A client-centered approach for thumb carpometacarpal joint osteoarthritis pain: Two case studies

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Design:Case study.Introduction:Hand therapists are often called upon to provide treatment for thumb carpometacarpal joint osteoarthritis.Purpose:These 2 case studies present a client-centered approach in the selection of orthoses and joint protection strategies for patients with thumb carpometacarpal joint osteoarthritis. At baseline, the participants presented with pain, decreased active range of motion, decreased pinch strength, and limitations in activity and participation.Methods:The outcome measures utilized at study entry and 6 weeks included the pain Visual Analog Scale, the Australian Canadian Osteoarthritis Hand Index, the Disabilities of the Arm, Shoulder and Hand questionnaire, the Canadian Occupational Performance Measure, active range of motion measured with goniometry, and pinch strength measured with a pinch gauge. The Canadian Occupational Performance Measure facilitated the client-centered approach by identifying occupational performance issues and rating the participant's performance and satisfaction for each. Each participant was prescribed a different orthotic design, received client-centered joint protection instruction, and evidence-based exercises.Results:After 6 weeks, both clients had decreased pain and improvement in their activities, participation, and satisfaction.Discussion:Using a client-centered approach can help therapists to carefully consider a patient's occupational needs when designing and fabricating orthoses and customizing their joint protection education for carpometacarpal joint osteoarthritis.Conclusion:Focusing rehabilitation strategies on that which is most important to the client should be considered to optimize their occupational performance.HIGHLIGHTSTwo case studies have been presented in which the participants received an orthosis and joint protection education using a client-centered approach that was facilitated by the utilization of the Canadian Occupational Performance Measure.Both participants showed improvement in pain, activity, and participation.Focusing our rehabilitation strategies on that which is most important to the client should be considered to optimize their occupational performance by tailoring treatment interventions to their identified occupational performance issues.

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