reference in occupational therapy. In: Duncan EAS, ed. Foundations for practice in occupational therapy. 5th Ed. Edinburgh: Churchill Livingstone; 2011:179-194; 2011.

        • Wienkes TL
        • Jewell VD
        • Chang IKT
        • Quaid SR
        • Watson CL.
        Clinical utility and validity of the occupation-centered intervention assessment for occupational therapy mental health practice.
        Ann Int Occup Ther. 2021;
        • Ting A
        • Rocker J.
        Evaluation and treatment of musicians from a holistic perspective.
        Open J Occup Ther. 2019; 7: 1-10
        • Greene JC
        • Caracelli VJ
        • Graham WF.
        Toward a conceptual framework for mixed-method evaluation designs.
        Educ Eval Policy Anal. 1989; 11: 255-274
        • Portney LG
        • Watkins MP.
        Foundations of Clinical Research: Applications to Practice.
        3rd ed. F.A. Davis Company, Philadelphia, PA2015
        • Onwuegbuzie A
        • Dickinson W
        • Leech N
        • Zoran A.
        A qualitative framework for collecting and analyzing data in focus group research.
        Int J Qual Methods. 2009; 8: 1-21
      2. IBM SPSS Statistics for Windows. Version 25.0.
        IBM Corp, Armonk, NY2017
        • Hsieh H
        • Shannon SE.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Braun V
        • Clarke V.
        Using thematic analysis in psychology.
        Quan Res Psychol. 2006; 3: 77-101
        • Depoy E
        • Gitlin L
        Introduction to Research: Understanding and Applying Multiple Strategies.
        5th ed. Mosby, Philadelphia2016
        • Curtin M
        • Fossey E.
        Appraising the trustworthiness of qualitative studies: guidelines for occupational therapists.
        Aust Occup Ther J. 2007; 54: 88-94
        • Creswell JW
        • Plano Clark VL
        Designing and Conducting Mixed Methods Research.
        3rd ed. SAGE, Thousand Oaks, CA2018
        • Coenen M
        • Kus S
        • Rudolf K-D
        • et al.
        Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand.
        J Hand Ther. 2013; 26: 332-342
        • Valdes K
        • MacDermid J
        • Algar L
        • et al.
        Hand therapist use of patient report outcome (PRO) in practice: a survey study.
        J Hand Ther. 2014; 27: 299-308
        • Wong J
        • Fung B
        • Chu M
        • Chan R.
        The use of disabilities of the arm, shoulder, and hand questionnaire in rehabilitation after acute trauma hand injuries.
        J Hand Ther. 2007; 20 (-46): 49
        • Kilgour E
        • Kosny A
        • McKenzie D
        • Collie A
        Healing or harming? Healthcare provider interactions with injured workers and insurers in workers’ compensation system.
        J Occup Rehabil. 2015; 25: 220-239
        • Snodgrass J.
        Effective occupational therapy interventions in the rehabilitation of individuals with work-related low back injuries and illness: A systematic review.
        Am J Occup Ther. 2011; 65: 37-43