Therapist perceptions of best practice as ordered by referral source: An exploratory survey

INTRODUCTION: Productive outcomes for the hand therapy patient involve many components. Understanding whether therapists agree with the recommendations they receive, or find these informative, is a first step into understanding how shared decision-making on a treatment plan can be optimized. PURPOSE OF THE STUDY: The purposes of this study include (1) the extent which therapists see variable presentations of primary surgical/management in some indicator exemplars where practices vary from accepted/evidence-based practice; (2) hand therapists' level of agreement with the interventions prescribed on referrals, (3) describe the undocumented complications observed by hand therapists, and (4) report the therapists' perceptions as to the reasons for these complications METHODS: A survey was designed and pilot tested. Multiple-choice questions and free text allowed further explanation. The survey was administered through an electronic mailing to all American Society of Hand Therapy members with available e-mail addresses. Raw survey data were extracted and processed. Descriptive statistics were used to analyze therapists' demographic information. Frequencies of therapists' responses were calculated. RESULTS: Ninety percent of all who responded have been in practice 10 years or more. The mean of the "often and always" ordered interventions was 20%. The mean of therapist perceptions as to whether these ordered interventions are best practice was 14%. Sixty percent reported that they had found an undocumented condition, and 60% reported to have found a postoperative complication. Perceived reasons for complications included the lack of communication and therapy intervention. DISCUSSION: Hand therapists can play an important role in improving patient outcomes. Therapists can provide the health care team information regarding best practice. Additionally, the hand therapist may be who first identifies a postsurgical complication or an undocumented issue. Communication between the hand therapist and referral source is vital in optimizing patient outcomes. CONCLUSION: Hand therapists can play an important role in improving overall outcomes for patients. The inter-professional working relationship between the referral source, hand therapist, and the patient is a complex phenomenon and communication between the hand therapist and referral source is vital.