A Scoping Review of Outcome Instruments Used in Hand Rehabilitation With Core Values of Occupational Therapy

SIGNIFICANCE: The use of psychometrically sound outcome instruments fabricated from the Occupational Therapy Practice Framework: Domain and Process reflects adherence to viewing health and wellness as complex and multidirectional in that outcomes are evaluated and reported in relationship to occupation. In this way, third-party payers and stakeholders will have an accurate understanding of occupational therapy and its outcomes of function and participation.

INNOVATION: This work provides occupational therapists (OTs) the ability to heighten awareness about their core professional values as well as illustrates how OTs uniquely evaluate and treat impairment-based problems to promote occupational competence and to achieve occupationally based outcomes. In this study, we drive the Centennial Vision by moving the field toward evidence-based decision making while upholding the foundation of occupational therapy: the use of occupation.

APPROACH: In this study, we attempted to answer the following research questions: What outcome instruments are frequented by OTs in the treatment of the hand and upper extremity, and what is the concordance between the instruments utilized to the core domains of occupational therapy?

One way to determine how well OTs align their practice with occupation is by their selection of outcome instruments, and because the degree of impairment does not directly inform functional limitations, instruments that directly assess performance in occupation and in participation must be utilized.

METHOD: We conducted a systematic scoping review from January 2013 to April 2014. A Cumulative Index to Nursing and Allied Health Literature (CINAHL) search strategy was developed and adapted to MEDLINE, OT Seeker, and the Cochrane Central Registrar of Controlled Trials. We independently screened abstracts using predefined criteria and were masked to each other’s assessment. Selection and training of raters included a mock review and competency assessment. The response of the rater with respect to the name of the outcomes instrument and the International Classification of Functioning, Disability and Health (ICF) and the Framework constructs that it measured was logged into an Excel construct table with letter assignment to ensure anonymity.

RESULTS: The search identified 7,267 potentially relevant publications, of which 65 full-text abstracts were screened, yielding 16 publications and 18 outcome instruments. Raters differed in their reports on the Framework and ICF constructs that were measured by the outcomes instruments. With respect to the Framework, the highest agreement among raters was on impairment/body structures, and self-care. Likewise, there was agreement on work and leisure. With respect to the ICF, the highest agreement among the three raters was on impairment/body structures and self-care. Similarly, there was agreement on general tasks and domains.

DISCUSSION: Hand therapy focuses on body functions and activity performance, including activities of daily living (ADLs), work, and leisure with less attention of the personal, social, and virtual dimensions of participation and on the environment. OTs who use instruments may not fully understand their design and intent, which may lead to over- and/or underinterpretation and misuse. A post hoc analysis was added for a comparison between raters’ response and the actual constructs of each identified instrument. The review reveals a void in instruments that focus on environment and participation and potentially points to a disconnect between occupational therapy in hand therapy and core values of the profession. A limitation of the study was less guidance around the scoping review methodology; therefore, the search strategy may not be reproducible.

CONCLUSION: OTs within hand therapy specialization focus on body function and ADLs and underevaluate areas of participation and environment.