Date Presented 03/26/20
This ongoing interpretive descriptive study explores hand therapists’ perspectives and practice patterns relative to upper-extremity pain. As per preliminary findings, participants emphasized biological contributions to pain but also acknowledged psychological influences and articulated a functional approach. The findings highlight the need for additional discussion of the value and role of biopsychosocial approaches to pain that extend beyond chronic low-back pain to the upper extremity.
Primary Author and Speaker: Brocha Stern
Additional Authors and Speakers: Jillian Yoo
Contributing Authors: Christina Couto, Hannah Jacobson, Samantha Hou, Allison Brekke, Karén Hinojosa, Armando Flores, Izabella Shimanova
PURPOSE: In the context of the opioid crisis, understanding clinicians’ beliefs about pain is critical to drive best practice (Nijs et al., 2013). Musculoskeletal pain is traditionally conceptualized from a biomedical perspective of structural pathology. However, modern pain science supports a shift to biopsychosocial approaches. To date, research on pain science has emphasized chronic low back pain (e.g. Cowell et al., 2018). Yet, even in acute hand conditions, psychological factors may play a role in pain (Hamasaki et al., 2018). The present study aims to explore hand therapists’ perspectives and practices relative to upper extremity pain.
METHOD: This interpretive descriptive study is part of a sequential explanatory mixed methods project. Participants were purposefully sampled for the qualitative strand based on their responses to an electronic survey of pain science knowledge distributed to members of the American Society of Hand Therapists. Survey respondents who expressed interest in the qualitative strand were screened for 1) primary practice in outpatient rehabilitation in the United States and 2) at least 10 hours per week of clinical hand therapy practice in the past 3 months. Invitations were extended to eligible respondents who received either high or low scores on the Revised Neurophysiology of Pain Questionnaire (Catley et al., 2013) with attention to enrolling a demographically diverse group.
The present abstract presents emerging findings from the initial six participants enrolled in the qualitative strand. Four were occupational therapists, and two were physical therapists. Four out of six were certified hand therapists. Their years of clinical experience ranged from <1 to >30 years. Each therapist participated in a remote semi-structured interview. One or two interviewers engaged with each participant using an interview guide developed for the present study. Interviews were recorded and transcribed. Data were thematically analyzed using a combination of open and a priori coding. Emerging themes were discussed by the investigators to achieve interpretive consensus and increase trustworthiness.
FINDINGS: Participants routinely described pain using a biological perspective, emphasizing tissue healing and describing structurally-directed interventions. However, they also acknowledged psychological factors, including cognitions and affect, with a related emphasis on patient education. Participants further highlighted dimensions of pain beyond intensity, valuing a functional approach to assessment and treatment.
CONCLUSION: The emerging findings suggest that hand therapists continue to emphasize the role of structural pathology in pain, yet they also acknowledge and use other lenses. Participants’ ongoing biological emphasis may be appropriate give the nature of the acute versus chronic conditions they primarily report treating. Nonetheless, a more explicit biopsychosocial focus may be necessary to optimize client-centered outcomes and prevent transitions from acute to chronic pain. Clinicians would benefit from additional training to support more holistic approaches to upper extremity pain management.
IMPACT STATEMENT: This ongoing study highlights the need for additional discussion of the value and role of biopsychosocial approaches to musculoskeletal pain that extend beyond the low back to the upper extremity. Occupational therapists who comprise the majority of hand therapists are positioned to be key players in this conversation.
References
Catley, M. J., O’Connell, N. E., & Moseley, G. L. (2013). How good Is the Neurophysiology of Pain Questionnaire? A Rasch analysis of psychometric properties. Journal of Pain, 14, 818–827. https://doi.org/10.1016/j.jpain.2013.02.008
Cowell, I., O’Sullivan, P., O’Sullivan, K., Poyton, R., McGregor, A., & Murtagh, G. (2018). Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: A qualitative study. Musculoskeletal Science and Practice, 38, 113–119. https://doi.org/10.1016/j.msksp.2018.10.006
Hamasaki, T., Pelletier, R., Bourbonnais, D., Harris, P., & Choinière, M. (2018). Pain-related psychological issues in hand therapy. Journal of Hand Therapy, 31, 215–226. https://doi.org/10.1016/j.jht.2017.12.009
Nijs, J., Roussel, N., Paul van Wilgen, C., Köke, A., & Smeets, R. (2013). Thinking beyond muscles and joints: Therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Manual Therapy, 18, 96–102. https://doi.org/10.1016/j.math.2012.11.001
