Occupation-centered practice in hand rehabilitation using the experience sampling method.

This article Wt!S acceptedfin publication November 3, 1997. I mplementing occupation-centered approaches in hand rehabilitation has been uncommon because this specialty has been dominated by biomedical approaches. However, some trends suggest that the practice of occupational therapy in hand rehabilitation is changing. Third-party payers are increasingly interested in final outcomes rather than in incremental increases in range of motion that do not represent functional progress (Foto, 1997). In addition, there is a trend toward treating more cumulative trauma cases and fewer acute injury cases (Wolfe, 1997). Acute injuries require specialized knowledge of the microcomponents of hand function to yield successful functional outcomes. In contrast, successful treatment of cumulative trauma injuries requires knowledge of psychosocial, contextual, and subjective factors in addition to knowledge of microcomponents (Blackmore & Hotchkiss, 1996; Johnson, 1993). As occupational therapists are expected to treat more clients with cumulative trauma injuries, there will be a growing need to monitor these factors because they will influence Outcomes. Despite this need, contextual and psychosocial factors are often missing from assessments used by occupational therapists (Dunn, Brown, & McGuigan, 1994; Foto, 1997). To address this problem, Park, Fisher, and Velozo (1994) have recommended that performance be assessed in the environment in which the client will be functioning, a view that is certainly consistent with the movement towards home health and community-based therapy (Baum & Law, 1997). However, occupational therapists specializing in hand rehabilitation are often unable to observe clients in their home and other community environments and need a method that captures physical, contextual, and psychosocial aspects of the rehabilitation process as they occur in the client's actual, lived environment. The experience sampling method (ESM) of data collection has the potential to enhance occupation-centered practice in hand rehabilitation by capturing the physical, contextual, and psychosocial aspects of functional return. This method is currently used by mental health clinicians and occupational therapy researchers (deVries, 1992; Hedricks, in press; Hedricks & Budetti, in press; Jacobs, 1994). The ESM, whose reliability and validity have been well-documented (Csikszentmihalyi & Larson, 1987), requires that clients carry an electronic signaling device (electronic pager, wrist terminal, or palm-top computer) and a booklet of identical questionnaires called Experience Sampling Forms (ESFs) with them as they go about their everyday lives. Clients are typically signalled at semirandom intervals throughout the day, at which time they