Background

To address the various risks contributing to work-related pain and injury experienced by manual therapists, strategies including proper equipment, corrections in body posture/mechanics, reducing long work hours, ergonomically designed work areas, larger joints and/or adaptive tools for deep pressure/massage techniques have been suggested (Caragianis, 2002). As research shows that therapists report modifying treatment techniques, taking time off on sick leave, seeking intervention, shifting the specialty area, and decreasing patient contact hours as the major consequences of WRIs, it is recommended that therapists should develop specific preventive strategies and put more emphasis on the use of aids and equipment to reduce the risk of an unnecessary injury (Gyer, Michael, & Inklebarger, 2018).

While the utilization of therapy tools is under-researched, advanced technology-improved and instrument-assisted techniques are being more commonly used in outpatient clinics nowadays. Therapy tools, which include instrument-assisted soft tissue mobilization (IASTM) tools, are used during rehabilitative care as a form of manual treatment for injuries to muscles, tendons, and ligaments (Thistle, Cannon, & Gallagher, 2020). These instruments are sensitive in the localization, specification and facilitation of the targeted area with the help of mechanical pressure applied on tissue with movement of specific muscle (Mahmood, Hafeez, Ghauri, & Salam, 2021). Studies of IASTM tools indicate that patient prognosis varies with good outcomes and uses fewer treatment sessions than others, but it needs proper localization of the muscle involved and, depending on the tools used, often needs special training (Mahmood, Hafeez, Ghauri, & Salam, 2021). The advantage to IASTM and other forms of therapy tools, however, is that WMSDs can also be prevented in practitioners as well (Mahmood, Hafeez, Ghauri, & Salam, 2021).

The evidence demonstrates that manual therapists may find ergonomic equipment and therapy tools (i.e. thumb splints, soft tissue massage tools) useful to decrease the physical demands of manual treatments on the musculoskeletal system. More research is needed to determine the effectiveness of massage therapy tools to prevent injuries from manual therapy (Darragh, Campo, & King, 2012). Additional research on work environment adaptations and ergonomic techniques is also needed, especially within the field of occupational therapy (Lecours & Therriault, 2017). Detailed observation is needed in all practice settings to determine effective prevention strategies for work-related pain and injury (especially within pediatrics and manual therapy) (Darragh, Campo, & King, 2012). Furthermore, more research is needed on the effects of work-related pain experienced by manual therapists on the quality of care they provide and their personal non-work activities (Campo and Darragh, 2010).

The Focus

For my scholarly component, I wanted to study the effects of therapy tools and client-centered interventions on work-related pain and injury. There are a lot of tools on the market that are available for therapists, including name-brand IASTM tools. As these name-brand tools often require trainings, certifications, and come in expensive sets that may not be affordable to therapists or clinics. The approach was to purchase tools that are more commonly and readily available to therapists. The goal of this methodology is to show therapists and clinics that preventative strategies through the use of therapeutic tools do not have to break the bank and are more attainable than they may be perceived. In addition, by focusing on readily available tools, it allows therapists and clinics to find that perfect fit and what works best for their needs. If therapists find that they are benefiting from the use of tools, then they could further explore all that IASTM has to offer.

Utilizing our preliminary work from the DEx Lite project and information gathered from the needs assessment, tools were purchased based on observed thematic trends in anatomical locations of work-related pain and injury, as well as in trends of other client factors (i.e. occupational demands and clinic culture). The following tools were purchased:

• Finger Joint Protector

• Long Arm Trigger Point Pressure Massager

• Carpometacarpal (CMC) Joint Protector

• Full Hand Trigger Point Compressor

• 3-Point Triangular Deep Tissue Massager

• Back and Neck Hook Massager

These tools were trialed by a certified hand therapist (CHT) and feedback was provided. Below, you will find images of the tools, videos on their use, as well as the CHT's comments on each. The exploration of these tools was completed in collaboration with my colleague, Kacey Gifford, OT-S. The tools I focused on were the finger joint protector, the CMC joint protector, and the back and neck hook massager.

Client-Centered Interventions

Through my clinical experience, preliminary work from the DEx Lite project, and information gathered from the needs assessment and through client feedback, I decided to focus my interventions to address my client's perceived thumb pain. Specifically, I wanted to address their self-reported carpometacarpal (CMC) joint subluxation and positive shoulder's sign. Through collaboration with my client, we elected to trial elastic therapeutic tape application and splinting. The therapeutic tape was applied in a pattern to support both the metacarpophalangeal (MP) and CMC joints of the affected thumb and a custom fabricated CMC splint was used. The biggest factor to selecting these two interventions was based off of my client's feedback on how the therapeutic tools took away sensory feedback during manual treatment. Both the tape and the splint were trialed at the client's place of work for 3 days at a time and were worn throughout the duration of the entire workday. The Disabilities of the Arm, Shoulder, and Hand (DASH) was completed before and after each intervention's trial period in order to track noticeable changes. In order to not skew results, no other interventions from group members were being carried out throughout the trial peroids.

Below, you will find images of the elastic therapeutic tape pattern as well as the custom orthoses my client used. You will also find the completed DASH questionnaires, DASH scores and interpetations, and additional feedback provided by my client.