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The Use of Psychosocial Services Post Hand and Upper Limb Injury and Trauma
Gregory A. Chown, OTD, BHSc
Alvernia University, Reading, PA

Purpose: The purpose of the study was to explore the use of psychosocial services by occupational therapists (OT's) and certified hand therapists (CHT's) who commonly work with patients sustaining a hand and upper limb injury.

Methods: A quantitative survey research design was implemented. A self-made questionnaire which consisted of questions in reference to hand and upper limb injuries or trauma, psychosocial services, psychological disorders, and the frequency of referral or use of psychosocial services was provided to 29 OTs and CHTs working in outpatient facilities in Pennsylvania, Maryland and New Jersey.

Results: The most frequently recorded frame of reference was the biomechanical. Only five of the 29 (17.2%) participants recorded utilizing psychosocial assessments. The most frequently reported psychosocial intervention used was massage (n = 21). The results revealed that 16 of the 29 participants referred to nine possible psychosocial services. However, the majority of the referrals were only ‘occasionally' or ‘sometimes'. Surgeons were reported as referred to the most by participants (M = 3.69, SD = 0.79) followed by family doctors (M = 2.81, SD = 1.05). OT's specialized in mental/behavioral health (M = 1.25, SD = 0.45), behavioral specialists (M = 1.31, SD = 0.48), and social workers (M = 2.31, SD = 1.30) were recorded with the least amount of referrals. The most frequently reported barrier to providing referrals to psychosocial services was restraints presented by insurance companies (n = 14), followed by minimal awareness by therapists (n = 11). Limited resources (n = 9), physician referral (n = 8), and cost (n = 6) were among the remaining frequently reported barriers. A Spearman rank correlation which examined the relationship between referrals by therapists and years of experience as an OT or CHT revealed a weak but significant correlation of -.322 and -.351 at the p < .05 level respectively. This reflected an indirect correlation where the less experience a participant had; the more likely they were to refer to psychosocial services.

Discussion & Conclusion:

  • Therapists appear to be biomechanically which may have an impact on outcomes.
  • The results emphasized the lack of psychosocial assessments, interventions, and referral services provided by OT's and CHT's post injury.
  • Psychosocial factors are not typically being addressed during the rehabilitation process and therefore have the potential to cause chronic psychosocial distress and dysfunction in occupational performance.
  • The practice and referral of psychosocial services is an important contribution to the recovery process.

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