Impact of Seating and Mobility Services for Individuals With Disabilities in El Salvador.

IMPORTANCE: Outcomes research on the impact of seating and mobility services delivered using a short-term medical mission (STMM) model is limited. OBJECTIVE: To evaluate the impact of seating and mobility services on the occupational performance of individuals with disabilities in El Salvador. DESIGN: One-group retrospective pretest-posttest. SETTING: Clinical (El Salvador). PARTICIPANTS: Individuals with disabilities in El Salvador. OUTCOMES AND MEASURES: Survey and the standardized Wheelchair Outcome Measure (WhOM) for those who received a wheelchair as their mobility device. METHOD: Participants rated satisfaction with performance of preferred in-home and out-of-home occupations on the WhOM before and after receiving seating and mobility services. RESULTS: For most survey questions assessing the impact on activities of daily living, more than 86% of the respondents selected agree or strongly agree. Nearly half of the respondents reported that questions regarding work and education were not applicable. Participants' WhOM scores (n = 86) demonstrated a statistically significant improvement in performance satisfaction for both in-home (p < .001; d > 1) and out-of-home (p < .001; d > 1) occupations after they received services, with a huge effect size (d > 2). CONCLUSIONS AND RELEVANCE: The findings suggest that seating and mobility services provided by rehabilitation professionals in El Salvador improved occupational performance for people with disabilities. Compared with STMMs that solely provide equipment, the findings emphasize the importance of professional service provision with education and training as best practice. What This Article Adds: Seating and mobility services delivered through a STMM model may improve occupational performance for individuals with disabilities. However, STMMs should be carefully planned in collaboration with in-country partners, provide customized seating systems, and include education and training from licensed rehabilitation professionals.

Developing a student competency exam for hand therapy clinical experiences: A cross-sectional survey of hand therapists.

STUDY DESIGN: Cross-sectional survey design. INTRODUCTION: Students pursuing hand therapy clinical rotations are expected to demonstrate foundational knowledge prior to the experience. PURPOSE OF THE STUDY: Identify content that should be included on a potential competency exam for students pursuing hand therapy rotations from the perspectives of current hand therapists. METHODS: This questionnaire, devised from the Scope of Practice and Domains of Hand Therapy, was emailed to members of the American Society of Hand Therapists. Data was collected and analyzed with SurveyMonkey to determine descriptive statistics and frequency distributions. RESULTS: All knowledge areas included in the survey were ranked important or very important. Knowledge areas with the highest responses of much importance were the range of motion assessments of the upper extremity, anatomy and physiology, and interpersonal skills and therapeutic communications. DISCUSSION: Hand therapy clinical instructors expect their students to demonstrate competency in relevant topics prior to starting their clinical experiences. A hand therapy competency exam addressing the valued knowledge areas may ensure students are prepared for the rigorous expectations of a hand therapy clinical rotation. CONCLUSION: A competency test, including knowledge areas presented in this study, given to students before starting a specialty rotation, may ensure that the student has the foundational knowledge needed to succeed in a hand therapy setting, provide an understanding of students' strengths and weaknesses, and help clinicians become more willing to accept students for hand therapy rotations.

Intra-rater reliability of goniometry to measure scapular protraction and retraction.

STUDY DESIGN: Observational, descriptive design. BACKGROUND: Despite scapular mobility being essential for the completion of activities of daily living (ADLs), there is currently no established, a reliable goniometric technique to measure scapular protraction and retraction. A proposed method has shown clinically significant inter-rater reliability for a goniometric technique for these measurements. PURPOSE: This observational descriptive study examined the intra-rater reliability of a goniometric technique to assess scapular protraction and retraction among a sample of healthy adults. METHODS: An occupational therapist who is a certified hand therapist (CHT) and an occupational therapy student used goniometry to measure the neutral (resting), protracted, and retracted positions of the right and left scapula for a sample of healthy young adults (n = 54; a total of 108 data points for each measurement). These measurements were compared to analyze intra-rater and inter-rater reliability. RESULTS: For measurements of the scapula in neutral, protraction, and retraction, the standard error of measure (SEM) for repeat measures by the expert and novice raters was < 4.5° and < 3.9° respectively and ICC values ranged from poor to moderate (0.37-0.63). The SEM for measures between evaluators was < 5.0° and the ICC was poor (0.16-0.35). Minimum detectable change (MDC) values as a percentage of the mean (% MDC) ranged between 15.9 and 43.7% for intra-rater reliability and 21.9-52.8% for inter-rater reliability. DISCUSSION: The results of the study were mixed; variance of less than 5° for repeat measures by the same rater and measures between raters suggest clinically acceptable reliability. However, variance as a proportion of available motion (%MDC) demonstrates a broader range both above and below the threshold of 30% suggested for rehabilitation assessments. CONCLUSION: There are few efficient, reliable techniques to measure scapular mobility in clinical practice. The absolute reliability of goniometry to measure scapular protraction and retraction is similar to measurements of other joints. However, additional research and possible refinement of the technique is recommended to further address relative reliability and validity.

Interrater Reliability of a Novel Goniometric Technique to Measure Scapular Protraction and Retraction.

IMPORTANCE: Scapular protraction and retraction are often essential for occupational performance; however, clinical assessment of these movements is uniquely challenging. OBJECTIVE: To analyze the interrater reliability of a novel goniometric method to measure scapular protraction and retraction. DESIGN: An observational, descriptive design was implemented to evaluate interrater reliability between two experienced occupational therapists who were also certified hand therapists. SETTING: Academic institution. PARTICIPANTS: Convenience sample of graduate students (N = 80). Outcomes and Measures: The hypothesis, developed before study implementation, was that the technique would demonstrate clinically acceptable interrater reliability, defined as a standard error of measurement (SEM) <8°. Goniometric measurements of the scapula at rest, in maximal protraction, and in maximal retraction were independently obtained from each participant by each evaluator. The goniometer was aligned on the scapula using the superior angle as the axis of motion to measure the movement of the acromion relative to the frontal plane. The SEM was calculated in each position using the intraclass correlation coefficient values and the average of the standard deviations from the two raters. RESULTS: The SEM values between the two evaluators for the resting, protracted, and retracted positions were 3.46°, 2.93°, and 2.74°, respectively. CONCLUSIONS AND RELEVANCE: The SEM between the two evaluators for each scapular position was <4°, suggesting that the technique may be clinically reliable. However, additional research regarding the reliability and validity of the technique is recommended. What This Article Adds: The findings of this study support the use of goniometry to measure scapular protraction and retraction in relation to occupational performance. The technique provides a way to quantify baseline scapular mobility and track progress.

Inclusion and perception of hand therapy content in occupational therapy programs: A mixed-method study.

STUDY DESIGN: Mixed-methods with cross-sectional survey and interviews. INTRODUCTION: Hand therapy is a specialty area of practice for occupational (OT) and physical therapists (PT), requiring experience and certification beyond entry-level generalist education. Perspectives and inclusion of content related to hand therapy differs among entry-level OT programs and faculty. PURPOSE: Perception and inclusion of hand therapy content in OT programs was examined in this mixed-method study to better understand the trends in academia regarding integration of content related to hand therapy. METHODS: A survey was developed, peer-reviewed, and emailed to all accredited entry-level masters and doctorate OT programs via Survey Monkey (SurveyMonkey, Inc., San Mateo, CA). Respondents were also given the opportunity to participate in an interview (n = 2; 5%). RESULTS: A total of 43 participants responded to the survey, representing a 23% response rate. Quantitative results revealed that 65% of OT programs report including 41+ hours of hand therapy content and 54% report integration of hand therapy content in 2-3 courses. Qualitative trends included the perception of hand content as necessary and beneficial to other areas of practice as well as the perspective that it is too specialized and advanced for generalist curriculum. DISCUSSION: Educators have a largely positive opinion regarding inclusion and generalizability of hand therapy content within OT curricula with varied content inclusion. While hand therapy related content is valued, increased emphasis on occupation during didactic instruction is recommended for more holistic understanding and occupation-based practice. CONCLUSION: While trends of hand therapy content inclusion were revealed in the survey, perceptions of hand therapy within the broad spectrum of OT curricula were diverse, indicating a possible lack of unity within the profession regarding this specialty area of practice.

Barriers and Solutions to Fieldwork Education in Hand Therapy.

STUDY DESIGN: Survey. INTRODUCTION: Fieldwork education is a vital component of training the next generation of CHTs. Barriers and solutions to fieldwork rotations in hand therapy are examined, as well as proposed solutions, including recommendations for student preparation. PURPOSE OF THE STUDY: This descriptive study examined barriers for certified hand therapist clinicians to accept students for clinical rotations and clinicians' preferences for student preparation before a rotation in a hand setting. METHODS: A survey was developed, peer reviewed, and distributed using the electronic mailing list of the Hand Therapy Certification Commission via SurveyMonkey. Aggregate responses were analyzed to identify trends including barriers to student clinical rotations and recommendations for students to prepare for hand rotations. RESULTS: A total of 2080 participants responded to the survey, representing a 37% response rate. Common logistical barriers were identified for accepting students such as limited clinical time and space. Many clinicians (32% agree and 8% strongly agree) also felt that the students lack the clinical knowledge to be successful. Areas of knowledge, skill set, and experience were surveyed for development before a clinical rotation in a hand setting. Most respondents (74%) reported increased likelihood of accepting a student with the recommended preparation. Novel qualitative responses to improve clinical experiences are presented as well. DISCUSSION: Student preparation before a clinical rotation in a hand setting appears to be a significant barrier based on the survey results. Areas of recommended knowledge, skill set, and experience may serve to guide both formal and informal methods of student preparation before a hand-specific clinical rotation to facilitate knowledge translation from experienced certified hand therapists to the next generation. CONCLUSION: Although logistical barriers may be difficult to overcome, hand-specific preparation based on clinician' recommendations may facilitate student acceptance and success in hand specialty clinical rotations. LEVEL OF EVIDENCE: N/A.

Exploring the needs of certified hand therapists regarding electronic applications.

STUDY DESIGN: Survey. INTRODUCTION: App technology may provide a beneficial clinical resource for CHTs. PURPOSE OF STUDY: This descriptive study examined beneficial components for inclusion in a potential app for certified hand therapists to use as a clinical resource based on a nationwide survey. METHODS: Certified hand therapist members of the American Society of Hand Therapists were surveyed to evaluate preferences of content to be included in a potential clinical app. RESULTS: Most of the 341 respondents were Caucasian, female, 51-60 years old, with 21+ years' experience. Respondents preferred home program illustrations, video demonstrations, evidence-based resources, postoperative protocols, and functional outcome measures. Regarding app usage, 26.7% responded "definitely use the app" and 37.5% reported "highly likely to use the app" within a price range of $1-$20. CONCLUSION: An ideal app should include home program media, evidence-based practice, postoperative protocols, and functional outcome measures related to reported diagnoses encountered in the clinic. LEVEL OF EVIDENCE: N/A.

Use of Dexteria application to improve fine motor coordination in the nondominant hand.

The authors report improved fine motor coordination when using Dexteria with a healthy population. Technology may improve patient engagement and participation when incorporated into treatment programs. - Kristin Valdes, OTD, OT, CHT, Practice Forum Editor, Journal of Hand Therapy.

Effectiveness of custom seating and mobility services for individuals with disabilities in Guatemala.

The purpose of this study was to evaluate the effectiveness of custom seating and mobility services provided via an international service learning (ISL) model on the occupational performance of individuals with disabilities in Guatemala. A one-group prospective pretest-posttest design was implemented using the standardized Wheelchair Outcome Measure (WhOM - Spanish) administered on the day of wheelchair fitting, and at 3- and 6-month intervals after receiving seating and mobility services. A two-tailed t-test demonstrated a statistically significant (p < 0.001) improvement in satisfaction for in-home and out-of-home occupations for all participants (n = 71) at 3-months with a huge effect size (d > 2) and this improvement was maintained at the 6-month interval. The results were consistent for various areas of occupational performance (e.g. activities of daily living). The provision of customized seating and mobility services by occupational therapists through an ISL model demonstrated effectiveness at improving satisfaction with occupational performance for individuals with disabilities in Guatemala. Cultural humility, customization of equipment based on personal and environmental factors, inclusion of education and training, and collaboration with in-country partners were identified as contributors to positive outcomes.

Custom seating and mobility services provided by licensed occupational therapists via an international service learning (ISL) model demonstrated a significant improvement on the occupational performance of individuals with disabilities in Guatemala.The customization of equipment based on environmental and personal factors and the provision of education and training were identified as contributors to positive outcomes.Rehabilitation services delivered using an ISL model should be developed and implemented with cultural humility in collaboration with in-country partners.

Impact of seating and mobility services for individuals with disabilities in Peru.

The purpose of this study is to critically analyze the perceived impact of seating and mobility services, provided by occupational therapists using an ISL model, from the perspective of the recipients of services in Peru. A quantitative, cross-sectional survey design was implemented using a survey that was developed based on areas of occupation outlined by the OTPF-4, translated into Spanish, and administered by an in-country partner via SurveyMonkey. More than 85% of respondents (n = 133) indicated they "agree" or "strongly agree" that receiving services had an overall positive impact on their life, ability to complete ADLs, social interaction, community mobility and participation, overall health, and sense of confidence and well-being; responses were generally "neutral" regarding impact on employment and education. The results support the potential of collaborative ISL, specific to the provision of seating and mobility, to improve occupational performance from the perspective of service recipients in Peru.

Wrist pressure and angulation during keyboarding: Comparison between two common wrist supports.

BACKGROUND: Wrist pressure and angulation while working at a computer workstation have been associated with cumulative trauma disorders (CTDs) like carpal tunnel syndrome (CTS). OBJECTIVE: This quantitative, comparative study analyzed wrist pressure and angulation between two common wrist supports while typing at a standardized computer workstation. METHODS: A convenience sample of healthy young adults completed a five-minute typing task at a standardized workstation with no wrist support, with the ErgoBeads™ wrist support, and with an Elzo™ (memory foam) wrist support. Pressure mapping (Tekscan™)) and goniometry were used as quantitative measures to examine wrist pressure and wrist angulation during the typing task; descriptive and inferential statistics were performed to compare wrist angulation and wrist pressure between two supports. RESULTS: For the sample (n = 54), both wrist supports demonstrated a significant (p < 0.001) reduction in wrist extension as well as pressure compared to typing at the workstation with no support. There was no statistically significant difference in peak or mean pressure between the ErgoBeads™ and Elzo™ wrist supports (p = 0.99). Significant difference was identified ((p < 0.001) for wrist angle as participants exhibited less wrist extension using the ErgoBeads™ (x¯=12.56∘; SD = 3.32°) support as compared to the Elzo™ (x¯=19.25∘; SD = 3.77°) support. CONCLUSIONS: The results suggest that the ErgoBeads™ and Elzo™ memory foam wrist supports are effective for reducing pressure between the wrist and work surface while the ErgoBeads™ support may promote a more neutral angle of the wrist while typing.