Danielle Ann-Marie Lesher, M. J. Mulcahey, Peter Hershey, Donna Breger Stanton, Andrea C. Tiedgen; Alignment of Outcome Instruments Used in Hand Therapy With the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health: A Scoping Review. Am J Occup Ther 2016;71(1):7101190060. https://doi.org/10.5014/ajot.2017.016741
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© 2021 American Occupational Therapy Association
OBJECTIVE. We sought to identify outcome instruments used in rehabilitation of the hand and upper extremity; to determine their alignment with the constructs of the International Classification of Functioning, Disability and Health (ICF) and the Occupational Therapy Practice Framework: Domain and Process; and to report gaps in the constructs measured by outcome instruments as a basis for future research.
METHOD. We searched CINAHL, MEDLINE, OTseeker, and the Cochrane Central Register of Controlled Trials using scoping review methodology and evaluated outcome instruments for concordance with the ICF and the Framework.
RESULTS. We identified 18 outcome instruments for analysis. The findings pertain to occupational therapists’ focus on body functions, body structures, client factors, and activities of daily living; a gap in practice patterns in use of instruments; and overestimation of the degree to which instruments used are occupationally based.
CONCLUSION. Occupational therapy practitioners should use outcome instruments that embody conceptual frameworks for classifying function and activity.
Were published between 2001 and 2013
Were peer reviewed and written in English
Addressed geriatric, adult, or pediatric populations
Included participants with congenital or manifested conditions including but not limited to orthopedic injuries, tendon injuries or repairs, nerve pathologies, injuries of the joint, congenital abnormalities, amputations, cumulative trauma disorders (carpal tunnel syndrome, cubital tunnel syndrome, lateral or medial epicondylitis, osteoarthritis, Dupuytren’s contracture, De Quervain’s tenosynovitis), and upper-extremity injuries
Used an outcome instrument that had been published by at least one additional (unrelated) author or research group other than developer of the instrument
Were authored or coauthored by an occupational therapist.
Ability to complete unilateral hand tasks such as turning a doorknob, picking up a coin, holding a glass of water, turning a key in a lock, and holding a frying pan
Performance on bimanual tasks, including opening a jar, buttoning a shirt or blouse, eating with a knife and fork, carrying a grocery bag, washing dishes, washing hair, and tying shoelaces
Ability to complete household or schoolwork activities
Appearance and its effect on social, public, and community interactions
Satisfaction with the current usability of the extremity.
The finding of a lack of instruments that focus on environment and participation, although not entirely unanticipated, may point to a disconnect between occupational therapy in hand therapy and the core values of the profession.
The findings and implications of this scoping review in no way minimize or discredit the contribution of occupational therapy in the rehabilitation of body functions and structures and activity participation. Constructs within these areas are important, need attention, and are tightly aligned with occupational therapy, particularly as precursors to function. Our recommendation is not that practitioners move away from assessment of body functions and structures but rather that they supplement their assessment with instruments that are occupationally based.
Occupational therapy practitioners must understand the links between the outcome instruments they use and the constructs of the ICF and Framework to select the most appropriate instrument for their clients and enhance communication among health care professionals, third-party payers, and other stakeholders.
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