Hand trauma and rehabilitation : the developemnt of an evidence based assessment framework
In the UK there is a concerted drive to deliver evidenced based, patient centred care.
Current hand therapy assessment might not reflect practice and policy recommendations
particularly in respect of explicit patient centred approaches. The study aim was to develop
an assessment framework, modelled on the ICF' to direct efficient and effective patient
1. Identify a baseline picture of UK hand therapy assessment practice
2. Explore patient perceptions of current assessment practice
3. Explore practitioner perceptions of assessment
4. Construct a framework to facilitate evidence based rehabilitation programmes
Purposive sampling and data and methodological triangulation were features of the studies,
1. A postal questionnaire used to survey current hand therapy assessment practice
2. Exploration of patient perceptions using a combination of assessment, self report
and interview (n=3), semi-structured interviews (n=10) and laddered interviews (n =
3. Exploration of practitioner perceptions using laddered interviews (n=5) and
structured interviews (n=3).
Data were analysed descriptively and using content analysis.
Clinical assessment was primarily at the impairment level. Various other 'bespoke' methods,
of questionable validity, were also in use. Inconsistent use of terminology was a potential
barrier to effective practice. Impairment-based measures did not reflect patient needs and
goals and discrepancies were noted between practitioner beliefs around assessment and its
The exclusive use of impairment measures for routine assessment is inadequate. An
assessment framework to facilitate reasoned and explicit practitioner choices was
developed, within which, patient partnership can be verified explicitly. The framework will
enable practitioners to demonstrate clinically reasoned, evidence based and patient centred