In 2003, 40% of participants in-dicated severe arthritis pain pre-instruction, compared with 11%post-instruction. Perceived confi-dence in utilizing pain management,activity modifications, and stressmanagement increased by 19.8%after completing class. Participants,perceived abilities to communicatetheir health needs to their doctorincreased 21.9% following class.

Individualized arthritis servicesare provided in our hand therapyclinic upon physician referral, incor-porating splinting, home programs,and activity modifications in addi-tion to self-management instruction.Although outcome studies have notbeen utilized in individual cases,patients’ response to a combinationof biomechanical and self-manage-ment interventions has been positive.

Conclusions: Occupational andphysical therapists will increasinglytreat patients with arthritis as fre-quency of occurrence increases in theU.S. population. Evidence-based ar-thritis education can be effectivelyutilized in both group and individualsettings to broaden therapists’ ap-proach to arthritis treatment. Ourlocal outcomes compared favorablywith national studies conducted bythe Stanford Arthritis Center, indi-cating decline in perceived pain andincreased self-efficacy, which per-sisted over time.

Relevance to hand therapy: Handtherapists already possess the knowl-edge base to be arthritis educators forgroup and individual programs. 36states in addition to Oklahoma areparticipating in the National ArthritisPlan, so public health resources areavailable to therapists seeking train-ing as arthritis educators. Our mar-keting efforts to educate physiciansabout our special arthritis serviceshave increased our patient referralsfrom primary care physicians andrheumatologists, in addition to af-fording us media exposure throughnewspaper articles and televisionappearances.

Predictors of Time Lost from Work

Following a Distal Radius Fracture.

Joy C. MacDermid, PT, PhD, Robert S.Richards, MD, FRCSC, James H. Roth,MD, FRCSC, Robert McMurty

A cohort of 145 patients who wereemployed and experienced a distal

radius fracture were identified attheir initial visit to hand clinic. Thefollowing variables were determinedfor all patients: age, sex, educationallevel, smoking status, injury compen-sation status, occupational use ofhand, energy of injury, dominanceof injury and baseline self-reporteddisability (Patient Rated Wrist Eval-uation [PRWE], Disabilities ArmShoulder Hand [DASH], and ShortForm [SF]-36). Radiographic injuryseverity (pre-reduction radial short-ening, dorsal angulation, and AOfracture type was obtained for 85patients. Patients were followed upat regular intervals (two, three, six,and 12 months) to determine theirwork status. Physical impairment ofgrip, motion, and dexterity at threemonths was measured. The averagenumber of weeks lost from work was9.4 (SD = 9.3; range = 0–44, median= 6). Significant correlates withlost time from work included:occupational demand, self-reporteddisability, workers’ compensationstatus, radiographic displacement,and grip/motion at three months. Astepwise multiple linear regressionindicated that 28% of the variation inlosttime could be explained at base-line on the basis of the DASH score,occupational demand, and SF-36score. When radiographic variableswere included (n = 85 patients) inmodeling, 44% of the variation inlosttime was explained by PRWE,workers’ compensation status, radialinclination, occupational demand,energy of injury, sex, and age. Pre-diction from three-month clinicaldata (self-report better than impair-ment) was more accurate than frombaseline data. Time lost from workafter a distal radius fracture is highlyvariable. Patients who use their handmore at work, or are on workers’compensation, report higher initialpain and functional problems and,with more severe displacement, canbe expect to have the highest lost-time.

Use of the Functional Dexterity Test

for Outcomes with Thumb Aplasia.

Kimberly Goldie Staines, OTR, CHT,David Netscher, MD, Ramsey Majzoub,MD, John Thornby, PhD

Purpose: Outcomes for childrenwith congenital hand deficienciesare difficult to conclude due tolimited available research on handfunctional dexterity, strength, andperceived deficits in children. Ourpurpose in this study was to use theFunctional Dexterity Test (FDT), ob-jective evaluation, and evaluation ofperceived deficits to establish func-tional outcomes post index polliciza-tion.

Methods: We used several objectiveevaluations of strength and handdexterity to evaluate outcomes on12 hands (10 children with indexfinger pollicization) as comparedwith normally developing childrenbased on recently published results,including the FDT. Evaluated chil-dren were 3 to 12 years of age, were 1to 10 years post pollicization, anddemonstrate no upper extremity de-ficiency with exception of the hand.Study evaluation included grip andpinch strength, total active range ofmotion (TAM), and dexterity [includ-ing FDT and Jebson Hand FunctionTest (JHFT). In addition, parentswere asked to complete a quantitativeinterview related to their child’shand appearance, perceived func-tion, and social perceptions. TheFDT was easily administered in chil-dren 3 and older. The JHFT had to bemodified by excluding two subtests

82 JOURNAL OF HAND THERAPY

Handling ‘‘Difficult’’ Hand Therapy

Patients. Cynthia Cooper, MFA, MA,OTR/L, CHT

Ideally, the hand therapy patientand the hand therapist have similargoals. Also ideally, the patient at-tends therapy as scheduled, partic-ipates in the care, is compliant, and

makes clinically appropriate re-quests. But when this is not thescenario, the patient–therapist rela-tionship may degenerate. This clini-cal paper identifies characteristicsassociated with hand therapy pa-tients whose behavior may causethem to be labeled as ‘‘difficult,’’and provides strategies and recom-mendations for handling such situa-tions. Literature on the ‘‘difficult’’patient is reviewed. Models ofpatient relationships (paternalistic,informative, interpretive, and delib-erative) are described. Hand therapycase examples are offered, illus-trating ways to promote effectivepatient–therapist relationships in sit-uations that could otherwise be chal-lenging and unrewarding.