Date of Award

2022

Document Type

Scholarly Project

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

First Advisor

Anne Haskins

Second Advisor

Karrianna Iseminger

Abstract

Background & Purpose: The experience of pain is different for every client (Felman, 2020). There are various ways to feel and describe the pain (Felman, 2020). A maladaptive response to pain has been associated with increased pain and physical limitations in clients with upper extremity pain (Verhiel et al., 2019). Upper extremity impairments can result in the disruption of many activities of daily living and instrumental activities of daily living (American Occupational Therapy Association, 2014). Clients with upper extremity pain often resort to maladaptive coping strategies, such as catastrophic thinking (Verhiel et al., 2019). The most common psychological factors related to upper extremity pain include anxiety, depression, pain catastrophizing, and problems related to work and sleep dysfunction (Hamasaki et al., 2018). Despite the significance of upper extremity pain, many therapists do not formally address the psychological factors of pain. Some occupational therapists may lack confidence in addressing the psychological factors due to the social stigmas of mental health symptoms, the lack of time, and inadequate training about how to address psychological factors of upper extremity pain (Knaak et al., 2017; Vranceanu et al., 2017). The purpose of this scholarly project was to develop a product to address the needs of occupational therapy clients demonstrating psychological factors of pain related to upper extremity conditions. Based on best-practice evidence and models of practice, this scholarly project used the findings from the literature review to develop a guide that will aid occupational therapists with psychologically based interventions to address the psychological factors of pain with upper extremity conditions.

Methodology: A needs assessment was conducted through a review of the literature to determine the needs of clients who are experiencing both pain due to upper extremity conditions and psychological symptoms that accompany that pain. PubMED, CINHAL, ClinicalKey, SAGEPub, Elsevier, and PsycINFO were searched using such combinations as: upper extremity pain AND psychological interventions AND occupational therapy, cognitive behavioral therapy AND pain management, cognitive distortions AND pain, Healthy coping skills AND pain. The Model of Human Occupation (MOHO) (Clifford O’Brien, 2017) was used to guide the creation and intended use of the product to assist occupational therapists in addressing the psychological factors of the pain of clients with upper extremity conditions. This model was applied to understand how the psychological factors of upper extremity pain can affect a client's volition, habituation, performance capacity, and occupational identity (Clifford O’Brien, 2017). This scholarly project was informed, too, by a concurrent doctoral experience placement in an outpatient orthopedic practice setting.

Outcome: This project resulted in a 4-part module for occupational therapists to use to address the needs in the areas of psychological impacts of pain for clients with upper extremity conditions. The target population is clients across the life span with upper extremity conditions who receive services in an outpatient occupational therapy orthopedic setting. This product includes intervention information to address the red flags of pain, cognitive distortions related to pain and restructuring pain thoughts, relaxation techniques, and learning to accept living with pain. This product will help occupational therapists establish specific needs and priorities of their clients’ concerning diagnoses and pain management. The product intends to add an important dimension to intervention, maximize the overall occupational performance (Clifford O’Brien, 2017), and contribute to the health and well-being of clients with upper extremity conditions.

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