British Association of Hand Therapists

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Standards of Hand Therapy Practice in the Rehabilitation of Flexor Tendon Injuries

In 2013, a committee of surgeons from the British Society of Surgery to the Hand (BSSH) including representative hand therapists, set up a National Trauma Working Group to develop the first hand trauma standards of care. These standards were intended to inform commissioners, providers and patients to improve hand trauma services nationally.

As these standards would include postoperative rehabilitation, a separate committee of specialised hand therapists was also formed with the support of the British Association of Hand therapists (BAHT) to produce standards for therapists working in this field.

A group of eight hand therapists representing units from across the UK, with extensive experience in the rehabilitation of tendon injury convened in December 2014 with the aim of producing standards to compliment those of those set by the surgeons.

After careful discussion, taking into consideration differing practices and geographical and demographic variation across the UK, it was decided that evidence based standards should reflect this and facilitate audit, without specific details of individual treatment regimens.

See the process involved in setting the standards here

Definition:

These standards relate to the treatment of all flexor tendon injuries of the hand, wrist and forearm in all age groups.

Standards:    DOWNLOAD YOUR OWN COPY HERE

  • Following surgery all patients should be referred to a recognized hand therapist for assessment and formulation of a treatment plan. Access to accurate operative details is required.
  • Following a robust repair the selected rehabilitation regimen should be initiated ideally between 3 – 5 days and before 7 days.
  • The regimen of choice should include a protective splint and an active motion component to promote tendon glide.
  • Patients should be offered Hand Therapy on a weekly basis for at least six weeks.
  • The postoperative rehabilitation regimen should be supported by both written and verbal information.
  • Range of motion should be measured at 6 and 12 weeks and outcome measures taken as a core data set including a patient recorded outcome measure (PROM) at the point of discharge.

Implementation of these standards should be used to guide and advise therapists in the field. However, it is recognised that they may be influenced by factors including access to hand therapy, injury and patient characteristics and surgical management. Professional judgement , based on clinical reasoning will strongly influence the management and outcome following flexor tendon injury.

Our standards will be presented to the surgeons group at BSSH in October 2015.

It is anticipated that on the completion of writing of the surgeons standards, that the two documents will work together to enhance and compliment each other.

Evidence/Supporting Literature:

  1. European Federation of Societies for Hand Therapy (EFSHT), Hand Therapist Profile, Education Committee May 2012
  1. Yi Cao, J.B. Tang. Resistance to motion of flexor tendons and digital oedema. An in vitro study in chicken model. J. Hand Surg (Am) 2006 31; 1645-51
  1. Starr HM, Snoddy M, Hammond KE, Seiler JG III. Flexor tendon repair rehabilitation protocols: A systematic review. J Hand Surg Am. 2013;38:1712-7
  1. Peck FH, Bucher CA, Watson JS, Roe AE. An Audit of Flexor tendon Injuries in zone II and its influence on management. J Hand Therapy, 1996 Oct-Dec;9(4);306-8
  1. NHS institute for Innovation and Improvement, 2006-13. Quality and Service Improvement Tools Patient Information
  1. Valdes K, MacDermid J, Algar L, Connors B, Cyr LM, Dickmann S, Lucado AM, Naughton N.  (2014) Hand therapist use of patient report outcome (PRO) in practice: A survey study. Journal of Hand Therapy. 27 (4): 299–308.
 
Occupational therapists in private practice please read:

Dear Provider

Your invitation to join the Bupa Occupational Therapy Network

I am writing to invite you to join Bupa’s new Occupational Therapy Network, which will ensure patients receive high quality care in line with standards set by your professional body, agreed levels of service and good value for money.

By joining the network you will benefit from:

  • Eligibility to provide treatment to Bupa’s 3 million health insurance customers in the UK
  • A choice of ways to submit your invoices electronically, including Providers Online (bupa.co.uk/providers-online), our free website, which allows you to view pre-authorisations and use them to pre-populate invoice details, track the progress of your accounts and see when they will be paid.
  • Promotion of your practice through Finder (http://finder.bupa.co.uk/), our online guide to therapists, consultants, and hospitals which is available to Bupa customers, GPs and the wider public. You will have your own personal profile which you can update at your convenience.

The network will be underpinned by formal agreements which will ensure our customers have access to therapy services in a range of care settings close to where they live and work.

Apply online

Details about the network including joining criteria can be found by visiting http://www.bupa.co.uk/occ-therapy-join 

Once established, only therapists who are members of the new network will be eligible to receive Bupa funding for treatment provided to our customers.

We have prepared answers to some commonly asked questions which can be found on Providers Online. http://www.bupa.co.uk/occ-therapy-join. If you have any further questions please contact us by email at ProvMgtConsultants@bupa.com or call the Bupa Provider Management team on 08456 00 59 61*.

We look forward to receiving your completed application.

Yours sincerely,    

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Debbie Dickerson

Customer Services Manager

Bupa Provider Management Team

 
Hand Therapy St Thomas' Hospital
 
CSP Musculoskeletal Outcome Measures Workshop, 2011
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CRPS Clinical Guideline Full Version; Royal College of Physicians 2012

CRPS Clinical Guidelines; Concise Version; Royal College of Physicians 2011

CRPS Assessment Form - M Trickett (2011)

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Mirror Therapy in Complex Regional Pain Syndrome

Graded Motor Imagery in Complex Regional Pain Syndrome

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Miriam is happy for therapists to use these documents for inspiration for their own leaflets or to amend them to suit their own service needs.  However please consider that if you use these documents that you acknowledge and reference their origin as these leaflets represent hours and hours of time and study.

 

Tendon rehabilitation

BAHT Effectiveness bulletin of the rehabilitation of tendon injuries to the hand (2004)

 
CSP Injection Therapy Guidelines

Download the CSP Injection Therapy Guidelines document