HAND THERAPY 1

LITERATURE REVIEW

HAND THERAPY AND EXTENDED SCOPE PRACTICE

Name

Institution

Professor

Unit

Date

HAND THERAPY 2

Introduction

This literature review focuses on the roles of hand therapy notably the linkage between

clinical and surgical practice for hand-related disorders. The literature review will engage the

current literature on the professional development of hand therapist and how it has changed over

the last 15 years. The selection of literature is evenly distributed for the time-based analysis. The

review will look into extended scope practice, barriers, and future application of hand therapy in

both physical and occupational therapy.

Key words

Hand therapy, Extended-Scope Practice (ESP), occupational therapy, physical therapy,

physiotherapy, Hand therapy roles, Continuing Professional Development (CPD)

Key word search for each section are explained in each section.

Hand therapy roles

The search keywords/phrase combination for this section was Hand therapy roles,

functions. The inclusion criteria included only peer reviewed journal articles. The articles were

chosen randomly with specific bias on relevance and British literature.

In the current dispensation, hand therapists perform more tasks than their counterparts did

a decade ago. According to Valdes, Naughton and Burke (2015), do general practice

consultancy, conduct diagnostics, refer patient for investigative tests, and person tests. Further,

hand therapists perform therapeutic functions that extend from clinical roles, they engage with

other specialists notably doctors to relieve them some routine duties, including and not limited to

HAND THERAPY 3

splinting, removal of surgical stiches and other aids, and scar management. These roles are

common among hand therapists working under surgical practitioners. Some of these functions

start before the surgical practice. Hand therapists perform physical exercises to patients in

rehabilitation. According to Toemen and Midgely (2008), hand therapists conduct tests notably

electrotherapy, conduction and ensuring organization of home-based care, self-care and assisted

care in hospital and outpatient environment.

Health professions tend to converge and the boundaries in practice are changing rapidly.

In the context of interlink ages of health practitioners, a hand therapist presides over orthopaedic,

and rheumatic of the hand (Daker-White, Carr, Harvey, Woolhead, Bannister, Nelson, 1999).

Further, hand therapists work with neuromuscular specialists in complications affecting nerves.

Daker-white and colleagues examined orthopaedic therapists and their roles in hospitals and

practice. They found out that orthopaedic therapists reduced direct hospital costs while also

reducing the burden on doctors and surgeons (1999 p.648). In the research, though orthopaedic

physiotherapists are specialists, the role of extended scope including other specialised training in

other fields. The research had a short follow-up despite being the only known controlled trial and

perhaps with a longer follow-up, they would have reported with more authority on key research

agendas. The authors concluded that trained physiotherapists are adequately capable of

conducting triage referrals (p.649). The use of therapists works to plug the hole where surgical

options may not work to rectify disorders. Lastly, the authors point at the lack of blinding in the

samples as a strength in ensuring practical application.

Health promotion is dependent on health service delivery. Timely health service delivery

does not only save time but also saves resources. Regarding time, Ellis and Kersten (2002) argue

that the purpose of extended scope practice which gives rise to the specialist group of therapists

HAND THERAPY 4

notably occupational therapists is a realignment of the healthcare system with an aim of saving

time lost by patients. Hand and occupational therapists work in pre and post environments

mostly in screening, surgical, and other clinical settings to conduct pre-examination or follow-up

on already existing case management. In such environments, occupational therapists work to

enhance the quality and speed of care to allow the patient to return to normal productive

functionality (p.119). In pre-examination stage, the authors observed that the hand and

occupational therapists provided timely recommendations regarding cases. The advice enhanced

the quality of intervention. In new clinics, therapists do initial contact with follow-up cases or

joint and nerves patients, conduct initial diagnosis and case review of hand and other injuries

(p.120-1). The authors used a qualitative research design, themes are well developed and no

notable research drawback emerged.

After surgical procedures, patients require assistive devices like continuous passive

motion (CPM). Hand devices like CPM are aimed at enhancing nerve, rheumatic or tendon

motion. Schwartz and Chafez (2008) studied the use of CPM in hand rehabilitation noting that

such use of devices may not have significant effects. Hand therapists however use such devices

in encouraging patients to exercise without putting pressure of individual musculoskeletal or

surgical conditions of the therapy. The authors conducted a retrospective research design, which

is prone to confounders and bias. The use of the research relies on the overarching agreement

with other researches on issues of importance to the study including the active benefits of

therapeutic rehabilitation. The research did not control for accuracy in measurement both

preoperatively and post operatively which provides another doubt for reliability. The research

however points to the important role that occupational therapists do before and after surgery and

possible popular use of locomotion devices in aiding rehabilitation and faster recovery of the

HAND THERAPY 5

patient. The research points to the underlying role of ensuring that patients return to normal

functional capacity within the optimally possible time (pp.261-2).

Occupational therapy borrows from other practice. In most cases, hand therapy works as

a cross-sectional practice. As Shin (2010) noted, the use of reflexology, acupuncture and other

traditional remedial medical practices is popular in occupational therapy culture and so in hand

therapy. Shin observed the use of such a traditional remedy the Koryo Hand Therapy. Using a

two-group experimental design to test quantitatively hypotheses, she found the use of Koryo

Hand Therapy beneficial to menopausal women (p.141). Although this research is not related to

occupational hand therapy, the relevance of the tackled topic shows the diversity and purpose of

hand therapy as a health profession. Notable in this research is the conclusion that Koryo hand

therapy can correct determinants of nervous imbalance relevant to rheumatic therapists. Such use

signifies the growing scope of handling rheumatic conditions like arthritis as a way of enhancing

dexterity among patients.

In accidents and emergency departments can cause strains in delivery of care. Peck and

Turner (2013) engaged in the development of therapy-led clinics and the functional capacities

under which they operate. Hand trauma injuries are common in daily activities and so are the

cases in hospitals. To remove pressure on hospital settings, creation of hand trauma clinics in

Britain as a system aid to extended scope practice is evident. In their evaluation of the

involvement of hand-trauma therapists and subsequent enhancement of their skill-set to support a

multidimensional notably musculoskeletal, orthopaedic and rheumatic disorders, enhances the

capacity, range of practice and support to other professions (p.91). Further, the authors

confirmed the value of occupational therapists in their ability to use their professional

development and experience to reduce cases referred for surgical procedures and their ability to

HAND THERAPY 6

handle the cases within their capacity using their gained skill-set. The research design is not

stated and the methods unclear, but the conceptual analysis and grounds of conclusion are

evident.

Education/continuing professional development of hand therapists

The search terms for this section were Education continuing professional development hand

therapists. The inclusion criteria was relevance and peer reviewed journal articles. 10 articles

were initially picked and only those that reflect significant issues worth addressing in the review

were picked.

At the beginning of the millennium, therapists had a high turnover (Collins, Jones,

McDonnell, 2000). The blame was placed on the lack of motivation in training, development and

functionality of the healthcare system. Healthcare system focused on profiteering moves making

it hard for occupational therapists whose work is labour and personnel intensive yet lacking in

financial incentive. The development of new professions such as hand therapy provided new

enthusiasm for prospective therapists and motivation for existing therapists (p.3). Using self-

administered questionnaires and a combination of mixed methods in analysis, the authors found

out that such new role within the healthcare system provided hope for those contemplating career

changes (p.3). Most of the concerns cited by therapists was that their efforts were poorly

motivated and rewarded. As a common understanding, the authors point tout the demanding

nature of therapy-based patient care requiring technical, innovative and extended scope of

approach. The advised the need to enhance professional development beyond the normal

extended scope practitioner-led training and development (p.11).

HAND THERAPY 7

Hand therapists training include capacity to perform four key functions in healthcare. The

therapist must be capable of using basic and fundamental science-based knowledge. The

therapist must be proficient in evaluation of upper extremities. Ability to form independent but

informed prognosis is imperative. In addition, the person must have capacity to organize

professional practice (Dimick, Caro, Kasch, Muenzen, Fullenwider, Taylor, ... & Walsh, 2009).

Because of this enormous range of expended proficiency, certification of hand therapists and

professional development has gradually changed and grown over time. Inclusion of a wide range

of proficiency aimed at making the therapist aware of the conditions necessary for consideration

before engaging the patient ensures that the level of innovativeness required is immense. Further,

in this paper, the authors noted the bulging professional diversity as a key ingredient to the

training programs and academic requirements of certification to work as a hand therapist.

Although most physiotherapists and occupational therapists are nurses, further requirements to

enhance proficiency in the upper extremity functions only serves to enlarge the professional

scope of the therapist (p. 372). This review focuses on the experiential position of existing

professional and certified practising hand therapists.

One of the professional development expected of a therapist is capacity to administer a

health facility. In such a move, the administration of a clinic by a hand therapist can enhance

capacity to create fully developed departments and care centres where referral to a hand therapist

is possible (Warwick & Belward, 2004). Alternatively, organization of such departments prove

efficient in handling and sorting out hand disorders. The author proved that having a consultant

wing and a hand therapy wing could enhance the suitability of cases handled by each (p.26). for

example, patients requiring both nerve conduction studies and electrophysiology diagnostic tests

from the general practitioner and therapist, respectively, can take advantage of having a one way

HAND THERAPY 8

care delivery. The patient will not have any more referral when such order of events is followed.

Unlike in other cases where any hand-related complication is referred to the therapists to conduct

tests. Such a case leads to more than one referral to ascertain the clients condition. The capacity

to align therapeutic care with consultant care in a general and specialised care is dependent on

the capacity and efficacy of the two departments (p.26).

While evaluating the need and the technical application of continued professional

development among and between increasing areas of physical and occupational therapy, French

and Dowds (2008) acknowledge the challenges envisaged by most professionals. While there is a

need to ensure that the professional capacity improves with increased research, inventions and

technological advances, there are barriers to extensive and practice-led professional growth.

Apart from professional growth, the value and application of research, reflective practice and

updated technical capacity to improve patient care is expected (p.193-5). The future lies in

overcoming the challenges of cost of development and sustainability of extensive specialization.

The authors of the research used literature review to examine what the other researchers

concluded. There is no particular concern preventing the use and adoption of this review work.

The authors conclude that development of specialist positions notably in the consultant level of

therapy, extended scope practitioner like hand therapists, and others find documenting

professional growth a challenge (p.195). The need to enhance a nomenclature to understand the

acquisition of specialist soft skills is recommended as a way of enhancing understanding of

individual professional position.

Though professional development is highly encouraged, core experience skills (soft

skills) that prove successful in therapy practice. In their research, Chipchase, Johnston and Long

(2012) advised on the growing overemphasis on professional notably academic development

HAND THERAPY 9

without focusing on its veracity. In their evaluation, every effort in healthcare system must be

evaluated on how it improves the quality of care and overall impact on the patient. They

evaluated the course content of most of the professional development courses noting the

continued emphasis on administrative, enterprise and commercial purposes. For example,

professional seek the reasons to refer to their consultant capacity mostly through professional

certification, but with little regard of ensuring consultant capacity in practice. Such issues

emerge as educational institutions venture with the popular consumerism to keep up with

competition (p.90). The review does not show how the review was conducted. The use and

acceptance of the source for this review rests on the fact that the paper is peer reviewed and it

allows one to develop the growing discontent on the quality of professional curriculum. The

authors conclude that there is a major disconnect between what is offered and what is required to

improve patient health outcomes. They however place responsibility on the practitioner to know

what their status is and how to align it towards enhancing patient outcomes (p.91).

A major component of professional development is adoption and alignment of research

findings in ones field in professional practice. In their research, Groth and Farrar-Edwards

(2013) envisaged a strong proportion of hand therapists who did not keep abreast with current

research on their field let alone try to use it in professional practice. It is hard for patient

outcomes to improve when research and development are not priorities. In this research, using a

randomized mail survey, the researchers proved that the use of research in practice is appalling

with the highest group having 45% adoption rates. They also observed the influence of age at the

expense of experience and demographic indicators as major differences between and among

group members (p.245). Though the research has its limitations based on the sampling and

possible bias, the population under scrutiny can adequately inform future areas of research

HAND THERAPY 10

notably different demographical characteristics. The four groups of certified hand therapists

evaluated notably analytics, pragmatic, sceptic and traditional groups exhibited poor adoption of

research findings with most remaining static to the status quo. Understanding the reasons for this

can help so that focus on improving research adoption can be realized.

How hand therapy has changed over the past 15 years

The search phrase was hand therapy changes over time History of hand therapy The

inclusion criteria was relevance and peer reviewed journal articles. Ten articles were initially

picked and only those that reflect significant issues worth addressing in the review were picked.

To understand these changes, the literature search focused on an inclusive criteria, research ideas

and review of the outcomes. Sources were picked selectively within the 15-year period, two in

every 2-3 years. The Elsevier ScienceDirect database was used to provide a bias of UK

journals.

Hand therapy is an extended scope practice that branched from physical and occupational

therapy. The hand therapists therefore generally have general practitioner knowledge like

occupational therapy and specialist skills in dealing with hand disorders. According to Amadio

(2001), the branch was informed by increased need for specialist skills in the field of physical

and occupational therapy. The argument is that, due to the growing medical cases in terms of

physical and occupational requirements of each case, the need to have specialist skills became

inevitable. During this time, general practice therapy was common with attention to occupational

therapy going to plug the need for therapists in biomechanical fields. According to Sullivan

(2001), the emergence of other neuromuscular, rheumatic and demands of the health system

ensured that such professional skills gained acceptance and development. Wide range of hand

HAND THERAPY 11

disorders emerged and the focus veered off the requirements and attentions of either physical or

occupational therapists. The development of a field that focused on Disabilities of the Shoulder,

Arm Hand (DASH) was gaining prominence then with attention on the disorders likely to lead

problems in the mentioned areas. The prominence of the hand in the field is obvious as it bridges

physical and occupational needs of a person. As evident in Sullivan research, the lack of a

universal modality in the practice signified a field in its development with greater promise and

emphasis on diversity of purpose (pp.66-7).

To plug growing need for efficiency in the health system especially in developed

countries of Europe and North America, Practitioner-led clinics become emerged (MacDermid &

Stratford, 2004) as various specialist practice-based fields gained acceptance (Peck, Kennedy,

Watson, & Lees, 2004). A major reason for the development of such practitioner-led clinics was

increase in hand trauma cases. As McDermid and Stratford observed the use of evidence and

research outcome in informing policy and system reviews can be assumed to play a part in such

development. However, they observed several challenges in research application including how

such clinics operated. Being a new idea, the need for extensive application of system, practice

and outcome evidence ought to be thoroughly synthesised. Since this research focused on

evidenced-based practice, it efficacy can be evaluated on the demands of pragmatism. It is

structural and thematically organized to warrant consideration and use in this review. Evaluation

by Peck et al. (2004) showed how responsive and effective such clinics were in improving

patient outcomes. The research showed a positive impact of practitioner-led clinics in both the

patient outcomes and in the efficiency of the whole system. The development and usage of

practitioner-led clinics further show resilience in moderating continuous care, which reduces

healthcare system pressure on demand for personnel involvement.

HAND THERAPY 12

According to Stanton (2008) in her review of Barr (2007) lecture, the development of

therapy as a holistic field, one that encompasses the mind, body and science, is inevitable. This

theoretical disposition of hand therapy emerged from the increased attempts and success in

incorporating historical therapies, notably eastern therapies like acupuncture, reflexology and

others. As evident in Kaiser, Bodell and Berger (2008) research, surgical methods may not

function fully without further assistance from therapy. Though science recommends the body,

that is the musculoskeletal, neuromuscular and other physical sides of hand disorders, a blend of

a holistic approach, one that seeks to innovate for case-by-case, remains paramount. Stanton

(2008) shows growing confidence in the acceptance of therapy-led approach as a way of

enhancing restorative capacity to function in an occupational setting. Kaiser et al. (2008) on the

other hand gives a similar response with emphasis on a stronger integration of the services for

patients. The aim is to improve patient outcomes. As expected, patients seek medical attention so

that they can lead a normal, fruitful and comfortable life. Without articulate attention to that

important goal, the efforts of individualized response may adversely undermine provision of

care. The two papers are peer reviewed and systematically organized to warrant acceptance for

this review.

Hand therapy tends towards rehabilitative functions of therapy. Current methods of

rehabilitation have improved to the extent of the use of hybrid methods. According to Liu,

Fujiwara, Shindo, Kasashima, Otaka, Tsuji and Ushiba (2012), such use hybrid methods of

rehabilitation are in use. While evaluating their efficacy, the authors observed the overwhelming

extended scope requirements for functional approaches towards care. The argument is that

rehabilitation of upper extremities have historically proved difficult and all efforts to change the

situation focus on the hybrid requirements of enhancement of the physical characteristics of most

HAND THERAPY 13

disorders. In the research, the use of newer rehabilitation approaches is emphasize. Further

research on the changes in the hand therapy includes the development of various approaches and

protocol. Despite dynamism and liberal protocols making sense to most, the referral and

continued resilience in the use of conservative protocols to respond to practice challenges cannot

be overstated. According to Wollstein, Wollstein, Rodgers and Ogden (2013) recommendation

and acceptance of a dynamic approach to care becomes evident. While evaluating the use of

hand therapy protocol among patients with lunate overloads, thy observed the possible need to

other protocols. This is a significant part of development of hand therapy as a collaborative field,

which seeks to enhance success in patient outcomes. Liu et al. (2012) shows how the use of

hybrid methods notably, HANDS and robots, and integration with other methods can enhance

occupational rehabilitation.

As more emphasis in medical care focuses on areas where profit can be achieved, a

growing risk area is that where specialized treatment is required without the incentive of bring

full recovery but improvement of quality of life. Children disorders, for example amyoplasia and

elderly citizens with chronic musculoskeletal and neuromuscular disorders can be time and

resource consuming. The expected outcome for the care may not bring the same level of

enthusiasm among caregivers. As Lake and Oishi (2015), observed, this cases represent a

neglected area but rowing in the community. The development of an extensive lifetime care

protocol involving a holistic and personnel dependant practice is required. Modern ideas about

the changing role of hand therapy to represent a strategic review of existing healthcare needs to

include neglected cases and to increase capacity and ability to function can help facilitate

improved outcomes for such patients. In the review of case study based on outcomes, the authors

show the need to improve elbow flexion among children with amyoplasia. Further, in the same

HAND THERAPY 14

theme of changing roles of hand therapists, innovativeness in improving quality of care is

emphasized by Peck-Murray (2015). The use of everyday items or he use of a home setting to

enhance quality of care as a way of removing the burden bestowed upon the extended scope

practitioners.

In this review of the last 15 years, three phases emerge, the phase where the role of hand

therapy is entrenched in other fields (Dependent), when it is independent, and when it seeks to

share some of its practice-based responsibilities.

Introduction of extended-scope-practitioner hand therapists

The original search included extended-scope-practitioner hand therapists The inclusion

criteria was relevance and peer reviewed journal articles. Ten articles were initially picked and

only those that reflect significant issues worth addressing in the review were picked.

Orthopaedics, rheumatologists, surgeons, general practitioners and other established

professional teams work hand in hand to develop a care protocol relevant for each case.

Therapeutic specialists also form part of this specialist group. Due to complications and desire to

align delivery of care, emergence of roles outside the traditional scope call for extended scope of

practitioners (Ellis & Kersten, 2001). The presence of these professional roles give rise to the

growth of the same professional requirements. The need is informed by the need to have relevant

knowledge and skill in such extension of service. As a requirement by most relevant bodies,

notably the British association of therapists, search extensive application comes with expected

training and professional growth. Normally certification is expected and recommended. The

reference term given to this professional is Extended Scope Practitioner ESP. Ellis and Kersten

(2001) further envisage the scope of practice and the field as one that is going beyond

HAND THERAPY 15

opportunistic roles, but also one that depends on the training needs of such practice. In their

research, they envisaged networking and professional orientation of the relevant fields to

enhance their service delivery. They arrived at this conclusion following a mixed method survey

using descriptive statistics to inform generalization. The research showed the extent of ESP

participation notably in non-medical or surgical clinic, rheumatology clinics, preoperative and

post-operative environments (pp.127-8).

Because of increased recognition of professional requirements and role-play among

physical and occupational therapists, and the confidence bestowed to them to manage various

disorders, ESP became possible. According to Gardiner and Turner (2002) who evaluated the

clinical diagnosis between ESPs and doctors, the role of ESPs is extensive depending on the

professional requirements of the scope of practice. Using a retrospective audit, they observed

that ESPs (physiotherapists) working in arthroscopy were more accurate that orthopaedic

doctors. The research was not independently audited which leaves room for possible bias. The

authors concluded that further acknowledgement of areas where ESs can assist should be sought

and even development of independent triage clinics facilitated by such ESP work (p. 156). The

challenge lies in enhancement of system level analysis to determine where ESPs can safely be

deployed.

Physiotherapists and occupational therapists forms the bulk of ESPs in UK. Their role

spans in various other medical, surgical and non-medical fields, which prompts evaluation of the

needs and requirements for one to function as an ESP. using a Delphi study, Ellis, Kersten and

Sibley (2005) looked at the roles and requirements of practice among ESPs. Workforce

shortages ranks high in current healthcare system requirements among the things that require

permanent solutions. One way of trying to bridge this disparity of need and availability of

HAND THERAPY 16

practitioners is partly filled by the ESPs. In the research, the authors found out the need to have

proper guidelines regarding deployment and roles expected is missing. The problem of

overreaching expectations among ESPs is real and a significant barrier in their development

commonplace. The authors used three questions to come out with the following outcomes. There

was a consensus that an ESP must have 3years of practice, know the scope of their abilities and

have specialist skills in the area of clinical ESP. Secondly, there was significant focus on the

professional capacity to administer and interpret investigative tests as a requirement to function

as an ESP. Regarding role parameters, the authors found emphasis on ability to run outpatient

clinics as the most significant requirement (p.84). ESPs receive support from other healthcare

stakeholders with the majority of the drivers towards ESP-led roles coming from existing

demands in the healthcare (Kersten, McPherson, Lattimer, George, Breton & Ellis, 2007). In the

same research, Kersten et al. (2007) view the ESP debate as a paradigm in the scope of practice.

The driver of the paradigm however does not reflect the holistic healthcare promotion approach.

They further identify patient outcomes, cost benefits, and informed research as the best drivers

for such a paradigm. The research uses a systematic review in an expanded Cochrane approach

to study the drivers growth of ESPs. In evaluating how ESPs work, Rose and Probert (2009)

enthused that ESPs work by altering patient pathways to care (p.96). By doing so, they require

experience, observation and training on specialist needs. The research looked at these issues in

depth. They stressed the need to develop specialist investigative skills of testing, creation of

mock pathways, training and assessment as stages of creation of an ESP clinic. The capacity to

function as assistive experts and independently to exercise leant clinical expertise is an important

stage of development for all ESPs.

Roles and barriers to practice currently and in the future

HAND THERAPY 17

The original search included Roles and barriers to practice currently and in the future for

hand therapists and Extended scope practitioners The inclusion criteria was relevance and peer

reviewed journal articles. Ten articles were initially picked and only those that reflect significant

issues worth addressing in the review were picked.

Development and encouragement of ESP roles faces significant barriers. According to

Huisstede, Fridn, Coert, Hoogvliet and European Handguide Group (2014), role definition can

impact negatively on the role an ESP plays in a clinical setting. Further, they noticed the growing

problem with definition of roles in a hierarchy. Even in clinical settings where clinical-led or

practitioner-led clinics, the concern about hierarchy of both protocol and practice is not always

developed well making the role uncertain. The research being a Delphi study shows the possible

issues likely to affect normal functionality in practice. The study is limited to the composition of

the group of participants of the research. However, if this was taken to mean that the group

reflects a multidimensional professional group expected to develop practice. Without a strongly

developed protocol, confusion and time wastage is inevitable. Hansen & Tromborg (2013) agree

with this concern about patient pathways. In their conclusion, they argued that evaluation of

measured functional outcomes relevant to the patient should be the guiding principle (p.2010).

They argue that the existing patient pathways guiding most ESP use tend to focus on the success

factors of practice. ESP being a relatively new protocol especially outside therapy-led practice.

In developing a patient pathway in hand therapy and occupational therapy, emerging

requirements include evidence-based and cost effective methods. Li, Westby, Sutton, Thompson,

Sayre and Casimiro (2009) identified significant concerns about the training requirements and

coordination of resources as considerable barriers to ESP practice. In the research, pursuing of

specialization and certification among and clinical experts seeking to venture in ESP does not

HAND THERAPY 18

support the fear of change and acceptance of extended role. Time management, training

requirements, coordination of resources and staff, fear of change and fear of taking more roles

and responsibilities, loss of job diversity and lack of mentors ought to be overcome to enhance

future development of ESP and related clinical practice roles.

The development of specific guidelines notably on matters beyond certification and

mostly on practice remains untrusted by existing functional bodies. A model of certification and

guidelines can work to alleviate deviation from acceptable levels of practice. Further, guideline-

setting efforts do not always collaborate with those of expected implementation always breeding

avenues of further concerns. However, with the implementation of nationwide and preferably

universal protocols, it can enhance the level of job satisfaction and self-efficacy among

upcoming professionals (Huisstede et al. 2014: Chipchase, Johnston & Long, 2012). Further

development of successful ESP role models can play a part in encouraging the grown of the

practice. Practical guidelines can set the tone for other professional seeking to venture into

creative fields, notably in ESP and hand therapy.

HAND THERAPY 19

Reference list

Amadio, P. C., 2001. Outcome assessment in hand surgery and hand therapy: an update. Journal

of Hand Therapy, 14(2), 63-67.

Chan, J., & Spencer, J., 2004. The usefulness of qualitative knowledge development in hand

therapy. Journal of Hand Therapy, 17(1), 1-5.

Chipchase, L. S., Johnston, V., & Long, P. D., 2012. Continuing professional development: the

missing link. Manual therapy, 17(1), 89-91.

Collins K, Jones M.L, McDonnell, A., 2000. Do new roles contribute to job satisfaction and

retention of staff in nursing and professions allied to medicine? Journal of Nursing Management

8, 3-12.

Daker-White, G, Carr, A J, Harvey, I, Woolhead, G, Bannister, G, Nelson, I 1999. A randomised

controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient

departments, J Epid Comm Health, 53, 643-650.

Dimick, M. P., Caro, C. M., Kasch, M. C., Muenzen, P. M., Fullenwider, L., Taylor, P. A., ... &

Walsh, J. M., 2009. 2008 practice analysis study of hand therapy. Journal of Hand Therapy,

22(4), 361-376.

Ellis, B, Kersten P., 2001. An exploration of the developing role of hand therapists as extended

scope practitioners. British Journal of Hand Therapy, 6(4), 126-131.

Ellis, B, Kersten P., 2002.The developing role of hand therapists within the hand surgery and

medicine services: an exploration of doctors views. British Journal of Hand Therapy, 7(4), 119-

123.

HAND THERAPY 20

Ellis, Kersten & Sibley 2005. A Delphi study of the role parameters and requirements of

extended scope practice in hand therapy. British Journal of Hand Therapy. 10(314), 80-87

French, H. P., & Dowds, J., 2008. An overview of continuing professional development in

physiotherapy. Physiotherapy, 94(3), 190-197.

Gardiner J, Turner, P, 2002. Accuracy of clinical diagnosis of internal derangement of the knee

by extended scope physiotherapists and orthopaedic doctors. Retrospective audit. Physiotherapy,

88(3), 153-157.

George, S., Bialosky, J. E., Bishop, M. D., Robinson, M. E., & Price, D. D., 2008. Effects of

manual therapy on pain perception in individuals with carpal tunnel syndrome. Journal of Hand

Therapy, 21(4), 428.

Groth, G. N., & Farrar-Edwards, D., 2013. Patterns of research utilization among Certified Hand

Therapists. Journal of Hand Therapy, 26(3), 245-254.

Hansen, A. ., & Tromborg, H., 2013. Increased use of the affected hand one and a half years

after surgical correction for cerebral palsy and subsequent intensive hand therapy. Hand

Therapy, 19(1) 1725.

Huisstede, B. M., Fridn, J., Coert, J. H., Hoogvliet, P., & European HANDGUIDE Group.

2014. Carpal Tunnel Syndrome: Hand Surgeons, Hand Therapists, and Physical Medicine and

Rehabilitation Physicians Agree on a Multidisciplinary Treatment GuidelineResults From the

European HANDGUIDE Study. Archives of physical medicine and rehabilitation, 95(12), 2253-

2263.

HAND THERAPY 21

Jack, J., & Estes, R. I., 2010. Documenting progress: Hand therapy treatment shift from

biomechanical to occupational adaptation. American Journal of Occupational Therapy, 64(1),

8287.

Kaiser, G. L., Bodell, L. S., & Berger, R. A. 2008. Functional outcomes after arthroplasty of the

distal radioulnar joint and hand therapy: a case series. Journal of Hand Therapy, 21(4), 398-409.

Kersten, P., McPherson, K., Lattimer, V., George, S., Breton, A., & Ellis, B., 2007.

Physiotherapy extended scope of practicewho is doing what and why?. Physiotherapy, 93(4),

235-242.

Lake, A. L., & Oishi, S. N. 2015. Hand therapy following elbow release for passive elbow

flexion and long head of the triceps transfer for active elbow flexion in children with amyoplasia.

Journal of Hand Therapy, 28(2), 222-227.

Li, L. C., Westby, M. D., Sutton, E., Thompson, M., Sayre, E. C., & Casimiro, L. 2009.

Canadian physiotherapists' views on certification, specialisation, extended role practice, and

entry-level training in rheumatology. BMC health services research, 9(1), 88-98.

Liu, M., Fujiwara, T., Shindo, K., Kasashima, Y., Otaka, Y., Tsuji, T., & Ushiba, J. 2012. Newer

challenges to restore hemiparetic upper extremity after stroke: HANDS therapy and BMI

neurorehabilitation. Hong Kong Physiotherapy Journal, 30(2), 83-92.

MacDermid, J. C. 2004. The quality of clinical practice guidelines in hand therapy. Journal of

Hand Therapy, 17(2), 200-209.

MacDermid, J. C., & Stratford, P., 2004. Applying evidence on outcome measures to hand

therapy practice. Journal of Hand Therapy, 17(2), 165-173.

HAND THERAPY 22

MacDermid, J. C., & Tottenham, V. 2004. Responsiveness of the disability of the arm, shoulder,

and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after

hand therapy. Journal of Hand Therapy, 17(1), 18-23.

Morris, J., Grimmer, K., Gilmore, L., Perera, C., Waddington, G., Kyle, G., ... & Murphy, K.

,2014. Principles to guide sustainable implementation of extended-scope-of-practice

physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers,

supports, and incentives. Journal of multidisciplinary healthcare, 7, 249-258.

Peck, F, Turner, S, 2013. The development of a therapy-led hand trauma clinic. British Journal

of Hand Therapy, 18(3), 87-91.

Peck, F. H., Kennedy, S. M., Watson, J. S., & Lees, V. C., 2004. An evaluation of the influence

of practitioner-led hand clinics on rupture rates following primary tendon repair in the hand.

British journal of plastic surgery, 57(1), 45-49.

PeckMurray, J. A. 2015. Utilizing everyday items in play to facilitate hand therapy for pediatric

patients. Journal of Hand Therapy, 28(2), 228-232.

Rose, R. L., & Probert, S. 2009. Development and implementation of a hand therapy extended

scope practitioner clinic to support the 18-week waiting list initiative. Hand Therapy, 14(4), 95-

104.

Schwartz, D. A., & Chafetz, R. 2008. Continuous passive motion after tenolysis in hand therapy

patients: a retrospective study. Journal of Hand Therapy, 21(3), 261-267.

Shin, H. S., 2010. Effects of Koryo hand therapy on serum hormones and menopausal symptoms

in Korean women. Journal of Transcultural Nursing, 21(2), 134-142.

HAND THERAPY 23

Stanton, D. E. B., 2008. The Mind, Body, and Science of Hand Therapy: Nathalie Barr Lecture

delivered at the ASHT Annual Meeting, Phoenix, Arizona, October 2007. Journal of Hand

Therapy, 21(1), 91-96.

Sullivan, J. L., 2001. Hand therapy: The healing touch with a touch of humor!. Journal of Hand

Therapy, 14(1), 3-9.

Toemen, A., & Midgley, R. 2010. Hand therapy management of metacarpal fractures: an

evidence-based patient pathway. Hand Therapy, 15(4), 87-93.

Valdes, K. A., 2008. Hand therapy & osteoarthritis: Efficacy of conservative treatment based on

literature review. Journal of Hand Therapy, 21(4), 427-428.

Valdes, K., Naughton, N., & Burke, C. J., 2015. Therapist-Supervised Hand Therapy Versus

Home Therapy With Therapist Instruction Following Distal Radius Fracture. The Journal of

hand surgery, 40(6), 1110-1116.

Warwick, D., Belward, P., 2004. Hand therapist carpal tunnel clinic, British Journal of Hand

Therapy, 9 (1) 23-26.

Wollstein, R., Wollstein, A., Rodgers, J., & Ogden, T. J. 2013. A hand therapy protocol for the

treatment of lunate overload or early Kienbock's disease. Journal of Hand Therapy, 26(3), 255-

260.