practice that includes professional-ism, empathy, trustworthiness, andreflection. A narrative approach inhand therapy requires the ability toabsorb, interpret, recognize, and bemoved by patients’ stories.

Methods: This paper reviews theliterature on narrative medicine andapplies narrative themes to handtherapy intervention in order to max-imize the integration of patientvalues into clinical care. Case exam-ples will demonstrate how narrativemedicine may look like casual con-versation between the therapist andpatient, but what is occurring is ac-tually quite powerful and poignant.This paper teaches specific commu-nication techniques that elicit per-sonal and meaningful informationfrom the patient. Case examples willshow how both the patient and theprovider participate in the exchange,with the provider listening actively,providing eye contact, reflecting,avoiding interruptions, and askingopen-ended questions. Patients feellistened-to when they have opportu-nities reflect on emotional aspects ofthe upper extremity problem forwhich they were referred. The caseexamples illustrate how use of narra-tive in hand therapy improves theircare.

Results: Narrative medicineteaches us that patients’ stories arenot trivial; that hand therapistsshould treat the patient’s illness ex-perience, not just the disease or im-pairment; and that patients’ medicalhistories represent only a part of theirrelevant stories. Hand therapy caseexamples will portray a scenario foreach of these themes and the narra-tive message of these examples willbe clearly explained.

Conclusions: The medical modeladvocates that therapists maintainobjectivity and professional distance.Hand therapists need to be structure-specific in order to treat diseases andinjuries safely and accurately. But wemaximize hand therapy’s relevanceand meaning to patients by acknowl-edging and incorporating the subjec-tive aspects of their experiences andstories. The practice of narrativemedicine in hand therapy allows pa-tients’ stories to unfold so that theirhand therapy care can incorporatetheir values and thus be more per-sonalized and meaningful to them.

e26 JOURNAL OF HAND THERAPY

Relevance: Narrative medicine ex-emplifies how much richness is illu-minated in the revealing of aparticular detail. When we listen topatients’ stories, we in effect collabo-rate with them to create new lifestories. Use of a narrative approachuncovers details that reflect patientvalues, thereby contributing to thepractice of evidence-based medicinein hand therapy.

OBJECTIVES

1. Define narrative medicine as itapplies to hand therapy.

2. Identify three ways to promotestorytelling in hand therapypatients.

3. Name three open-ended ques-tions to elicit patients’ stories.

INNOVATION INPRACTICE: ONE-STOPCARPAL TUNNELCLINIC

Donna Kennedy, ImperialCollege Healthcare NHS Trust,Cathy Ball, Jagdeep Nanchahal,United Kingdom

Purpose: Carpal tunnel syndrome(CTS) is the most common compres-sion neuropathy and in the UnitedKingdom in 2000, operative treat-ment was undertaken for 31% ofnew cases. In 2008, the NationalHealth Service Improvement Planstated that no patient should waitlonger than 18 weeks from referralto hospital treatment. In response, aOne-Stop Carpal Tunnel Clinic (CTC)was developed to provide timely,quality care.

Methods: The CTC is a treatmentand research clinic, investigating theoutcomes of the management of CTS.Prior to attending, patients receivepatient information sheet and com-plete questionnaires. At the clinic, aSurgeon completes an examinationand provocative tests and HandTherapist completes evaluation andnerve conduction studies. Nerve con-duction studies are performed utilis-ing portable electrodiagnostic device.Assessment findings and nerve studyresults are reviewed, a diagnosismade, and treatment administered

on the day. The CTC is innovative;conducted bi-weekly on Saturdaymornings, accommodating patients’schedules; assessment and treatmentprovided in one appointment, mini-mising visits and delays; treatmentand research clinic; hand therapistswork in extended scope role, performnerve conduction studies

Results: Patient satisfaction withthe CTC is evaluated with a ques-tionnaire with a high degree of satis-faction reported. Clinical outcome isassessed at three months with theBoston Carpal Tunnel Questionnaire(BCTQ), and at one year with theBCTQ, Michigan Hand OutcomesMeasure (MHQ), strength and sensi-bility. The BCTQ is a disease-specificquestionnaire for evaluating symp-tom severity and functional impair-ment (Levine et al 1993). Items arerated on a scale of 1 to 5, with lowerscores implying milder symptomsand less functional impairment. Apaired-samples t-test was conductedto evaluate the impact of treatmenton BCTQ scores. In the surgery group(n 5 43) there was a statisticallysignificant decrease in symptomscores from pre-surgery (M 5 3.10,SD 5 0.98)) to 3 months postsurgery(M 5 1.99, SD 5 0.94, t (42) 5 7.73,p , .0005). There was a large effectsize for symptoms (.587) and a mod-erate effect size (.35) for function. Inthe injection group (n 5 5), there wasa decrease in symptom and functionscores but this did not approach sta-tistical significance.

Conclusions: Results of a patientsatisfaction questionnaire and theBCTQ indicate a high level of patientsatisfaction and excellent clinical out-comes at three months post-surgery.

Relevance: Evidence of the effec-tiveness of hand therapists in ex-tended scope role; Increasedunderstanding of clinical outcomerelative to pretreatment symptom se-verity; Evidence of patient satisfac-tion with innovative service.

OBJECTIVES

1. To report on and increaseawareness of innovation inpractice.

2. To report evidence of handtherapists working in an ex-tended scope fashion, with

high degree of patient satisfac-tion and excellent clinicaloutcome.

3. Long term objective of CTCstudy is to increase under-standing of clinical outcomerelative to pre-treatmentsymptom severity, enablingbetter prediction of outcomeand communication of suchwith patients.

VALIDATION OF ANINTEGRATED MODELOF RESEARCHUTILIZATION INCLINICAL PRACTICE

Gail Groth, University ofWisconsin Madison, DorothyFarrar Edwards, Elizabeth D.Cox, Ruth Benedict, UnitedStates of AmericaCarpal tunnel syndrome (CTS) is adistressing condition for individuals,families, and communities. Whilenearly 50 clinical trials are conductedannually on CTS research, this re-search will not improve the lives ofindividuals with CTS if it is not used.Unfortunately, insufficient researchutilization is a widespread problem.A pressing need exists to ensure handtherapists use CTS research findings.

Purpose: To better predict and ex-plain research utilization among cer-tified hand therapists (CHTs) in orderto enhance the lives of individualswith CTS.

Methods: Using a cross-sectionaldesign, a mail survey was distributedto a random sample of 600 AmericanCHTs. The main study variables wereresearch use, intention, attitudes,subjective norms, self-efficacy, work-load and autonomy. Structural equa-tion modeling estimated the effects ofstudy variables on CTS treatmentdecisions. Competing models weretested to optimize fit.

Results: Three hundred and eightCHTs responded to the survey (55%).A competing model, the IntegratedModel of Research Use in ClinicalPractice (IMRUCP) was superior tothe Theory of Planned Behavior(Dx2 5 0.77, Ddf5 4, p5 .94) and ex-plained a large proportion of vari-ance in research use (R2 5 0.57). As

anticipated, intention (b 5 .65) andself-efficacy (b 5 .22) significantlypredicted research use (p , .00).Perceived usefulness (b 5 .54) andsubjective norms (b 5 .17) signifi-cantly predicted intention (p , .00).Autonomy (b5 .35) significantly pre-dicted self-efficacy (p , .00).Contrary to hypotheses, self-efficacy(b5 .35) did not significantly predictintentions (p 5.30) and workload (b5 .04) did not significantly predict re-search use (p 5 .44). Furthermore,subjective norms (b 5 .67) directlypredicted perceived usefulness (p ,.00) andworkload (b5 .19) positivelypredicted perceived usefulness (p 5.02).

Conclusions: Research utilizationin clinical practice is a complex yetpredictable phenomenon. Researchutilization was most strongly pre-dicted by intention followed by self-efficacy, subjective norms, perceivedusefulness, autonomy and workload.The IMRUCP provides a validatedmodel of research utilization applica-ble for researchers, policy-makersand practitioners.

Clinical Relevance: Individualswith CTS should be able to count onreceiving rehabilitation services thatmeets their needs and is based on thebest scientific evidence available.However, many individuals withCTS do not receive these services.As a CHT your use of research find-ings for clinical decisions is facilitatedby your own cognitions, the expecta-tions of your colleagues and by char-acteristics of your job. Likewise, thesesame factors can hinder your use ofresearch findings. The IMRUCPhelps organize important predictorsof research use to illuminate a pathfor change.

EXTENDED SCOPEHAND THERAPIST LEDACUTE TRAUMATICWRIST INJURY CLINIC

Gaylene Branstiter, St. Thomas’Hospital, Fiona Sandford,United Kingdom

Purpose: The purpose of settingup the extended scope clinic was forearly detection of traumatic ligamentdamage to the wrist. Hand surgeonswere noting late presentation of wristinstability to their clinics. This was

resulting in salvage procedures forthose patients.

Methods: Clinical Specialist thera-pists set up a therapy led clinic withdirect referral from Accident andEmergency. Patients present to A&Eand are first cleared of fractures. Ifthey continue with pain 10 days aftertheir injury they are referred andassessed within the therapy ledclinic. All appropriate investigationsare ordered including MRI’s, X-rays,dynamic ultra sound or nerve con-duction studies. Any patient with anacute ligament tear is referred di-rectly to a surgeon for management.

Results: From June, 2008 toMarch,2009, 52 patients were referred di-rectly from A&E. Diagnosed were 6fractures, 12 ligament tears, 8 gangli-ons and 8 other wrist conditions.Statistics continue to be taken andmissed fractures, ligament tears, gan-glions etc continue to be detected.Immediate treatment has lead to ashortened patient pathway and betterpatient outcomes.

Conclusions: Our results were sig-nificant and continue to exceed theoriginal intent of the clinic. We havedetected numerous scaphoid frac-tures and have risk managed manypatients. Clinical assessment, imag-ing and investigations have resultedin greater number of optimal patientoutcomes and satisfaction.

Relevance: Immediate posttrau-matic injury to a wrist can be difficultto assess. Waiting 10 days for theacute swelling to resolve can allow atherapist to perform specific ligamenttests and determine more specificareas of pain and injury. ExtendedScope practitioners can assess andinvestigate for early detection of lig-ament tears or missed fractures. Thisprovides more timely and appropri-ate management for patients withsignificant injury that may havebeen previously missed leading topoor patient outcomes.

OBJECTIVES

1. Explanation of ExtendedScope practice in the area ofacute traumatic wristassessment.

2. Methods and assessment usedwith patients, investigationsordered and clinical findings.

October–December 2010 e27