Evaluation of an occupational therapy-led hand clinic for subacute and chronic wrist and hand conditions in an Irish public hospital.

STUDY

DESIGN

Retrospective service evaluation

INTRODUCTION

Therapist-led clinics are evidenced to be safe, effective alternatives to consultant-led outpatient clinics for musculoskeletal conditions.

PURPOSE OF STUDY: To evaluate the impact of an occupational therapist (OT)-led hand clinic in one acute hospital in Ireland.

METHODS

Referrals received by Plastic and Reconstructive Surgeons were redirected to the OT-led hand clinic at the initial point of triage. Patients were scheduled for clinic appointments according to clinical priority and were evaluated using diagnosis-specific assessment proformas. Assessment included detailed history taking, investigating activities which worsen symptoms, and provocative testing where appropriate. When a diagnosis was unclear, further imaging/investigations were ordered. Following comprehensive assessment, patients were either discharged to the referring doctor, scheduled to the consultant-led clinic for further clinical assessment/surgery booking, or continued with hand therapy. Hand therapy interventions were multi-modal, and incorporated injection therapy (commenced 2022, 1-year after the service began). Outcomes included patient wait times, correlation of referred versus treated condition, patient satisfaction, outcome of assessment/treatment and patient perception of change using Global Rating of Change (GROC).

RESULTS

A total of 1072 patients were referred to the service from March 2021 to September 2024. Of those, 973 (91%) were scheduled and 99 (9%) declined an appointment. Approximately 91% of patients were seen within 6 months, compared to a previous average wait of 12-15 months. More than 31% of patients were treated for a different complaint than their referred complaint. Over 65% of patients did not require consultant plastic surgeon review and their full episode of care was managed by a single OT. Patients expressed high satisfaction and 97% reported improvements in their symptoms on GROC completion.

CONCLUSION

This OT-led clinic successfully reduced patient wait times, yielded high patient satisfaction and was an effective way to treat subacute/chronic wrist/hand pathology.