07.02.2023 09.20 M & FU - 2959 - 05 - 22 Thumb injuries - professional standard, ver.

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05 - 22 Thumb injuries - professional standard

 
           
1) Standard
2) Diagnosis
3) Structure and framework
3.1) Legal basis
3.2) Audience
3.3) Visit for rehabilitation
3.4) Form / scope
3.5) Examination forms
3.6) Testing
3.7) Staff for the course
3.8) Place and physical framework/requirements for equipment in the gym
3.9) Educational and other material
3.10) Carriage
4) Process / content in the course
4.1) Startup
4.2) Testing
4.3) Training course
4.4) Possible complications / known genes
4.5) Closing
4.6) Follow up
4.7) Miscellaneous
4.8) Documentation
5) Quality measures
6) References and recommended literature
7) Prepared and approved

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1)  Standard
Rehabilitation of citizens with thumb injuries.

 
2)  Diagnosis
Wejlby operated/trapezioectomies, thumb fractures, ligament damage to the thumb, dislocations.

 
3)  Structure and framework
 (The structural dimension in work with quality)

 
3.1)  Legal basis
Section 140 of the Health Act https://www.retsinformation.dk/eli/lta/2019/903 

Cf. law, the citizen will be contacted within 4 days of receiving the rehabilitation plan and the rehabilitation plan is offered to
start within 7 calendar days or the day of discharge or as recommended in the rehabilitation plan.

 
3.2)  Target group
Citizens who, due to the above problems, have received a rehabilitation plan.

 
3.3)  Visit for rehabilitation
The hospital has the right to refer via the rehabilitation plan. Esbjerg Municipality determines the scope and method , as well as
what level the citizen must train at general basic or general advanced level.

 
3.4)  Form / scope
Time frame and team size* can be seen from indicative times approved by the Authority & Professional Development. 
There is flexibility in the efforts, as the standard times are indicative. 
It is an individual concrete decision in relation to the achievement of the goal, which is decisive for the scope. 
 *applies to Rehabilitation.

 
3.5)  Examination forms
The investigation form can be found in the Municipality's EOJ System, and the internal investigation form in D4 may be is used.

 
3.6)  Testing
The PSFS (Patient Specific Functional Scale) is used at start-up and end 

For 24 -hour stays, COPM is used at start and end.

It can also be considered relevant to use other tests in the rehabilitation process. This will be based on the circumstances
surrounding the individual course, including the citizen's wishes and goals for the rehabilitation course.

 
3.7)  Personnel for the course
the cleaning is divided into general basal and general advanced level.
 
Advanced level is chosen if there is complexity at the body level or if there is an extensive functional impairment, where more
efforts and an interdisciplinary approach are needed. 
For functional impairment where there is a need for more efforts and an interdisciplinary approach, emphasis is placed on
rehabilitative skills and experience rather than specific continuing education/courses. 

Basalt Level 
The occupational therapist who takes care of the rehabilitation at the basal level must, as a minimum: 
Have basic training as an occupational therapist and work in a professional environment where there is an opportunity for close
supervision in relation to citizens with the above hand problems.

Continuing education/courses (advisable) 

Basic courses in hand therapy 
MEM 
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Kinesio tape 

Advanced body level 

The occupational therapist who takes care of the rehabilitation at an advanced level must: 
Have a minimum of 4 years' experience as an occupational therapist and within these 4 years have a minimum of 2 years'
experience with rehabilitation within the field of hand therapy and must primarily work with interventions in relation to citizens
with the above hand problems.
The occupational therapist must be a member of the functional group for the hand therapy area in Rehabilitation, or have close
professional sparring/supervision from a member of this. It is expected that, as a minimum, via the functional group, but also in
addition, you keep your knowledge up-to-date regarding evidence in the area. 

Continuing education/courses (Minimum requirements for advanced level at body level): 

In order to train at an advanced level, it is required that the occupational therapist has participated in an orthopedics
course/relevant themed days within the professional area of ​hands within the past 5 years. 

The following continuing education/courses are advisable: 

Relevant themed days and teaching during DSF Hand therapy 
Extended courses in hand therapy 
Rail courses 
Shoulder course/elbow course 

Advanced level rehabilitation 

Have 4 years of solid practical experience as an occupational therapist and experience with rehabilitative and interdisciplinary
collaboration. 

Used where there is a need for more efforts and an interdisciplinary approach, emphasis is placed on rehabilitative skills and
experience rather than the specific continuing education/courses. 

In the case of the slightest uncertainty about the rehabilitation at the body level, contact Rehabilitation regarding supervision.

 
3.8)  Location and physical framework/requirements for equipment in the training hall
Room/screening for individual examination and treatment 
Desks for examination, tables for treatment, chairs that ensure a good sitting position
Training tools for both gross and fine motor skills as well as strength training 
Rail vessels and material for the production of individually manufactured rails in processing 
Prefabricated splints, edema gloves and putty for delivery 
Various small aids for testing 
Kitchen-like facilities with table and sink for ergonomic guidance. Furthermore, it would be preferable for there to be a
stove and a refrigerator 
Possibly. testing in own home in relation to transfer value

 
3.9)  Educational and other material
Anatomical arm or planks for use in guidance and instruction or skeleton forearm and hand 
Material for explaining pain management 
Printed program or electronic program for preparing exercise programs 
Business cards are handed out at the introduction to the training. The card contains the therapist's name, email address,
phone numbers and the option to note training times
 
3.10)  Transportation
Cf. applicable rules for transport. See procedure for transport

 
4)  Process / content of the course
(The process dimension in work with quality)

 
4.1)  Startup
On the start date, an individual occupational therapy examination is carried out with a focus on movement restrictions, oedema,
soft tissue conditions and level of function in everyday life. The rehabilitation plan and any restrictions are reviewed. 
Retraining is always carried out according to the regimes described in the citizen's GOP. Instruction in starting exercises is
included. The starting exercises can be delivered either in print or as a virtual training program 

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Goals and a plan for the rehabilitation are prepared together with the citizen, and informed consent is made in the municipality's
EOJ system. 

 
4.2)  Testing
The citizen completes the PSFS test at the first consultation.

For inpatient rehabilitation services, COPM is used at start-up.

 
4.3)  Training course
In a typical course, there will initially be a focus on splint manufacturing and adaptation, as well as ergonomics and pain
management. (2)
Loading will typically only occur after 6-9 weeks, and here it will have to take place carefully and gradually (2,4) 

Edema mobilization (pumping exercises, manual edema mobilization, kinesio tape) 

Training of joint mobility and stability (active-passive mobilization) 
Ergonomic guidance with the aim of optimally involving the hand in daily tasks. (2) 
Educational guidance that provides information on anatomical issues, as well as advice and guidance in relation to degree
of strain and pain management (4,2) 
Provision of splints or manufacture of splints for use in stabilization, pain relief, correction of wrong postures
Scar tissue mobilization (osteosyntized) (including transverse massage, scar tissue release, kinesiotape silicone/topigel)
Desensitization (brush, litter box) 
Strength training (putty, solitaire with springs, dumbbells)
Ongoing reassessment of the set goals

 
4.4)  Possible complications / known genes
Trapezioectomy: no full passive adduction for the first six months, as the scar tissue that must stabilize the joint must
mature. (5)
Ulnar collaterals equal. be loaded with care, as ruptures may occur
Wejlby: Attention that the MP joint does not hyperextend
 
4.5)  Termination
At the end of training, the course is evaluated based on a final examination including Tests. The goals that were set at the start
of training are followed up . The final status is prepared. 
The citizen is guided in the importance of continuing the training, e.g. in the home, in sports associations, gyms or other internal
training facilities in the municipality.
At the end of rehabilitation, the responsible therapist sends a closing note to the Hospital. Concluding
status is also sent to the citizen's general practitioner, if deemed relevant.

 
4.6)  Follow-up
If the citizen is called in for a check-up by the referring doctor, this appears in the Rehabilitation Plan. If necessary , e.g. lack of
progress, increased pain, the occupational therapist can arrange a check-up appointment with the referring doctor. In case of a
medical check-up during the rehabilitation course, a written status is sent to the referring doctor.

 
4.7)  Miscellaneous
An active effort is made to have a close collaboration with the referring doctors, physiotherapists/occupational therapists in
order to optimize the citizen's course. The collaboration takes place around the individual citizens, but also as a general
professional exchange of experience and mutual information about changed operating techniques and training principles.

 
4.8)  Documentation
Examination findings, test results, initiated training/treatment, ongoing evaluation and final status must be documented. 
Cf. applicable standard for documentation cf. Journal Order https://www.retsinformation.dk/Forms/R0710.aspx?id=201378

 
5)  Quality measures
(The quality dimension in work with quality)

Results
Specific
We are working towards:
That the stability of the wrist and joint mobility in the fingers is so good that the hand can be involved in daily tasks
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That the hand pressure force measured with a dynamometer is approx. 50% compared to healthy hand.
That the pain is reduced (M-VAS).
   
General
We are working towards:
That the citizen achieves the best possible functional capacity through targeted training and guidance
That the citizen, to the greatest extent possible, is able to resume his previous everyday life/occupation/leisure interests
or is clarified with adaptation in relation to this
That the citizen feels motivated and takes responsibility for his own training
That the citizen experiences satisfaction with the rehabilitation process.
That the citizen gains an understanding that it requires continuity in the process to achieve the goal and get a good result
That the citizen gains an understanding of the importance of continued training after the end of the course
That the citizen has received advice on post-operative training
 
Indicators
We are working towards:
That the set goals for the rehabilitation course have been reached 
That at the end the citizen has achieved a higher score on his PSFS compared to the start 
That the citizen has both subjectively and objectively achieved progress within the established training parameters has
been achieved

 
6)  References and recommended literature
1. Dekkers, Merete, Occupational therapy study , Munksgaard 2008. 
2. Runnquist, Cederlund, Sollerman, Rehabilitation of the hand 1 and 2, Student literature AB 1992 
3. Mackin, Callahan, Skirven et al: Rehabilitation of the hand and Upper Extremity, 5th edition, Vol, 1: Mosby 2002. 
4. Butler David; Moseley: Explain Pain , Noigroup 2013
5. Occupational therapy for patients with arthrosis in the root joint of the thumb operated with interposition arthroplasty .
Published by Region Nordjylland: Aalborg University Hospital: Head Clinic - Ortho: Physio- and Ergotherapy 
https://pri.rn.dk/Sider/12989.aspx
6. Danish Society for Hand Therapy - " National Measurement Standard Joint Measurement - Force Measurement " 
https://www.etf.dk/uploads/uploads/public/documents/Faglige_selskaber/EFS_Haandterapi/national_maalestandard.pdf
7. Competence profile for occupational therapists within hand therapy. Recommendations for occupational therapy knowledge,
skills and competences. Developed and prepared by Alice Ørts Hansen, occupational therapist, Postdoc, Odense
University Hospital and University of Southern Denmark and Susanne Boel, developmental occupational therapist, Herlev
and Gentofte Hospital. Published by the Occupational Therapist Association, 2020.
 
Also see 
PSFS (Patient Specific Functional Scale) at start and end
Hand surgery examination form 
Professional standard kinesio tape 

When the body says no - information about functional disorders, Committee for Health Information, 2012
https://funktionalelidelser.au.dk/fileadmin/www.funktionalelidelser.au.dk/patient_Pjecer/Na__r_kropent_siger_fra.pdf
 
 

 
7)  Prepared and approved
Prepared: January 2009
Last revised: February 2021 by Anja Østergård in collaboration with Hanne Bundsgaard and Rikke Vad Madsen, Håndgruppen.
Approved: March 22, 2021
Approved by: PTA/Authority & Professional Development

3159 Hand surgery examination form 1, Hand surgery examination form

3185 Kinesio tape - professional standard 2, Patient Specific Functional Status (PSFS)
3327 COPM - manual
3436 Patient Specific Functional Status (PSFS)
3518 Transport - rehabilitation according to the Health
Act - procedure

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