Understanding the implications of hand impairments in light of the International Classification of Function model

Danit Langer; Avigayil Horwitz; Hanna Melchior; Ehud Atoun; Tal Mazor-Karsenty

doi:10.1016/j.jht.2024.05.004

Understanding the implications of hand impairments in light of the International Classification of Function model

J Hand Ther. 2024 Aug 31:S0894-1130(24)00047-4. doi: 10.1016/j.jht.2024.05.004. Online ahead of print.

Authors

Danit Langer¹, Avigayil Horwitz², Hanna Melchior³, Ehud Atoun⁴, Tal Mazor-Karsenty⁵

Affiliations

¹ School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Occupational Therapy, Shaare Zedek Medical Center, Jerusalem, Israel. Electronic address: danit.langer@mail.huji.ac.il.
² School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Hand Therapy, Barzilai Medical Center, Ashkelon, Israel.
³ Department of Occupational Therapy, Shaare Zedek Medical Center, Jerusalem, Israel.
⁴ Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon, Israel.
⁵ School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

PMID: 39218760
DOI: 10.1016/j.jht.2024.05.004

Abstract

Background: Incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely in hand therapy practice.

Purpose: (a) Explore correlations between body functions, activities and participation (A&P), and quality of life (QOL); (b) assess the extent to which personal factors and body functions contribute to variations in A&P and QOL; (c) compare the QOL of individuals with and without hand impairment (HI).

Study design: Cross-sectional.

Methods: Seventy-seven patients (Mean age=43.70 SD=17.56; 47 males and 30 females) with chronic and acute hand impairment were recruited from two hand clinics and matched with healthy participants. Assessments were administered to participants in their first visit to the hand clinic. QOL was measured with the World Health Organization QOL questionnaire; A&P with the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire; pain with the Patient-Rated Wrist/Hand Evaluation; hand function with The Functional Dexterity Test, Jamar Dynamometer and Pinch Gauge.

Results: Significant correlations were found between QOL and A&P, dexterity, and pain, as well as between A&P and hand strength and pain. Personal factors, hand function, and pain collectively explained 28.9% of QOL variance and 61.4% of A&P variance. Pain emerged as the sole significant contributor to QOL variance, while both hand function and pain significantly influenced A&P variance. Comparisons between the study group and controls highlighted significant differences in QOL domains, with the HI group reporting lower perceived QOL in physical, social, and environmental domains.

Conclusion: The significance of adopting a comprehensive approach in HI intervention was highlighted. A complex interplay of factors across different levels of the International Classification of Functioning, Disability and Health (ICF) framework imply that clinicians should avoid fixating exclusively on isolated factors or specific domains.

Keywords: Activity and participation (A&P); Body function; Hand function; Hand impairment (HI); International Classification of Function (ICF); Quality of life (QOL).