Goal 2: Identify and utilize best practice techniques to assess and treat complex upper extremity conditions.
AOTAs Standard for continuing competence: Knowledge, Critical Reasoning, & Performance Skills
One of the reasons I pursued a clinical doctorate in occupational therapy is because I wanted to learn about the differences between assessment and treatment plans for the more complex orthopedic patients. I wanted to know how comorbidities affect healing rate and prognosis. Before I started the OTD program at NYU, I embarrassingly made two mistakes, that I now adjust for in my treatment planning and evaluations. One, I would treat similar populations the same, for example, I would treat a patient with wrist pain and rheumatoid arthritis the same as I would treat someone with wrist pain with a history of lymphedema. Second, I would not effectively assess a patient; I took a thorough occupational history, including collecting all relevant past medical history, but I did not do anything with that information. I did not process how comorbidities affected my plan of care. My two artifacts associated with this goal, the systematic review and clinical tool: how knowledge translation informs practice, respectively improved my ability to assess and treat complex conditions of the upper extremity.
My systematic review influenced how I assess patients. My topic on lymphedema and quality of life, following a mastectomy was prompted by an oncologist nurse reaching out to me looking for a rehabilitation site to send her patients to. Therefore, when I first started seeing them, I treated them like any regular orthopedic patient. However, they did not improve. Following the completion of the systematic review and my course work, I learned how important it is to understand how their medical history affects their quality of life. I used Self-Determination Theory to understand the need of my patients to be autonomous, competent and relate to their peers. I learned that this populations' body image, roles, and confidence are significantly affected, which limits their autonomy and competence. Furthermore, their immune system is not functioning at full capacity and thus they are not able to return to work and leisure activities and therefore do not feel related to their peers. With this information, I now change how I approach this population during the evaluation. I set more realistic goals based on their immune system functioning and desire to be independent. This population is affected by fatigue and low endurance, therefore I will set short term goals to focus on compensatory techniques to improve their functioning immediately, then focus on remedial strategies for long term goals. This allows these patients to regain their roles and independence as soon as possible; and allow them to be autonomous and competent in successfully completing self-care tasks. In addition, I will screen for depression/anxiety and make a referral to social work if necessary. And thus, allowing then to achieve their basic needs according to Self-Determination Theory.
The clinical tool: how knowledge translation informs practice, transformed how I treated patients. This artifact stemmed from peer feedback that I received on my competence project. In a section of my competence project, I created evidence tables with the newest, available research for efficacy of orthotics for specific conditions, similar to evidence tables we created in Evidence-Based Practice. I received feedback to condense and provide instructions on what to do clinically based off of the research (see Screwdriver, goal 3 for more detail). I transformed this information via knowledge translation, and educated the therapist on “what the evidence tells us”, and then “what to do with that evidence.” I am proud of this chart because it will be used in my clinic. It provides options of types of orthoses that are recommended based on the evidence, but prompts the therapist to use their clinical experience to ultimately make the decision. Therefore, the main lesson I took from this artifact was how to condense the evidence and use it in treatment. Prior to creating this guide and my coursework in the OTD program, I was not effective at analyzing the research. In Evidence Based Practice and Advanced Assessment for the Treating Therapist, I learned how to assess quality of evidence. Now, when reading multiple articles, like I did in both the systematic review and clinical tool: how knowledge translation informs practice, I weight each article based on quality, add up all the research and get a final outcome. I then can apply that information into a treatment plan to get the best outcomes.
These two artifacts have respectively improved my ability to both assess and treat complex upper extremity conditions.
Continue reading to goal 3: Screwdriver: hand tool that functions as a stabilizer