Date of Award
Master of Occupational Therapy (MOT)
Anne M. Haskins
Arthroplasty -- rehabilitation; Carpometacarpal Joints -- surgery; Occupational Therapy -- methods
The carpometacarpal (CMC) joint is located at the base of thumb and, functionally, is the most important joint within the hand due to its extensive mobility and the importance it has on the dexterity of human prehension. Due to the hypermobility and high degrees of utilization of the CMC joint, it is a common area for increased pain, joint disease, and the development of arthritis. Arthritis can be a debilitating condition as it is associated with instability, deformities, and limited range of motion, which all impact engagement in activities of daily living and meaningful occupations. When conservative treatments and non-surgical interventions have been exhausted, in efforts to increase joint function and decrease pain, surgical intervention is often implemented, followed by rehabilitation. Presently, there is a lack of a research regarding the implementation of occupation-based treatment as the typical approach to treatment has been biomechanically based. Despite the general research of the benefits utilizing occupation in the treatment process, there is limited evidence regarding the use of occupation-based activities following a CMC joint arthroplasty.
The purpose of this scholarly project was to develop an intervention protocol that utilized “occupation” as a medium in the therapy process for clients who have undergone a CMC joint arthroplasty. Traditionally, the biomechanical approach used intervention methods focused on improving range of motion, strength, and endurance. However, research regarding the use of occupation has provided support that inclusion of occupation can improve physical impairments (similar to the biomechanical approach), in addition to enhancing self-efficacy, self-esteem, motivation and role engagement. Three biomechanical approaches were identified through research which were used, analyzed, and integrated to form one universal approach to intervention. Occupation-based activities selected for the purpose of this protocol were carefully assessed and analyzed to correlate with the established biomechanical approach.
Following a thorough review of literature to assess current rehabilitation protocols and approaches utilized in practice, it was determined that there was minimal focus on occupation and occupation-based interventions. The Model of Human Occupation (MOHO) and Occupational Adaptation (OA) Model were utilized to assist in the development of this protocol as both emphasize the importance of occupation, in addition to motivation, contexts, habits and routines, roles, and adaptation. This protocol was developed to be a clinical guide that is easy to use in practice that can be implemented in conjunction with current biomechanical approaches for the rehabilitation of clients’ who have undergone a CMC joint arthroplasty.
Gillbertson, Joshua A. and Johnson, Christopher G., "An Occupation Based Intervention Protocol for Carpometacarpal Joint Arthroplasty" (2013). Occupational Therapy Capstones. 70.