Hand therapist use of patient-reported outcomes.

BACKGROUND: The use of standardized outcome measures is essential for best clinical practice by hand therapists to determine patient status, progress, and the outcome of interventions. A better understanding of current patient-reported outcome (PRO) use in hand and upper extremity practice is warranted. PURPOSE: This study sought to understand what outcome measures are being used in clinical practice, how they are being used, and the perceived usefulness of PROs by active members of the American Society of Hand Therapists (ASHT). STUDY DESIGN: This study employed a cross-sectional design. METHODS: The web-based survey was distributed through Qualtrics (Qualtrics, Salt Lake City, Utah) to active members of ASHT with an email address on file. The survey consisted of multiple choice and open-ended questions. RESULTS: A total of 348 members responded to the survey. Seven hundred thirty-two different outcome measures were reported to be used by the hand therapist respondents. The most used outcome measure was QuickDASH by 38% of the respondents. Two hundred seventy-five (88%) indicated that their workplace advocated the use of PROs. Most respondents indicated that there were not constraints preventing the use of a PRO. Few therapists respondents use a psychosocial PRO in clinical practice. CONCLUSIONS: Most of the hand therapist respondents to our survey use a PRO and discuss the results with their clients. The QuickDASH was the PRO used most often by hand therapists. Only a few hand therapists use a psychosocial tool to measure patient status in clinical practice.

Psychometric properties of body structures and functions measures in non-surgical thumb carpometacarpal osteoarthritis: A systematic review.

BACKGROUND: Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored. PURPOSE: The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations. STUDY DESIGN: Systematic review. METHODS: A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted. RESULTS: Eleven studies were included in the review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case-control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good. CONCLUSIONS: Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research.

Desired student characteristics for hand therapy clinical placements: A mixed method study.

STUDY DESIGN: Mixed method design. INTRODUCTION: Conceptualizing the desired characteristics of a student for a clinical site is vital information during the matching process. PURPOSE OF THE STUDY: The objective of this study was to identify the specific student characteristics preferred by the hand therapy clinician educator. METHODS: A questionnaire was emailed to members of the American Society of Hand Therapists. A semi structured interview was developed to investigate the topic further. Data was collected and analyzed to determine descriptive statistics and themes regarding the preferred student characteristics. RESULTS: The most common themes found regarding desired student characteristics by hand therapists were students that possess strong interpersonal skills, a willingness to self-study and learn independently, and students that exhibit professional behaviors. DISCUSSION: If students are successfully matched to clinical placements, this may encourage sites to take students in the future and also reduce the need for the clinical educator or university to address problems that arise during the experience. CONCLUSION: Hand therapy clinical educators desire students with strong interpersonal skills, a willingness to self-study and learn independently, demonstrate professionalism and clinical reasoning skills, who possess a sincere interest in hand therapy and demonstrate cultural competence when interacting with patients from different backgrounds and social environments. Finally, hand therapy clinical educators want students to be honest about what they know and what they don't know regarding hand therapy.

Test-retest reliability of joint position sense in the elbow among healthy adults.

BACKGROUND: Proprioception of the elbow is necessary for daily activities. Proprioception can be impaired with injury or pathology, and rehabilitation efforts seek to improve proprioception for improved upper extremity functioning. In clinical practice, joint position sense (JPS) testing is often utilized to assess conscious proprioception; however, varying methods exist with little evidence of psychometric properties, especially for the elbow. PURPOSE: The primary aim of this study was to create a standardized elbow JPS test protocol using goniometry measurement to determine the most reliable testing position. The secondary aim was to determine if the elbow JPS test had acceptable test-retest reliability in healthy adults. STUDY DESIGN: This was a cross-sectional study using a convenience sample of healthy adults. METHODS: Three elbow positions (45°, 60°, and 75° of elbow flexion) were measured twice on the same day by a single rater using a universal goniometer. We calculated the absolute error in degrees between each position and reposition and the intraclass correlation coefficient (3,1) for relative reliability. We also calculated the standard error of the measurement and visually inspected Bland-Altman plots for absolute reliability. RESULTS: Sixty-eight healthy adults (mean age 27.9 years, standard deviation 8.59) were assessed. The mean absolute error for all positions for test and retest was 5.7°. The intraclass correlation coefficients were moderate to good (0.57-0.75), and the standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were moderately narrow, and the Bland-Altman plots showed a random distribution of errors for each position, indicating clinically acceptable measurement error. CONCLUSIONS: The joint position reproduction test for JPS using goniometry demonstrated moderate to good test-retest reliability and acceptable measurement error in healthy adults. The elbow joint angle of 60° flexion was the most reliable for JPS testing, providing insight for JPS assessment in clinical practice.

Test-retest reliability of joint position sense in the carpometacarpal joint among healthy adults.

BACKGROUND: Accurate proprioception in the thumb carpometacarpal (CMC) joint is necessary during activities such as performing fine manipulative tasks, such as coin handling, opening doors, using keys, and pressing control buttons. PURPOSE: The primary aim of the present study was to examine the test-retest reliability of CMC joint position sense (JPS) in healthy subjects. The secondary aim was to determine the most reliable JPS testing position for the thumb CMC joint. STUDY DESIGN: This was a cross-sectional study of a convenience sample of healthy adults. METHODS: Three thumb positions (20°, 30°, and 40° of thumb abduction) were measured twice on the same day by a single rater using a universal goniometer. The absolute error in degrees between each position and reposition was calculated. The intraclass correlation coefficient (2,1) was calculated for relative reliability. The standard error of the measurement was calculated. RESULTS: Sixty-four healthy adults (mean age 27.8 years, standard deviation = 8.7) were assessed. The intraclass correlation coefficients were poor (-0.08 to 0.22), and the standard error of the measurement was 1.4° for all positions. CONCLUSIONS: The joint position reproduction test for JPS using goniometry demonstrated poor test-retest reliability and acceptable measurement error in healthy adults.

Proprioception evaluation and treatment: Hand therapist practice patterns.

BACKGROUND: Little is known about how hand therapists assess proprioception and treat deficits in clinical practice and what types of diagnoses they see most often. To our knowledge, no survey has been completed regarding proprioception practice patterns among hand therapists. PURPOSE: The purpose of this study was to examine current practice patterns related to the treatment and assessment of proprioception deficits by hand therapists in the United States. STUDY DESIGN: This was a cross-sectional study using a survey instrument. METHODS: The survey was sent to occupational and physical therapists identified as certified hand therapists or members of the American Society of Hand Therapists. The Checklist for Reporting Results of Internet E-Surveys was used in reporting results. RESULTS: Members of American Society of Hand Therapists (n=152) responded to the survey. The participants were asked if they provided rehabilitation services to people who have proprioceptive deficits, and 122 (82%) responded yes, and 27 (18%) responded no. Most therapists use a standardized technique for assessing proprioceptive deficits. Hand therapists' mean confidence level in treating proprioception deficits was 7.2 out of 10 compared to the mean confidence level reported evaluating them, which was 6.1 out of 10. CONCLUSIONS: Most hand therapists evaluate and treat proprioception deficits across a variety of diagnoses. While the frequency and duration of proprioception treatment varies, most hand therapists reported high use of open- and closed-chain exercises and activities along with elastic taping as part of their intervention approach.

The use of occupation-based interventions and assessments in hand therapy: A cross-sectional survey.

INTRODUCTION: The purpose of this study was to gather information on how hand therapists incorporate occupation-based interventions in their clinical practice and what outcome measures hand therapists use to measure the occupational performance of their clients STUDY DESIGN: Cross-Sectional Survey Design. METHODS: The 16-item Survey was distributed to members of the American Society of Hand Therapists on two occasions. RESULTS: Three hundred eleven hand therapists responded to the survey. Hand therapists use a variety of occupation-based interventions (OBI) in clinical practice and most believe they are important. Findings from this study reveal that incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely. One hundred twenty-six (41%) respondents indicated that they use occupation-based activities 26-50% of the time with their clients. DISCUSSION: The top three OBI interventions used by hand therapists included dressing tasks, cooking and meal preparation, and in hand manipulation of coins and medication. The lack of understanding of the theoretical models regarding occupation-based interventions may be a barrier toward implementation of occupation-based interventions and assessments as many hand therapists may have trained under a medical model. CONCLUSION: Most respondents to this survey indicated that they believe OBI should be performed by hand therapists and use them routinely in practice. The most frequently used type of assessment was the DASH (Disabilities of the Shoulder Arm & Hand). The least frequently used assessment was the Short Form 36 and patient specific occupation-based assessment.

Usefulness of a hand therapy application.

STUDY DESIGN: Cross-sectional cohort design that collected data by means of a survey. INTRODUCTION: Performance and adherence to a home exercise program (HEP) has been identified as an integral component of hand therapy rehabilitation. Understanding how patients learn along with offering creative options to improve engagement is important. Advancements in technology including the use of smart phone apps should be considered. PURPOSE OF STUDY: To determine if a hand therapy app is a useful method for patient education and home exercises for patients receiving hand therapy for an orthopedic injury distal to the shoulder. METHOD: Individuals receiving hand therapy at an outpatient hand therapy clinic via a convenience sample (n = 41) were asked to download use The Hand Therapy Application for an individualized exercise program. The Mobile Application Rating Scale (MARS) questionnaire was used to assess the smart phone app. RESULTS: The overall MARS score for the hand therapy app was 3.5 out of 5. The MARS also gathered information on the app's engagement, functionality, aesthetics, and subjective quality of the app with mean scores of 3.6, 3.8, and 3.7, respectively. Data was also collected on the app's description accuracy, goals, quality and quantity of information, visual information, credibility, and evidence base. DISCUSSION: Participants receiving skilled hand therapy gave an overall rating of The Hand Therapy Application as above average for providing information about the participants condition and for HEP instruction. CONCLUSION: The findings of this study suggests that The Hand Therapy Application should be a consideration as a HEP tool in clinical practice.

Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial.

STUDY DESIGN: Randomized Control Trial. INTRODUCTION: Thumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population. PURPOSE OF THE STUDY: To establish the effectiveness of a proprioceptive training program as a complementary therapy for patients with thumb CMC joint OA. METHODS: Standard conservative thumb CMC joint OA treatments were received by both the control (n = 26) and experimental groups (n = 26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included severity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). RESULTS: Fifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. DISCUSSION: Experimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between-group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. CONCLUSION: Proprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.

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.

Seated vs. standing workstations: A pilot study.

ABSTRACT: Although nurses are constantly on their feet caring for patients, they still work on the computer at seated or standing workstations. This study examines workers' self-reported pain and discomfort while using these two workstation designs and their risk of developing musculoskeletal disorders.

Patient satisfaction with the CMC controller: A cohort study.

STUDY DESIGN: Cohort study. INTRODUCTION: The evidence specific to understanding patient satisfaction, preference and the effects on occupational performance using a CMC orthosis is sparse. PURPOSE OF THE STUDY: The main purpose of this study was to determine patient satisfaction, aspects of the orthotic preference, and the effect on pain and function of the CMC Controller Plus neoprene orthotic device. METHODS: This research was conducted at two outpatient clinics located in Pennsylvania and Florida during 2019. The subjects of this study included any individuals referred to one of two participating hand therapy facilities with either a primary or secondary diagnosis of thumb CMC joint arthritis or present with this diagnosis as a comorbidity. The CMC Controller Plus orthosis (Hely & Weber) was provided to each patient by the treating therapist at no cost to the patient after the patient agreed to take part in the study. None of the patients received hand therapy treatment for the CMC pain; the only intervention provided was the CMC Controller Plus. RESULTS: The CMC Controller Plus orthosis improved the patients' functional status and reduced their pain. The effect size for the change in function was large (1.29) compared to the effect size for the reduction in pain which approached moderate at 0.49. DISCUSSION: The CMC Controller Plus orthosis improved the patient's functional status by 52% and reduced their pain by 29%. CONCLUSION: The results were both statistically and clinically significant.

Patient satisfaction of hand therapy services.

STUDY DESIGN: This study utilized a cross-sectional cohort design that used survey techniques for data collection. INTRODUCTION: Patient satisfaction is becoming increasingly important in the health care field; however, it is typically evaluated with the use a single question. Patient satisfaction encompasses numerous aspects that should be considered on evaluation. PURPOSE OF THE STUDY: The purpose of this study was to determine if the Patient Satisfaction Questionnaire Short Form (PSQ-18) is an appropriate outcome measure to determine patient satisfaction for people receiving hand therapy services and to determine mean satisfaction scores of participants. METHODS: Participants (n = 123) who received hand therapy services from an outpatient hand therapy center and a health care institute were obtained via a convenience sample. The PSQ-18, adapted for hand therapy, was used to assess patient satisfaction. RESULTS: The mean satisfaction score was 1.81 (SD = 1.26). The following patient satisfaction subscales were also evaluated: general satisfaction, communication, technical quality, interpersonal manner, time spent with therapists, accessibility and convenience, and financial aspects. DISCUSSION: Eighty percent of participants were satisfied with the therapy services they received. Patient satisfaction is complex, involving a multitude of components and thus must be evaluated in a manner that considers its multidimensional aspects. CONCLUSION: The findings of this study suggest that the PSQ-18 adapted for hand therapy is an appropriate outcome measure to determine patient satisfaction for people receiving hand therapy as it evaluates multiple subscales of the phenomena.

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis.

STUDY DESIGN: This is a longitudinal, observational, multicenter, cohort study. INTRODUCTION: Thumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process. PURPOSE OF THE STUDY: The purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient's self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability. METHODS: Eligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after. RESULTS: One hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively. CONCLUSIONS: Although more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient's self-perception and satisfaction in thumb CMC OA.

Certified hand therapists membership in the American Society of Hand Therapists: A survey study.

STUDY DESIGN: Survey research. METHODS: A pilot tested survey was administered through an electronic mailing system to 5777 CHTs with email addresses on file at Hand Therapy Certification Commission. The survey was electronically distributed on two separate occasions to maximize the response rate. RESULTS: The response rate was 53% (n = 1271). The majority of the respondents who were not members of ASHT, 49% (441), indicated that member fees are too expensive, and 35% (311) respondents selected other as the reason. They specified that they were members in another country, the expenses were too high, or that they were retired. Ten percent (93) of respondents answered that they did not know what member benefits were offered, and 4% (40) responded that they do not value the member benefits offered. Finally, 2% (14) of participants answered that they do not value membership in any other professional organization. DISCUSSION: While ASHT membership cost is lower than the benefits the member receives, some do not believe that the costs outweighs the benefits. The combination of these factors accounts for approximately half of all CHTs choosing not to join ASHT. CONCLUSION: Many established members value their membership and find it beneficial not only for themselves but also for furthering the profession as well. Many CHTs identified cost as the most apparent factor for not joining ASHT.

Purdue manual dexterity testing: A cohort study of community-dwelling elderly.

INTRODUCTION: The Purdue Pegboard Test is a manual dexterity test that requires the manipulation of pegs, washers, and collars. Our population for this research study focused on the geriatric community owing to the lack of recent available normative data. PURPOSE OF THE STUDY: The purpose of this study was to provide updated normative data for hand therapists to use in clinical practice to determine if seniors have dexterity deficits. STUDY DESIGN: This is a cohort study. METHODS: This study was completed through a convenience sample which included 128 participants. Participants were stratified into three age groups (60-69, 70-79, and 80+). Participants were asked to complete the Purdue Pegboard Test. Mean scores were analyzed using an independent-sample t-test and one-way analysis of variance to compare the mean scores of each designated age group. RESULTS: A one-way analysis of variance reported statistically significant differences between the 3 age groups (F = 15.03, P < .00). The results supported that those individuals who were younger (60-69) scored better on the assessment than those aged 80+ years. There was not a statistically significant difference between PPT mean scores of males and females. DISCUSSION: Mean scores for the PPT for community-dwelling seniors were established. CONCLUSION: The findings from this study support that dexterity may decline with age, which can affect occupational performance over time.

Linking ICF components to outcome measures for hand osteoarthritis and rheumatoid arthritis: A systematic review.

STUDY DESIGN: Systematic review. INTRODUCTION: A patient with rheumatoid arthritis (RA) or osteoarthritis (OA) may have functional impairments, decreased quality of life, and productivity reductions. The International Classification of Functioning (ICF) provides a scientific basis for understanding health, outcomes, and determinants. PURPOSE OF THE STUDY: The purpose of this study was to critically appraise the current literature for outcome measures associated with the management of OA or RA to determine if they describe the components of the ICF that includes body functions and structures, activities, participation, environmental factors, as well as quality of life. The secondary purpose is to examine if patient satisfaction was addressed in the interventions associated with management of OA or RA. METHODS: A comprehensive literature search was conducted in the CINAHL and PubMed databases using the search terms joint protection, hand OA, hand RA, and assistive devices. RESULTS: Six of the outcome measures were linked to body structures and body functions, three were associated with activity limitations and participation restrictions, one was linked to environmental factors, and two outcome measures addressed quality of life. DISCUSSION: Practitioners should incorporate outcome measures that address environmental factors and quality of life as they relate to the ICF. CONCLUSION: Most of the outcome measures associated with hand OA or RA are related to body structures and body functions or activity limitations and participation restrictions.

Joint position sense impairments in older adults with carpometacarpal osteoarthritis: A descriptive comparative study.

STUDY DESIGN: This study has a descriptive-comparative, cross-sectional design. INTRODUCTION: Sensorimotor (SM) impairments have been observed after common wrist and hand injuries such as distal radius fractures. However, there is a lack of research regarding SM impairments in patients with carpometacarpal (CMC) osteoarthritis (OA). PURPOSE OF THE STUDY: This study sought to quantify proprioception deficits in older adults with CMC OA as compared with healthy adults using the joint position sense (JPS) test. METHODS: The active JPS test was used to measure proprioception function in 29 thumbs with CMC OA and their 29 matched-control healthy counterparts. For comparison, participants with unilateral CMC OA were matched against themselves, whereas those with lateral CMC OA were age matched with a healthy participant. Data analysis was performed to compute the mean error of JPS; an unpaired t test was used to compare the mean error of the non-CMC OA group with the healthy control group. RESULTS: The mean positional error measured from subjects with CMC OA was 9.53° compared with 1.32° for the age-matched healthy subjects. The effect size for the difference in means was D = 1.96. CONCLUSIONS: Thumb SM impairments were found to be greater in subjects with CMC OA than in their healthy counterparts when using the JPS test to assess proprioception.

Client preferences and perceptions regarding a written home exercise program or video self-modeling: A cross-sectional study.

STUDY DESIGN: This was a cross-sectional study. INTRODUCTION: Home exercise programs (HEPs) are frequently prescribed to maximize a patient's recovery and ensure maintenance of therapeutic gains produced during supervised treatment. Improved understanding of patient preferences and incorporation of simple mobile health technologies may be beneficial strategies for improving patient HEP adherence. PURPOSE: The purpose of this study was to determine client's preferred mode of home exercise program delivery when offered a choice between a cellular video and paper handout. METHODS: A convenience sample was recruited from clients receiving services at an upper extremity rehabilitation facility. Participants were provided a paper handout with written instructions and an audiovisual recording of themselves performing the exercises. A questionnaire was developed to compare clients' preferences and perceptions. Quantitative data regarding patient preference were gathered and analyzed with descriptive statistics. Collected qualitative data were themed to determine the characteristics of home exercise programs (HEPs) perceived by patients. RESULTS: A total of 30 patients participated in the study. Of the 29 responses regarding patient preference of HEP mode, 20 (69%) patients preferred a video, 4 (14%) patients preferred a paper handout, and 5 (17%) patients preferred both paper and video HEP. Patients with preference to a paper HEP reported the handout was helpful to be accessed in a simple manner and could be displayed as a visual reminder to perform the exercises. Those who preferred the cellular video reported increased understanding and confidence with accurate performance of exercises using audiovisual instructions. DISCUSSION: HEP adherence enhancement techniques include improved understanding of patient preferences in order to facilitate customized client-centered treatment. CONCLUSION: The majority of participants in this study preferred a mobile-based video HEP. Participants perceived the video as visually appealing and a more effective mode of instruction than paper handouts.

Use of mobile applications in hand therapy.

INTRODUCTION: Mobile devices can be incorporated into therapy as an engaging alternative to traditional therapy options. The use of mobile devices and smartphone applications can enhance the quality of care provided by health care professionals. PURPOSE: To find mobile apps that can be incorporated into hand therapy practice. METHODS: Hand therapy evaluation, interventions, proprioception, laterality, and home exercise program applications can be incorporated into practice. Patient education can also be provided via the use of mobile applications. CONCLUSION: Smartphone applications can be a valuable intervention and impact performance in individuals with impaired hand function. Smartphone applications offer a client-centered, and potentially motivating, activity option that can be utilized to aid the hand therapist.