Our hands are described as the “keys to the human world”, allowing us access to the everyday tools that facilitate the independent completion of critical everyday activities, such as: feeding, eating, touching, working, creating, etc.
When an individual has an upper limb injury, e.g. an amputation, it is a devastating event, resulting in physical and psychological impairment, which can have a greater impact, making the overall injury multi-layered. The physical aspects can relate to loss of movement, strength and hypersensitivity experienced around the injury and the psychological aspect can be demonstrated in loss of confidence related to the cosmetic effect, or the lack of belief that the injured limb can be used, all of which impact on the overall functional outcome.
The Rehabilitation Challenge
It was identified that cases were being referred and the specialist needs of these clients were not being adequately addressed. There was no specialist assessment and rehabilitation programme, with a direct focus on the restoration of function and return to work to support them. Rehabilitation plans were being issued with no specific recommendation for hand and upper limb intervention, which was having a direct impact on the clients’ engagement and motivation and restricting the overall success of the rehabilitation programme.
Discussing these cases with customers, Obair identified that hand and upper limb injuries were achieving poor outcomes, with limited improvement in independent function and reduced success in returning to work. The use of the traditional, more general therapy routes was very often unsuccessful. Treatment drift was experienced, which was costly, and insurers were dissatisfied by the outcomes and less likely to support further rehabilitation.
Obair Associates, part of Proclaim Group, is a specialist Occupational Therapy and Vocational Rehabilitation service.
Obair is well known in the marketplace for its innovation in assessment and intervention.
Anne Byrne, Clinical Director at Obair, is an occupational therapist who has been working in rehabilitation for 41 years in the UK and Canada and is a specialist in hand and upper limb rehabilitation.
Based on Anne’s experience, and working with Obair colleagues, they designed an objective and evidence based face-to-face Hand & Upper Limb Evaluation (HULE), delivered by specialist Occupational Therapists. Occupational Therapists are dual trained in physical and psychological health and are uniquely placed to work with clients demonstrating both physical and psychological impairment in function.
The HULE is an objective evaluation of the bio-psycho-social factors impacting on hand/upper limb function, which includes a brief overview of the main job functions and the demands of the job role.
One significant key outcome of the evaluation is that it establishes if the client has rehabilitation potential to improve function and the efficacy of current, and/or future hand and upper limb therapy. This is important, as it offers the client and their solicitor a clear direction for the on-going rehabilitation and facilitates the early consideration of alternative vocational options, if rehabilitation is ruled out.
The HULE evidenced exceptional outcomes and it was quickly recognised that there was a requirement to provide the therapy to realise the outcomes. From this, Obair designed sessional intervention services. Together, the HULE and the sessional occupational therapy hand interventions form Obair’s innovative Hand & Upper Limb Programme. For clients who demonstrate rehabilitation potential in the HULE, a comprehensive programme is provided, which will regularly be completed to meet goals within 3-4 sessions.
Integration with an Initial Needs Assessment (INA)
Building on the success achieved, Obair identified that if the HULE could be integrated into the start of the rehabilitation process, there was even greater potential for timely and effective rehabilitation outcomes for the client.
A joint HULE and INA (HULINA) was developed and piloted with great success for the client and all parties involved. It provides a more comprehensive assessment and earlier intervention for the hand and upper limb injury and the client rehabilitation outcomes are improved.
Managing through Covid-19
With the same innovative approach to the development of the HULE and HULINA, Anne and her team have redesigned the service to provide a virtual assessment and intervention sessions. These are supported by ‘assessment tool kits’ and items of rehabilitation equipment sent to the client prior to the assessment and rehabilitation sessions. This has proved highly successful and long-term the programme will include blended support of face to face and virtual.
This blended approach can often better meet the needs of the client and allow for greater flexibility in delivery of services and improved specialist coverage nationally.
This outstanding piece of innovative clinical work is changing lives and helping clients return to work in a timely manner and when otherwise considered unlikely.
The HULE and HULINA have proved highly effective with significant difference made to the client.
- Improved SMART Goals
The evaluation has enabled the practitioners/case managers to write SMART goals relating to the specifics of the injury and rehabilitation plan and, where further rehabilitation is not considered viable, early vocational goals can be included in the initial plan.
- Faster Access to Rehabilitation
The intervention sessions are evidenced and provided by specialists, which facilitates prioritisation of goals and more targeted intervention, and subsequently a quicker return to improved function in the upper limb. More so, where required, the concurrent psychological intervention provided by the occupational therapists encourages greater engagement and improved motivation of the client.
- Faster Return to Work
The programme ensures that the case manager can have positive and focussed discussions with an employer at the start of the rehabilitation. Being in a stronger position to engage with the employers at the outset means faster return to work. In cases where returning to the same job is not possible, discussions on alternative duties can start immediately.
- Tangible Results
From a data set of 114 cases, Obair has evidenced results of:
- An average of 10 weeks reduction in treatment duration.
- An average saving of £468 in treatment cost.
- An average saving of £457 in adaptation equipment.
Educating the Market
To support the education of the market, Obair Associates designed a free interactive training module.
Obair has delivered the training throughout the UK to solicitors and general and life insurers.
To access the training, please contact firstname.lastname@example.org
“Anny Byrne deserves all the credit there is to be given. She supported me from day 3 or 4 after leaving hospital. She helped me get back to work.
At the time, the doctor that did the operation on my arm said to me on my first visit back to him – What were the 3 things I wanted to be able to do. I said – play with my grandkids, get back to work and get back to driving. My consultant said I would get one out of the three and I proved him wrong. When he wrote his letter to Anne after the help he said, “Mr Joiner deserves everything he got and that is thanks to you”. If we were back to school days, she would get 10 gold stars a day not just one with all that she has done for me. There will never be another one of her”