Tyler Stecher

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

Keywords

psychosocial, mental health, upper extremity orthopedic injuries, anxiety, depression, post-traumatic stress disorder

Abstract

Approximately one-third of people who sustain any type of acute orthopedic injury experience depression, one-quarter experience post-traumatic stress disorder (PTSD) and up to one-half have anxiety up to 10 years after the initial injury (Breazeale et al., 2021; Muscatelli et al., 2017). These psychosocial factors can have negative impacts on clients’ everyday life and occupations such as participation in social activities, return to work, and limit independence in daily activities (Vincent et al., 2018). Occupational therapists are often responsible for evaluating and providing intervention for individuals with upper extremity orthopedic injuries; more than 85% of certified hand therapists are occupational therapists (Hand Therapy Certification Commission, n.d.). Providing holistic care to clients through interventions for both mental and physical health demonstrates the unique view occupational therapy brings to the orthopedic setting and how occupational therapists can aid in increasing individual’s performance range (Dunn, 2017; Ikuigu, 2017). While occupational therapists are able to address psychosocial needs of clients, they are not always the main priority with orthopedic injuries. The benefit of addressing both physical and mental health following orthopedic injuries is continuously being studied to gain further information on best-practice in the area (Archer et al., 2022). With the practice gap between physical health and mental health rehabilitation in the field of orthopedic OT, a need to bridge that gap has emerged with a focus on implementation of both mental and physical interventions (Archer et al., 2022). The purpose of this project was to build a product to facilitate enhancing occupational performance outcomes for individuals experiencing upper extremity orthopedic injuries through the implementation of interventions targeting psychosocial factors in conjunction with orthopedic interventions in an outpatient occupational therapy setting, specialized in hand therapy. I partnered with occupational therapists, certified in hand therapy, at an outpatient orthopedic clinic in an urban town that serves both urban and rural populations. This aided in completion of a needs assessment to learn about the client population, client needs, current clinic needs, and educational experience to further inform the creation of the product. A literature review and an on-site needs assessment were conducted to guide the project’s development and build a useful product based on existing literature paired with community need. A literature review was conducted using journal articles from the Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Google Scholar, OT Seeker, Substance Abuse and Mental Health Services Administration (SAHMSA), Center for Disease Control and Prevention (CDC), American Occupational Therapy Association (AOTA), UND Scholarly Commons, and American Society of Hand Therapists (ASHT). Key terms included Occupational therapy, upper extremity, lifestyle redesign, Complex regional pain syndrome, mental health, orthopedic injuries, hand therapy, model of human occupation, ecology of human performance, and orthopedics. The information gathered from the literature review aided in the identification of the problem statement, demonstrating an increased need for addressing psychosocial factors in the orthopedic setting. The theory used to guide the creation of the product was the Ecology of Human Performance (Dunn, 2017). The Ecology of Human Performance is an ecological model within the occupational therapy profession that focuses on the interaction between the person, their contexts, the tasks available within their contexts, and how those interactions influence the person’s performance range (Dunn, 2017). The theory was used with the facets of the model in mind, working to address and enhance client performance range through increased task availability, the client’s contexts in which they participate in, and looking at all aspects of the person highlighted by the Ecology of Human Performance (Dunn, 2017). The completed product consists of a compilation and education on various mental health screening tools, a constructed tip sheet consisting of evidence-based occupational therapy interventions for psychosocial well-being to implement into the orthopedic setting, and a referral resource for continued mental health care specifically for the surrounding community. The product is intended to positively impact clients working with outpatient occupational therapists treating upper extremity orthopedic injures as to guide occupational therapy intervention planning for holistic care of clients. This addresses the stated problem as implementation of physical and mental health interventions are suggested with the use of the created product.

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