Instructional Concurrent Session I
Amplifying the Patient’s Voice for Excellence in Hand and Upper Extremity Care: The Value of Patient-Reported Outcome Measures
Maximizing value—conceptualized as the outcomes that matter to patients relative to the costs of care—is the future of excellence in hand and upper extremity care. Patient-reported outcome measures (PROMs) are one way of amplifying the patient’s voice in clinical care for meaningful measurement and co-production of health. PROMs can assess aspects of self-reported physical, mental, and social health, including intermediate outcomes, such as self-efficacy or patient activation. They can be used for many purposes in clinical contexts, including risk stratification and prognostication, expectation setting, progress monitoring, collaborative goal setting, and decision making. Discussion of PROMs is timely as it aligns with regulatory initiatives, such as the Centers for Medicare and Medicaid Services “Meaningful Measures 2.0.” However, despite the role of PROMs in clinical practice, these measures are often underutilized or are viewed by clinicians as solely an administrative burden. This intermediate-level session will discuss the potential of PROMs for high-value clinical hand and upper extremity care. Topics will include selecting PROMs for meaningful measurement in hand therapy, use of PROMs in hand surgery, and applications of PROMs in pediatric hand care.
- Describe three benefits of capturing patient-reported outcomes for clinical hand and upper extremity care
- Discuss three considerations for selection of meaningful patient-reported outcome measures in hand and upper extremity care
- Compare and contrast applications of patient-reported outcome measures in pediatric and adult upper extremity populations
Clinical Manual Assessment of the Wrist
A patient enters your clinic with complaints of wrist pain that has been going on for the past few months. He reports his symptoms are getting worse and he is now having difficulty performing his daily activities. Where do you begin? This course will help to provide a systematic approach for the clinical evaluation of the wrist by describing the basic clinical examination process and interpreting the findings in terms of common pathology. Perform clinical testing to confirm the working diagnosis and/or rule out differential diagnoses to optimize clinical outcomes! Whether you are a newer clinician or experienced hand therapist, this course will improve your efficiency with evaluating your patients with wrist pain!
- Explain the basic clinical examination process to determine the presence of an intra-articular or extra-articular issue at the wrist.
- Perform clinical testing to determine the presence of a tendinopathy versus a tenosynovitis.
- Describe and perform the special tests to evaluate radial-sided versus ulnar-sided wrist pain.
Translating Science into Practice: Keys to Optimize Patient Outcomes using Best Evidence
It takes years for evidence to be consistently applied to patient care. This is referred to as the research-practice gap. This means that patients are receiving potentially outdated and less than optimal care that may result in poorer outcomes at excess cost. Translating research to clinical decision-making in patient care with upper extremity disorders can be challenging. Given time constraints in practice, evaluating available research evidence is impossible. Choosing scientifically validated methods of examination and treatment to best meet our patients’ needs is essential. Since, each individual we treat is unique, the care of our patients will be individualized. To best achieve optimal outcomes, hand therapists must be integrating their own expertise with the best available evidence that aligns with patients’ preferences and values. The Academy of Hand & Upper Extremity PT is working to bridge the gap between science and practice. Pre-appraised literature can accelerate the process of implementing the best available evidence in to patient care. This educational session will provide a framework highlighting sources of pre-appraised literature, describing how to use these sources to enhance clinical decision making, and understanding how this information can impact hand therapy outcomes, advocacy and reimbursement efforts.
- Describe the relationship between EBP and knowledge translation to align patient care with best practice standards according to best available evidence.
- List the benefits of reducing unwarranted variations in patient care including optimizing outcomes and improving reimbursement.
- Utilize clinical practice guidelines as sources of pre-appraised literature.
- Critically review hand therapy examination tools and interventions in order to provide the highest quality, evidence-informed, and economical care for the patient.
When a “Zebra” comes to Hand Therapy: Intervention for those with Joint Hypermobility - (Available on the Virtual Platform ONLY)
Joint hypermobility syndrome (JHS) is a group of diagnoses or conditions with joint hyper-flexibility and pain as the primary clinical presentation. Joint hypermobility may be commonly known as Ehlers Danlos Syndrome, and now broadened to include Hypermobility Spectrum Disorders, can also include Benign JHS, and Marfan’s Syndrome. All types are functionally limiting, with a higher female incidence and in which youth often present with a multitude of sports injuries before they may be diagnosed. The zebra is their logo (https://www.ehlers-danlos.com). Our clinic has seen a significant increase in patients with this diagnosis. By understanding more about this spectrum of disorders, we will improve our ability to provide excellent care to our communities, as this is a disorder that affects all aspects of our populations. This course will share our experience and outline how to evaluate, provide intervention from orthoses to exercises and will include the importance of coordination with inter-professional team members.
- Describe the pathophysiology of Ehlers-Danlos Syndrome (EDS) including clinical subtypes.
- Identify potential signs and symptoms of joint hypermobility-related conditions that may be identified on clinical evaluation.
- Design an effective home exercise/home occupation program to prevent further injury and maximize function.
- Identify appropriate bracing and orthotic options to support hypermobile joints, including when to use them.
- Identify other interdisciplinary team members' roles and when to refer.