Occupational therapy and/or physiotherapy services following a traumatic hand injury for people who live in rural and remote locations

Kingston, Gail Ann (2014) Occupational therapy and/or physiotherapy services following a traumatic hand injury for people who live in rural and remote locations. PhD thesis, James Cook University.

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Despite growing evidence regarding access to health care services in rural and remote areas, there has been limited research on the provision of specialist allied health services for these populations, particularly hand therapy. Therapists (occupational therapists or physiotherapists) who specialise in hand injuries are required to have a thorough knowledge of anatomy, wound healing, biomechanics, and treatment protocols of various traumatic injuries. In metropolitan and regional areas therapists with these specialist skills (gained through further study or experience) provide treatment for a hand injury. However, rural residents, due to distance and the lack of specialist hand therapy services, often receive hand rehabilitation from generalist therapists.

The aim of this research was to explore service provision and propose a model of service delivery for occupational therapists and/or physiotherapists who work in Australian public health care facilities and provide intervention to rural and remote clients who have had a traumatic hand injury. This research used a mixed methods approach with a complementarity purpose where overlapping but separate facets of the rural and remote hand therapy research area were explored.

A secondary data analysis compared rural/remote and metropolitan/regional populations to explore the commonalities and differences in functional recovery and rehabilitation following a traumatic hand injury. Qualitative interviews expanded the understanding about the client's lived experience of a traumatic hand injury. A survey of occupational therapists and physiotherapists in public health care facilities explored issues about patient care and staff professional development needs. A feasibility study was also conducted to determine if DVD technology could enhance compliance with a home exercise program for improvement of rehabilitation outcomes.

Findings show that regardless of residential location, a traumatic hand injury can result in stiffness and pain and affect work, leisure and day to day activities. Incorporating activity and occupation in rehabilitation programs as opposed to focusing on strict protocols is an important consideration in the recovery process for rural and remote clients. Rural and remote patients in this research demonstrated resilient, rather than stoic, qualities. They valued the opportunity to return to activity and their paid employment and felt 'useless' when they were unable to do so. Rural and remote patients in this research were able to adapt, seek help and support, and look towards the future. They reported they were 'grateful' for the function they had and appreciated the opportunity to return to work.

The distance and expense in accessing health care services were identified as barriers that can further limit participation in functional activities. The cost of travel on the whole family was significant, with family members often required to take time out of their employment to drive the patients to what was usually only a 30 minute appointment.

Rural health professionals in this current research reported they were expected to undertake a broad range of hand therapy intervention such as splinting and exercises prescription. Of concern is the lack of access to professional development for hand injury treatment for rural health professionals. Rural and remote therapists in this research felt that they benefited from clinical supervision and support from experienced hand therapists to assist with relevant hand therapy interventions. Metropolitan health professionals highlighted the suitability of adopting a shared care approach. In this shared care approach, the metropolitan therapist provided formalised collaboration and support to rural and remote therapists with patient care.

Technology was viewed positively by patients and therapists who felt it would allow for increased communication and clarity of exercises. Many therapists believed it would have been useful to be able to have access to technology if a problem arose. Several patients felt that further complications may have been averted had they been able to contact a specialist. Therapists reported a reticence about replacing face to face contact, particularly with regards to hand assessment.

This research proposes a set of principles that can be adapted into services unique to the needs of individual organisations that provide hand therapy intervention for rural and remote clients. Treatment planning needs to be flexible and collaborative, with realistic goal setting utilising the resilient qualities demonstrated by rural participants in this research. The use of technology can support face to face treatment and can address issues of access, provide improved communication, education and clarity regarding home exercise programs. Formal links between rural/remote and metropolitan therapists is recommended to address issues of skills development, professional support and supervision in hand injuries. This research provides evidence for collaborative service delivery with rural and remote clients who have a traumatic hand injury.

Further exploration and research into the use of a shared care approach for hand therapy to rural and remote patients is strongly recommended to determine both the suitability and applicability within the occupational therapy and physiotherapy professions. Research that investigates technologies, other than DVD, that can be used when recommending home exercise programs, or to facilitate communication between therapists, is also recommended. This research confirms and adds to previous research regarding the contextual factors that impact upon service delivery in rural and remote areas and encourages therapists to review and potentially change their practice for improved outcomes with rural and remote clients. The current research has also recognised gaps in current services, ways to address these gaps and opportunities for further research into, and the development of, occupational therapy and physiotherapy services for rural and remote residents who have had a traumatic hand injury. Given the ongoing changes to health services in Australia and the increasing availability of technologies, it is timely that these recommendations are acknowledged through the development of policies and procedures for the provision of services for rural and remote residents.

Item ID: 39231
Item Type: Thesis (PhD)
Keywords: activities of daily living; Australia; compliance; DVD; functional outcomes; hand injuries; hand rehabilitation; hand therapy; hand trauma; home exercise programs; pain; resilience; rural and remote; traumatic hand injuries; work
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Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 5: Kingston, G.A., Judd, J., and Gray, M.A. (2014) The experience of living with a traumatic hand injury in a rural and remote location: an interpretive phenomenological study. Rural and Remote Health, 14. pp. 1-12.

Chapter 5: Kingston, Gail A., Judd, Jennifer, and Gray, Marion (2015) The experience of medical and rehabilitation intervention for traumatic hand injuries in rural and remote North Queensland: a qualitative study. Disability and Rehabilitation, 37 (5). pp. 423-429.

Chapter 6: Kingston, Gail A., Williams, Gary, Judd, Jenni, and Gray, Marion A. (2015) Hand therapy services for rural and remote residents: results of a survey of Australian occupational therapists and physiotherapists. Australian Journal of Rural Health, 23 (2). pp. 112-121.

Chapter 7: Kingston, Gail A., Williams, Gary, Gray, Marion A., and Judd, Jenni (2014) Does a DVD improve compliance with home exercise programs for people who have sustained a traumatic hand injury? Results of a feasibility study. Disability and Rehabilitation: Assistive Technology, 9 (3). pp. 188-194.

Appendix A: Kingston, Gail, Tanner, Bronwyn, and Gray, Marion (2009) A pilot study evaluating a home exercise DVD for patients who reside in a rural and remote location. Journal of Rural and Tropical Public Health, 8. pp. 1-7.

Appendix B: Kingston, Gail, Gray, Marion A., and Williams, Gary (2010) A critical review of the evidence on the use of videotapes or DVD to promote patient compliance with home programmes. Disability and Rehabilitation: Assistive Technology, 5 (3). pp. 153-163.

Appendix C: Kingston, Gail, Tanner, Bronwyn, and Gray, Marion Alexandra (2010) The functional impact of a traumatic hand injury on people who live in rural and remote locations. Disability and Rehabilitation, 32 (4). pp. 326-335.

Appendix D: Bell, Joanna, Gray, Marion, and Kingston, Gail (2011) The longer term functional impact of a traumatic hand injury on people living in a regional metropolitan Australian location. International Journal of Therapy and Rehabilitation, 18 (7). pp. 370-381.

Date Deposited: 23 Dec 2015 07:09
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110321 Rehabilitation and Therapy (excl Physiotherapy) @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110317 Physiotherapy @ 50%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 50%
92 HEALTH > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services) @ 50%
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