The type of hand therapy chosen for an individual can be based on various factors. These include the rehabilitation goals, the natural history and expected course of injury or condition, and patient preference. It is important to consider each factor related to a particular injury, condition, or pathology to facilitate each patient’s most effective management plan. The following is a brief discussion on the major factors that influence the choice in hand therapy modalities:
Goal Of Treatment
Clinicians should identify the goal of each patient’s rehabilitation plan before therapy. Each patient’s treatment plan should vary depending on the desired outcomes for each individual. For example, a patient diagnosed with Dupuytren’s contracture may have a goal of achieving flexion deformity correction if their daily activities and quality of life are adversely affected by their limited range of motion. On the other hand, a patient with arthritis may have a goal of pain management and avoidance of joint deformation.
Patient’s Natural History and Expected Course
The expected length of time that any given condition or pathology will last should be discussed before therapy. This discussion allows the clinician to identify the most suitable modality for the projected duration of the patient’s condition. For example, a patient with Carpal Tunnel Syndrome (CTS) may only be symptomatic for a few weeks following an acute injury or illness such as mastitis. In this instance, it would not be more beneficial to pursue intensive hand therapy modalities that focus on the upper extremity’s goal achievement and functional gains.
The treatment plan selected should reflect the patient’s preferences as much as possible. Patient preference can also be influenced by their previous experience with a particular type of therapy or response to previous intervention. For example, one patient may respond better to heat modalities, while another may function best with ice. Furthermore, some patients are sensitive to touch and require more aggressive physical therapy interventions, whereas others cannot tolerate this type of therapy.
Type, Stage, And Severity of The Injury
The type of injury (e.g., acute vs. chronic), the stage (i.e., how long it has been since the onset of pathology), and the severity (degree or extent of deformity or disability) should all be taken into consideration when choosing a hand therapy modality. For instance, in the early stages of an injury (acute phase), ice followed by compression may be most beneficial for pain management and limiting joint effusion while encouraging soft tissue healing. Once edema has subsided, heat modalities would be more appropriate to increase blood flow and tissue flexibility and prevent adhesion and scarring.
When choosing a hand therapy modality, clinicians must consider all factors associated with a particular injury or pathology. By understanding the natural history and expected course of a patient’s condition, as well as their preferences and goals of treatment, an effective management plan can be developed that will yield optimal outcomes for each individual.