Kate Westphal

Date of Award

2025

Document Type

Scholarly Project

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

First Advisor

Karrianna Iseminger

Abstract

Introduction: In 2021, upper extremity (UE) injuries accounted for 21.3% of injuries by U.S. active duty service members (Mahlmann et al., 2024). Right or left shoulder pain were the top two diagnoses in active-duty service members between fiscal years 2016 and 2021, with overuse/non-specific injury being the most common UE injury (Isaacson et al., 2024). Pain often follows service members after discharge. It is estimated 66% of the 20 million Veterans in the United States experience musculoskeletal pain, and chronic pain is more intense in a Veteran population, limiting their ability to engage in preferred activities of daily living (Areias et al., 2024; U.S. Department of Veteran’s Affairs, 2021).

Problem: Occupational therapists saw 14% of all direct care UE musculoskeletal injuries in outpatient settings (Isaacson et al., 2024). Hand therapy specialists often see clients in outpatient settings. Ninety-eight percent of hand therapy specialists report that their clients identify pain as a symptom of UE injury (Stern & Howe, 2020). Pain is one of the most common outcome measures used by occupational therapists and hand therapy specialists (Grice, 2015; Takata et al., 2019). However, many occupational therapists and hand therapy specialists have limited pain science and neurophysiology understanding, and nearly one-fourth are unfamiliar with impairment-based assessments, making it difficult to provide effective pain interventions based on objective measures (Grice, 2015; Stern & Howe, 2020).

Methodology: The Ecological Model of Human Performance (Dunn, 2017) was used to guide this scholarly project. A comprehensive literature review was conducted on topics related to pain, pain neuroscience education (PNE), occupational therapy and pain, and current evidence-based practice in the hand therapy practice context. The current literature and information gleaned from key communities of interest were compiled to create the resulting product.

Results: The products of this scholarly project were therapist and client educational materials to educate therapists and clients about pain, pain neurophysiology, PNE, and reconceptualizing pain in order to promote PNE in UE rehabilitation in the hand therapy practice context with Veterans. This scholarly project supported the use of PNE in a hand therapy practice context with a Veteran population. This scholarly project allowed hand therapy specialists to implement PNE with their interventions to provide more holistic client care.

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