AHTA News - Issue 104

Issue 104 Jul - Sep 2015

In this issue…

2015 National Conference

Pg 10

What GP’s want! Part Two

Pg 49

A Patients Perspective

Pg 52

AHTA PO Box 84 SOUTHEN CROSS WA 6426 AUSTRALIA P: +61 8 9049 1666 F: +61 8 9049 1677 E: info@ahta.com.au W: www.ahta.com.au

CONTENTS Regulars Message from the Editor

P3

Research and Scholarships

P22

President Report

P4

Professional Development

P59

Organisational Structure

P5

Mentor List

P60

Communications Report

P6

Library Resource List

P61

Marketing and Promotions Report

P7

IFSHT Update

P65

Education Report

P8

Journal of Hand Therapy

P66

Advocacy Report

P9

SAGE Journals—Hand Therapy

P68

State and Territory Affairs Report

P15

Contact us

P70

Membership Report

P20

Divisional Coordinators

P71

Knowledge and Resources Report

P21

AHTA Newsletter Advertising Rates

P73

Issue 104 Jul - Sep 2015 Broadening Horizens P10 New Trends in Upper Limb Therapy 2015 National Conference

AHTA Fundamentals of Hand Therapy Course (Hobart) Review Mel Bennett

Mean and Standard Devi- P23 ation Nicola Massey-Westropp

TMCJ Osteoarthritis: Review P28 of the evidence and Current Practice Patterns Part One: Non-operative Treatment Kylie Bebel

Volunteer Trip to Kenya October 2015 Jess Medland

P24

Hand Weights and SiliP25 cone Compensable Bodies Approval - an Update Karen Fitt

P27

TMCJ Osteoarthritis: Review P35 of the evidence and Current Practice Patterns Part Two: Operative Management Kylie Bebel

Expected Hand Therapy P45 Competencies in Australia Amy Geach What GP’s want!

Part Two: Strategies to marketing used by allied health professionals Amy Geach

P49

A Patients Perspective Julie Condon

P52

Zone III extensor tendon injury of the finger Catherine Chong

P54

Hand Therapy Awareness P25 Week Jo Marsh AHTA Advanced Trauma Course Review Kylie Bebel

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P26

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

A Message from the Editor Catherine Reid

your contribution.

This is our fourth digital edition of the newsletter and its full of hand therapy news and clinical information . Hats off to all those members who have taken the time to share their information and knowledge. Thank you to all the members who contributed and congratulations on earning CPD points for

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I look forward to hearing from members for our December edition of the newsletter. We haven't had any Clinical Pearls in the last few newsletters despite the fact that they are one of the most popular sections of the newsletter? Or perhaps consider a site profile or sharing any presentations or assignments you may do.

Members have been very positive regarding the digital format and it has the added benefit of being able to embed videos: don’t miss out on our link to the conference on page 9 of the newsletter. The conference program looks fantastic and I am looking for-

ward to catching up with everyone at the conference.

Warm regards Catherine Reid Communications Officer communications @ahta .com.au Insert Text Here...

Letters to the Editor are welcome and may be emailed to: communications@ahta.com.au

Letters to the editor should be not more than 300 words and must be accompanied by the therapist’s name (published) and contact information.

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Presidents Report

Tracey Clark

or memorandum of understanding

Several weeks ago, I travelled to Adelaide to attend the Associations Forum annual conference. It was a tremendous opportunity to learn more about the structure and function of “Not for Profit” associations across a broad array of sectors. I attended a number of sessions on association’s growth, governance, advocacy and lobbying, and came away with lots of ideas and suggestions for the future direction of the AHTA, with specific notes for each portfolio, and for the Management Committee as a whole.

The conference provided an unequalled opportunity to network with Management Committee and Board members and staff of associations similar to our own.

Specifically, I was fortunate to arrange an informal meeting with the CEO of OT Aus, Rachel Norris, and we discussed ways in which our associations could work together on range of issues:



   

Contributing to OTAus understanding of hand therapy (advanced) scope of practice Possible hand therapy stream at the biennial OT Aus Conference Co-branding or recognition of AHTA courses for OTAus CPD requirements Lobbying Health Insurers for PT/OT parity in ancillary tables Forming a strategic alliance

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laws and appendices, ahead of this meeting. The by-laws are the association’s operational guideI have arranged to follow these lines, which allow the working items up with Rachel in a formal party to implement the AHTA meeting, on her return from Own Rules (our constitution). leave at the end of September. I They need to be revised from was also able to secure the sup- time to time to make sure that port of the APA for the AHTA’s they reflect current practice, application to become a friend and support our future direction. of “Allied Health Professions Aus- Each portfolio has provided a tralia”. The AHPA is the national report of their key achievements peak body representing and for 2014/5. These are being advocating for the role of allied compiled into the AHTA annual health professions in Australia. report, which will be presented at the AGM. The other most important item to report is the appointment of Thank you to everyone who AHTA’s second staff member, took the time to read the draft Kate Noller, who was successful proposal for accreditation of in her applicamembers, and tion for the posi“I was also able to provide feedtion of Execuback to the secure the support of working party. tive Support Assistant / Prothe APA for the AHTA’s The feedback gramme Manwill be evaluatapplication to beager. Kate ed ahead of the come a friend of the AGM where the commenced her role on July proposal will be “Allied Health 20 and she will open to the Professions Australia”” be working 25 floor for discushours a week. sion and voting.

Kate has been undergoing oriFinally, don’t forget that the Reentation and induction over the search and Scholarship Commitpast few weeks with Sarah, and tee are accepting applications has been speaking with each for this year’s research scholarmanagement committee mem- ship, with applications closing ber to plan how she can best September 11, 2015. support the portfolios with their strategic plan. Congratulations I look forward to seeing you all and welcome to Kate. Thank at the annual conference and you to the recruitment working AGM in Perth. party (Helen Burfield and Liz Ward) for enabling Kate’s emKind regards, ployment.

Tracey Clark AHTA President.

The annual general meeting is fast approaching, and the man- Great news Karen Fitt has acagement committee has been cepted a nomination for the working furiously on process im- position of president elect for provements, including a com2016, plete overhaul of the AHTA by-

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

AHTA Executive Committee Organisational Structure

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Communications Report

Catherine Reid

In the communications portfolio we continue to for events / products which need to be adverwork toward our strategic goals of: tised in a timely manner. We are always seeking new revenue sources through advertising so 1.

Improving communication between the welcome any suggestions members may have executive and the membership, increasin this regard. ing member contributions to the Enews, newsletter and increasing member inWarm regards volvement in the google group.

Catherine Reid 2.

To continue to maintain old advertisers Communications Officer and continue to seek out new revenue Communications@ahta.com.au sources through advertising The newsletter continues to grow in size with 12 member submissions in the last newsletter and thirteen submissions for this newsletter . The google group also continues to grow at a steady rate having just joined its 300th member this past week.

Newsletter Contribution Deadlines for 2015 November 14th 2015

Sadly we say goodbye to Erin Harders from the communications subcommittee, and would like to take this opportunity to thank her for all her Remember that contributions from Members to hard work on behalf of the AHTA putting the the newsletter earn valuable CPD points. So monthly Enews together. Thankfully Kate Noller send in your case studies, research articles, clinfrom the AHTA executive has kindly agreed to ical pearls, book and App reviews, and DVD take on the role of compiling the Enews so if reports to communications@ahta.com.au. you would like to join the communications subPlease send your work as an attachment to committee to assist with the Enews (or in any your email, font Century Gothic size 11. Try to other way) you would be most welcome. avoid bullet points as these can be a little tricky to edit.

We are excited to announce a new initiative of sending out a PDF flyer attached to an email Page 6

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Marketing and Promotions Report Position Vacant

The AHTA Marketing and Promotions Portfolio needs you!!!!

Under our strategic plan the objective of the Marketing and promotions person is to: 

Promote awareness of the expertise of AHTA members to referrers and general public.

Due to a resignation from the position for personal They are to do this by: reasons the position of Marketing and Promotions officer is now vacant and just right for someone  regularly updating the website, developing to take it on and make a real difference to the business and running or coordinating a deway the AHTA is promoted and seen by the pubvelopment/ marketing workshop for AHTA lic and our fellow therapists. members.  Promotion and coordinating material for The Marketing and promotions officer has a posiNational Hand Therapy Awareness Week tion on the management committee that conJune venes via teleconference bi- monthly.  Assist with development /purchase of promotional and marketing material The Marketing/Promotions Officer shall:  Coordinate media releases or opportunities for general public awareness.  Maintain a database of information that is relevant to hand therapy If you are interested in taking on this interesting  Organise promotional materials for the and rewarding position please contact Sarah at AHTA including brochures, posters and ban- info@ahta.com.au ners  Facilitate promotional lectures and workshops by AHTA members.  Review the logo design and website marketing.  Set a date and develop a list of activities for the annual hand therapy day  Organise the display of promotional material for a booth at the annual conference

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Education Report Julie Condon

A big thank you to Anna Scott, Kerry Stingel, Ben Cunningham, Cara Gilbert, Judith Wilton, Katie Anderson and Sally Colwell – the Education Sub-Committee, from all members of the AHTA, the Management Committee, and myself for all of your hard work and dedication to the educational needs of hand therapists in Australia. I am making the time to express my gratitude publicly as the Education SubCommittee is undergoing major changes.

These changes are very exciting and it will mean that we are better able to serve AHTA members (keep an eye on your emails for more details and how to get involved!) Before these changes take effect I wanted to thank the current members who dedicate their time to help us out – many members have been doing so for many years! So once again to all members of the Sub-Committee, thank you!

We are on the look out for webinar presenters!

Webinars are extremely popular with all members – and why not? Sitting around in your pyjamas with a glass of wine while engaging in an interactive presentation is a great way to spend an hour! In order to have this great hour though we need someone to present! Presenters get points that count towards upgrading to full memberPage 8

ship/maintaining full membership, plus you get to share your passion and knowledge with a very rapt audience! Feel free to dob in those great in-service presenters – we all know them; and please be brave and step forward yourself to share your awesome knowledge!

Happy learning!

Julie Condon Education Officer education@ahta.com.au

AHTA WEBINAR PRESENTERS WANTED! Interested in presenting?

We still need to fill some of our webinars this year.

Please email info@ahta.com.au to express your interest.

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Advocacy Report Janet Dindler (Interim Chair)

The advocacy committee is busy writing documents to support approaches to key stake holders later this year and next. In order to impress regarding the level of professional activity of our members we urgently need to update our list of publications by AHTA Members. If you have EVER had an article published could you please email the details to Janet Dindler on handtherapy@senet.com.au to be included in our submissions. Name, title, journal details please.

There will be changes in the composition of the Advocacy committee in the future which will be beneficial. I would like to acknowledge the excellent contributions of Judith Wilton who has been on the committee since its inception, and has decided to retire from it, and Barbara Hall who has resigned as chair but will hopefully stay on the committee. The immediate past president will chair future Advocacy committees and Tracey Clark has already been involved. Thanks to Wilma Walsh and Rosemary Prosser also for their input.

Janet Dindler Interim Chair

The 2015 Conference Committee, on behalf of the Australian Hand Therapy Association, invites you to join us at the AHTA 2015 National Conference, Broadening Horizons – New Trends in Upper Limb Therapy. The 2015 Conference theme was chosen to showcase new innovations, ideas and trends found within the dynamic and progressive Hand Therapy industry. The conference has an exciting line up of expert clinicians and researchers including International Key Note Speaker: Tracy Fairplay and National Champions: Tanya Cole, Lauren Miller & Hamish AnPage 9

derson. We also have a fantastic array of cutting edge presentations and diverse workshops that will ensure that therapists take home current practical ideas for clinical intervention, research and practice management. The conference committee are also still offering exciting opportunities for any company or organisation that would like to be a part of conference. With over 200 delegates already registered to attend, this conference gives organisations unique opportunities for networking and promotion of business, and we are keen to ensure that

your participation as a sponsor and/or exhibitor is rewarded. If you would like to discuss these options further, please contact Emily Adams, AHTA Conference Secretariat on (07) 3368 2422 or email ahta@yrd.com.au Join us in Scarborough Beach, Western Australia from the 16th – 18th October 2015, to learn, be inspired, network with colleagues and relax by the beach.

View our conference promotional video by clicking on this link https://youtu.be/7n5hE8Z7a28 Simon Garbellini Conference Convener

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

"Broadening Horizons – New Trends in Upper Limb Therapy"

has been chosen as the theme of the 2015 Conference. This theme was selected to showcase new innovations, ideas and trends found within the dynamic and progressive Hand Therapy industry.

The 2015 conference will include an exciting line up of expert clinicians and researchers.

Cutting edge presentations and diverse workshops will ensure that therapists take home current practical ideas for clinical intervention, research and practice management.

The 2015 AHTA conference will be held in beautiful Western Australia. As proud “Sandgroper’s” the 2015 conference committee believe there is no better way to showcase Perth's average of 3,000 annual hours of sunshine, than by holding the conference on Scarborough Beach.

Located on the west coast, an easy 15 minute drive from the Perth central business district, or by bus from the city station, Scarborough is a place where sunscreen, swimmers, surfboards and now SPLINTS (it should really be orthoses but that ruins the alliteration) are the fashion essentials.

Nearby, various shops sell everything from sturdy backpacker wear to high-end fashion, and restaurants range from a la carte dining to casual cafés - the majority of which capitalise on the epic ocean views. After taking in a day of cutting edge presentations focusing on the newest innovations in hand therapy, what better way to finish than grabbing a drink at the bars and pubs and watch the sun go down.

So please, do yourself a favor, book in your leave, book a ticket, pack your sunscreen and prepare for a dynamic, informative conference experience. Before you go ahead and book those tickets, take the time to meet the 2015 Conference Committee (minus the leather chaps and native american indian outfits).

For more information on the 2015 Conference, PLUS committee shenanigans click here

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Australian Hand Therapy Association Conference Committee 2015 Simon Garbellini: Conference Convenor/Scientific Committee Simon completed his degree in Occupational Therapy at Curtin University, Western Australia, in 1994. He has worked within the health, not for profit and private sectors in the area of hand and upper limb rehabilitation since graduating with a particular focus on neurological disabilities.

Simon is a Senior Occupational Therapist within the Cerebral Palsy Mobility Service at Princess Margaret Hospital for Children. His role is to assist with upper limb spasticity and surgical management for children with cerebral palsy.

Simon completed a Masters of Health Services Management in 2003. He is a full member of the Australian Hand Therapy Association. He has been involved in upper limb research as a blinded OT assessor and clinical supervisor. He is a PhD candidate at the Australian Catholic University investigating the effectiveness of orthoses for children with cerebral palsy.

No one in the AHTA would know.....Simon never plays “Simon Says” with patients at PMH.

Jasmine Cameron: Social Committee Jasmine graduated from Curtin University with a Bachelor of Science (Occupational Therapy) in 2004. Since graduating she has worked in the clinical area of hand therapy in the public health sector, private practice and overseas in Canada. She is currently working in the hand clinic at Sir Charles Gairdner Hospital.

Jasmine is a full member of the AHTA. She is committed to the development of hand therapy in Western Australia. She has held many organisational positions on committees including convener of the Western Australian Occupational Therapy Associations Hand Interest Group and has been the divisional coordinator for the Western Australian division of the AHTA. No one in the AHTA would know that......Jasmine’s maiden name was Cowmeadow and when a patient presented at the hand clinic at Sir Charles Gairdner Hospital with fractured hand as a result of being bucked by a cow, she said to them “I am the perfect therapist for you as my name is Cowmeadow”.

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Vicky Allbrook: Social Committee Vicky is a Senior Occupational Therapist and Clinic Co-ordinator at the Hand & Upper Limb Centre in Perth, Western Australia.

Vicky has worked in hand therapy and orthopaedics since graduating from Curtin University in 2005. Vicky worked in WA’s beautiful South West region as a new graduate before returning to Perth to work in a private hand therapy practice for two and a half years. Vicky then spent four years working in hand therapy, orthopaedics and rheumatology within the National Health Service in busy London hospitals before returning to Perth in 2013.

Vicky is passionate about the future of Hand Therapy in Australia and the importance of having a thriving national association. Vicky is excited to be part of such an amazing conference team and can’t wait to provide an excellent scientific programme in 2015. As part of her social committee role Vicky is planning an exciting social calendar for the conference.

No one in the AHTA would know that…. Vicky almost fainted after she accidently nicked her PIP joint with scissors during a treatment session and that her 92 year old patient looked after her for the rest of the therapy session!

Helen Fitzgerald: Scientific Committee Helen is a co-director of InHand Occupational Therapy with her husband Michael. With 14 years of experience as an OT she has primarily worked in the public sector in Hand & UL Therapy both in Perth and the UK, and has additional clinical experience in Spinal Injury, Burns and Rheumatology.

Helen has a passion for all things “splinting” and has a strong interest in extended scope practice. She is the co-author of a research publication on conservative management for waitlisted public hospital patients with Carpal Tunnel Syndrome. Helen is committed to the growth of the profession and area of Hand Therapy, mentoring many therapists and being a course presenter for the AHTA. She is an active member of the AHTA where she currently acts as the WA mentor and has previously held the position of National Membership Portfolio on the AHTA Management Committee. She is looking forward to providing a dynamic scientific programme at the Perth 2015 conference.

No one in the AHTA would know that.... as a new graduate Helen cried when management advised her she was going to be rotated out of spinal and into hands… clearly it wasn’t so bad after all!

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Ceri Pulham: Treasurer / Scientific Committee Ceri is a Senior Occupational Therapist at Macquarie Hand Therapy in Sydney.

She graduated from Curtin University, WA in 2004 and spent the next 10 years working in private practice at the Hand & Upper Limb Centre, she has also worked in the public sector at Princess Margaret Hospital for children.

Ceri recently relocated to Sydney, to expand her horizons and continue to develop and grow in the area of hand therapy. She is passionate about supervising students/staff and giving back to the profession through education, presenting talks nationally and internationally. She is looking forward to contributing to the AHTA conference as her role as Treasurer and helping to set up an interesting and diverse scientific program which all therapists, from new graduates to experienced therapists, can benefit from.

No one in the AHTA would know that…..Ceri fainted at the site of blood whilst on practicum as a student

Yvette Robert: Secretary / Marketing and Sponsorship Yvette works both in the private sector at Inhand Occupational Therapy, and in the public sector within the Cerebral Palsy Mobility Service at Princess Margaret Hospital for Children. Yvette has worked in hand and upper limb rehabilitation since graduating from Curtin University in 2010, and has clinical experience in Burns and Orthopaedics. Yvette currently works in acute trauma and in upper limb spasticity management. Yvette is looking forward to an exciting and diverse 2015 conference in Scarborough Beach, WA. She is committed to providing professional development opportunities to AHTA members, and is currently coconvener of the WA AHTA divisional meetings.

No one in the AHTA would know that.....Yvette fainted on the first day of her hand therapy prac. Very embarrassing!

Stuart Wilson: Sponsorship and Marketing Stuart is currently employed as a Senior Hand Therapist at Hand Works Occupational Therapy. He currently holds a position on the Australian Hand Therapy Association Divisional Representative Sub-Committee as well as being a committee member for the AHTA Annual Conference Perth 2015. Stuart completed a Bachelor of Science in Occupational Therapy at Curtin University and, prior to entering private practice, gained experience within the public health system. Stuart has experience treating a range of acute and chronic hand and upper limb injuries / conditions and has a particular interest in the diagnosis and treatment of ulnar sided wrist pain, and the application of mobilisation orthoses.

No one in the AHTA would know that.....Stuart’s first ever splint was a thermoplastic barrel for a tip amputation– splinted perfectly…on the wrong finger. His patient, a large German man, laughed till tears rolled down his eyes, stood up and showed the whole clinic.

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

State and Territory Affairs Report Jennifer Kaess

Working towards getting stable, reliable and easy remote access for our regional and rural therapists to attend SIGs remains the major focus of the State affairs team. Every state continues to work hard to put on exceptional educational opportunities for members and I encourage all members to take full advantage of your membership to attend in person and if possible by remote if that is impossible. We have had wet labs, PhD candidates, surgeons, neurologists, psychologists. as well as our talented members presenting on fascinating topics including pain management, latest treatment of Lateral Epicondylosis, tendon repair management, the use of technology in hand therapy, just to name a few. SIG meetings are a great way to network with fellow hand therapists at a local level, as well as to have an opportunity to present to your peers about both interesting and unusual diagnoses as well as daily and basic practice activities. SIG’s attract therapists who are both new to the profession as well as those with much more experience so please consider offering to present at a SIG meeting.

to be more streamlined in future so if you have ever thought of how you can contribute to your professional body, considering joining a subcommittee might be a great place to start.

Our committee is particularly excited about the support each state can offer with respect to lobbying for members, we are able to share information and strategies on how things work in other states to assist with leveraging at a state level.

With Kate now on board, we are planning on getting more strategic with our documentation making hand over for new committee members

Our next meeting is scheduled for the Monday 14th September for the rare opportunity for a live cadaver demonstration of hand and wrist anatomy presented by Dr Ian Yuen at Macquarie Hospital. This is an RSVP event only so please contact our team on nswigmeeting@gmail.com to confirm your attendance. This is a free event however; we will be collecting gold coin volun-

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Jen Kaess State and Territory Affairs Officer stateaffairs@ahta.com.au

New South Wales / ACT The New South Wales Members had the great opportunity to go to Susan Dunn’s practice at Royal North Shore Private in August to listen to her team talk about Congenital Hand Disorders. Michele and Victoria are continually looking into different methods to allow the SIG meetings to be accessible to regional members. We have appreciated all feedback that we have received so far and endeavour to continue to improve our methods.

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

State and Territories Reports tary donations on entry.

As most of you know Professor Gumley organises a group of Hand Surgeons and Hand Therapists to volunteer their time in Cambodia to operate/ treat and teach local surgeons/therapists each year. This year Anne Wajon and Cathy Merry will be going and mentioned that some extra silicon gel sheets would be fantastic. We will be using the donations received on the night to support this worthy cause and help our fellow hand therapists.

Please feel free to contact us if you have any exciting news or research on nswigmeeting@gmail.com so we can let the rest of the AHTA know.

By Nadia Jenkins

Tasmania No Report received

Western Australia

tific Meeting was held at Fraser’s Restaurant and Function Centre in Perth. As usual, the turn out from AHTA members to his meeting was fantastic.

The topic for the meeting was ‘Basal Thumb Arthritis’, and we had very interesting presentations from International Guest Speaker Professor Amy Ladd (Head of the Hand Surgery Department at Stanford University California), as well as National Guest Speaker Mr Steven Tham, from St. Vincent’s Hospital in Melbourne.

Congratulations to Lucinda Allen from the Hand and Upper Limb Centre, who was the only therapist to present at this meeting! Congratulations also go to our newest full member from WA, Brent Byrne. Well done on gaining your full membership Brent. Stuart Wilson presented awards on behalf of the WA AHTA Subcommittee on Thursday 30th July at Curtin University of Technology to students Rina Eto and Cleo Drygan. Rina and Cleo were awarded the highest marks in the Orthoses and Rehabilitation Science 642 unit. Well done to you both.

Our last interest group meeting for the year will be run by therapists at HULC, and is due to be held on November 28th, at Sir Charles Gardiner Hospital OT Department from 9-12:00. Further details will follow closer to the date.

On Saturday 25th July, the

By Lani McAuliffe annual West Australian Hand Surgery Society ScienPage 16

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

State and Territories Reports Northern Territory It has been a busy few months as always in the NT. Sadly we have lost two members interstate, leaving our total membership numbers at seven. This includes six associates and one full member. The last general interest group was held last month in Darwin with Ngaire Turnbull from Territory Hands presenting on common congenital disorders affecting the hand. We are hoping to link in with Perth to access their SIG meetings, with the aim of providing more PD opportunities to NT members. We are hoping to trial this in the coming months.

ference in Perth and hope to see some of you there!

By Jayne Donovan

The AHTA Advanced Trauma course was held in Darwin last month which was a great opportunity for therapists to access training locally. There was very positive feedback from attendees, with Royal Darwin Hospital looking at trialling swing traction splints for the management of comminuted PIP joint fractures. Here in Alice Springs we are trialling regular outreach visits to Tennant Creek (550Kms up the road) to provide a more accessible service to our remote clients with hand injuries.

We are all looking forward to the National ConPage 17

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

State and Territories reports Victoria We have had held two excellent interest group meetings on Monday 1st June and Wednesday 5th August. Topics included: · “Management of Lateral Elbow Tendinosis”, by Lin Wegener (PhD candidate at Monash University), “Update on Management of Flexor Tendon Repair” by Virginia Wise (The Alfred), “Medical and Psychological Management of Complex and Chronic Pain”,

by Dr Tim Hucker (Pain Specialist Consultant) and Jodi Salinger (Clinical Psychologist in Pain), Luke Robinson kindly volunteers to arrange our Victorian regional and rural members to Skype into our interest group meetings. We do ask that if you wish to join the meetings via Skype that you please contact Luke at least 24 hours in advance so that this can be arranged.

Congratulations to Lauren Young and Helen Scott who have sat and passed their Certified Hand Therapy exams.

In the last quarter we have had an influx of members, including associates this month Lisa Slade, Marnie Lowry, Mel Bennett, Nicole Eustace, Angela Cheng, Pearse Fay and Holly Kozlowski. Congratulations to Helen Scott who recently upgraded to Full Membership status. We Page 18

also welcome existing member Georgia McGuinness to Victoria from South Australia.

Huge credit goes to Jen Kaess and the other therapists who have been liaising with TAC and Workcover regarding the payment of goods and services for private hand therapists. They have been able to get small hand weights and liquid silicone gel on the prior approved list, which is a huge win that they have been working on for over 12 months! There is still further streamlining to be achieved, however progress is being made!

Virginia Wise and Lisa O’Brien

Queensland Hand therapists from Queensland have recently enjoyed attending the annual Queensland Hand Surgery Society mid year dinner, held on the 31st of July 2015. The keynote speaker for the evening was Mr David McCombe - Hand, Plastic and Reconstructive Surgeon - who discussed the use of vascularised bone grafts to treat scaphoid nonunion/humpback deformities, in particular the use of medial femoral condylar free graft. Dr Alok Jhamb also presented two interesting case presentations to conclude the evening. This intellectually stimulating material was as usual,

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

State and Territories reports accompanied by excellent food and wine, with drinks continuing into the small hours of the following morning!

Thank you to Kylie Bebel from The Prince Charles Hospital who presented at our July special interest group meeting. Kylie delivered an extremely thorough review of the evidence for management of base of thumb osteoarthritis.

The interactive nature of Kylie’s presentation was well received by therapists.

Our August SIG meeting will be held in Cairns, followed by our September meeting being held at Advance Therapy Solutions, Greenslopes. Further event details will be confirmed soon.

We request that all Queensland members continue to check the Queensland Divisional Meetings calendar on the AHTA website to ensure you and your team are aware of when you will be expected to host a meeting.

Frances Black

South Australia No Report received

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Membership Report Kylie Flynn It has been a very busy period for the membership subcommittee. Congratulations to our new full members (& their mentors) for successfully applying to upgrade their membership: Hayley O'Sullivan Kelly Briody Brent Byrne Helen Scott

VIC VIC WA VIC

Welcome also to all our new associate members Judith Feldman Sarah Armanios Taya Klisowski Lauren Storey Lisa Slade Nadia Vigna Daniel Ceh Tyrone Williams Sunelle Hargreaves Mikayla Southam Paula Peralta Catherine Fitzhardinge Nicola Eustace Roy George Angela Cheng Letitia Power Pearse Fay Esther Leung Page 20

WA VIC WA NSW VIC NSW NSW QLD QLD QLD NSW WA VIC QLD VIC QLD VIC SA

Emily Sevier Chris Burns Emma Tozana Kate Martin Meghan O'Donnell Angela Davies India Fenelon Hannah Munro

WA NSW WA WA NSW NSW QLD NSW

Planning on upgrading your AHTA membership?

Contact your state mentor.

They can assist you with your application.

QLD/NT: Katie Whittle cradwhit@me.com

VIC: Hamish Anderson hamish@andersonhandthera py.com.au WA: Helen Fitzgerald hfitzgerald@inhand.net.au SA: Suzanne Caragianis Suzanne_caragianis@bigpon d.com NSW: Cathy Merry cathymmerry@hotmail.com or Naomi White

naomiw@sapphirephysio. com.au By becoming a full member and supporting your profession, you assist the AHTA to represent Hand Therapists to lobby insurers for improved remuneration rates and liaise with government bodies regarding recognition of our profession. A full member also benefits from inclusion of their name and professional details in the online Membership Directory, further discounted costs for AHTA Courses and discounted costs for advertising in the AHTA Newsletter, Enews or AHTA website.

Membership subcommittee Reminder for all state mentors & membership review panel the next teleconference meeting is on September 7th 2015 7:30pm EST. An agenda will be emailed to those involved prior to the meeting.

Kylie Flynn Membership Officer membership@ahta.com.au

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Knowledge and Resources Dion Sandos

As I’m sure most people are aware we have recently offered AHTA Members a discount on anatomical models.

Mentone Educational offered us a 15% wholesale discount for their range of hand related models and posters. After a late surge we managed to place a reasonable amount of orders that made the process worthwhile. By my count we placed over 20 individual orders purchasing a total of 73 items. I’d like to thank everyone who supported this initiative again this year.

I would like to remind everyone that the AHTA library is now available via the website. I am still getting quite a few requests to post out the DVD’s, but the process is now much quicker and simpler. To access the DVD collection, simply logon to the AHTA Members area and follow the link to the ‘Videos’ section (located in the top right hand side of the page). All of our recorded Hand Therapy interest group meetings and Page 21

Exploring Hand Therapy DVD’s are available.

from 1995 to the current edition.

We are currently in the process of reviewing our online journal subscription. Journals that we are looking to add to our subscription include; ‘Hand Surgery’ which is the Journal of the Asia-Pacific Federation and the ‘Journal of Hand Surgery (European Edition). I will hopefully have more concrete news for the next edition of the newsletter. For those who are interested, here is a summary of our current subscription:

Hand Clinics- Online access is available, through the AHTA website, from 2002 to the current edition.

Hand Therapy (Formerly British Journal of Hand Therapy)Online access is available, through the AHTA website, for the complete back catalogue.

As always, if you have any suggestions regarding a text or resource that you would be interested in purchasing or reAmerican Journal of Hand sources and journals you would Therapy- Online access is avail- like available through the AHTA able, through the AHTA webplease let me know. site, from 1995 to the current edition. We also hold all of the For any loan requests, resource earlier editions (except 1994, suggestions or general enquirNo 3) in paper format. Articles ies please contact me at reearlier than 1995 can be sources@ahta.com.au. scanned and emailed to Members by request.

Dion Sandoz Knowledge and Resources OfAmerican Journal of Hand Sur- ficer gery- Online access is availaresources@ahta.com.au ble, through the AHTA website,

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Research and Scholarship Helen Burfield The AHTA Research and Scholarship Committee objective is to further the hand therapy profession by promoting, encouraging and supporting research that advances hand therapy knowledge and practice. The committee are now calling for applications for: AHTA Research Scholarship 2015 A maximum of $10,000 will be made available for grants in 2015 Applications close September 11, 2015 For more information please go to: Research Scholarship Application Form 2015, Research Scholarship Guidelines 2015 or visit www.ahta.com.au and follow the links from the “Research and Scholarship” tab on the home page.

Cheers Helen Burfield President Elect and Research and Scholarship Chair presidentelect@ahta.com.au

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Research and Scholarship Mean and Standard Deviation

By Nicola MassyWestropp Means and standard deviations are useful ways to describe a sample or a population when a continuous measure like a pain visual analogue 0-10 or days since surgery is being described. They aren’t to be used when nominal data such as male=1 and female=2, or Likert scale data such as 5= happy with splint and 0=will not wear splint are used.

The mean represents the average and the standard deviation represents how dispersed, or how far from the mean that a number of the people in the sample are placed.

If you wanted to calculate the mean and standard deviation of your patients’ return to work after carpal tunnel release you could do it manually or just use Excel to calculate it for you How is it calculated? 1. Work out the mean, 2. Take the mean from the score, 3. Square that number (this is now the variance), 4. Work out the square root of the total of squared scores. I would definitely mess this up so I use Excel to perform this function for you by selecting =STDEV(put your range of scores from start:end). treatment A return to work

treatment B return to work

patient

days

patient

days

Sam

15

Tim

1

Joe

16

Paul

25

Pat

14

Rose

31

Tom

13

Tina

2

Bob

16

Ruth

3

Pete

17

Joy

25

Matt

15

Seth

42

Ally

14

Bill

1

Cath

14

Mark

3

Rhys

15

John

2

Lee

16

Kay

30

15.0

mean

15.0

mean

1.2

SD

15.6

SD

If you look critically at treatment A, the standard deviation is very small, so the mean of the days until return to work represents the sample of patients who received treatment A very well. But if you look at the mean and standard deviation for treatment b, does the mean really represent that treatment group? No! Another measure should be used to summarise this data, and the range of days, (1- 42 days) should definitely be described.

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

News Items

From Fellow Members...

Volunteer Trip to Kenya October 2015 Jess Medland

In October I, Jess Medland (Occupational Therapist) with Jenni Medland (Physiotherapist) are returning to Mumias in Western Kenya for our 3rd volunteer trip. Over the years we have developed a strong connection with local Occupational Therapist Martin Nafukho and this vibrant community located 10 hours north west of Nairobi. The aims our trip are the following:





 



Set up an orthotic workshop at the Educational Assessment and Resource Centre (EARC) in Mumias. Currently there is an empty building and new Orthotist employed.

Run a splinting and hand therapy workshop to develop skills to fabricate night POSI splints for Cerebral Palsy contractures and positioning with casts or thermoplastic following burns contracture release surgery.

Replace all the night splints for children with Cerebral Palsy at Nyabondo Centre for Disabled (right).

Initiate a pre-operative education program including interactive books for children and parents to assist with compliance with post-op attendance and improve surgical outcomes.

Start a school education program for burns prevention including safety in the community and provision of alternate safe sources of light for night study such as solar lanterns.

To achieve our goals we will work collaboratively with Allied Health staff at the Mumias EARC and the local surgical team at Nyabondo Mission Hospital. Plastic and Orthopaedic surgical rotations occur 6 times per year. Regular cases include burn contractures, cleft lip and palate, club foot, knock knees and other congenital hand deformities.

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To make our trip as successful as possible we are seeking assistance with the following:  Educational material e.g. handouts or slideshows relevant to the out lined projects  Expired thermoplastic, plaster, fi breglass, dressings  Contact person at Qantas or Emir ates that can assist in approving additional luggage  Hand Therapists that may be inter ested in future volunteer roles in rural Kenya Thank you to the AHTA for generously contributing monetary funds to assist in basic set up of the EARC orthotic workshop and cost of running the education workshops in October 2015. Additional thank you to Deb at OPC for donating thermoplastic, Lin at Linkron for donating Velcro and for Royal Melbourne, Frankston and Northpark Private Hospitals for clearing out old dressing supplies and plaster.

We look forward to hearing from anyone that is interested in our projects in rural Kenya and providing a comprehensive update following the trip. Please refer to our website http://mamacynthia.wix.com/mama-cynthia or email me anytime.

Jess Medland mama.cynthia.kenya@gmail.com Occupational Therapist Melbourne Hand Therapy and Frankston Hospital Julia (left) was 14yrs of age and presented to the EARC in 2010 after sustaining severe burns when her mosquito net caught alight years ago. I observed Julia’s left elbow contracture release surgery in October 2010, following up with wound care, scar management, splinting and an exercise program. She returned for another successful surgery performed by team at Nyabondo to release her neck contracture December 2010.

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

News Items

From Fellow Members...

Hand Weights and Silicone Compensable Bodies Approval An update by Karen Fitt

I would like to detail the events in Victoria regarding the approval of small items such as weights and liquid silicone by TAC and WS. Historically, hand weights have been approved with minimal fuss. Approximately 12 months ago, when a new small stock item list was documented, hand weights started to be rejected.

There was a google group thread which detailed a number of ridiculous reasons for rejection given by various case managers. View here: Essentially, hand weights were not listed on the policy document, and so the claims managers felt they were “justified” in rejecting them, despite our fair clinical justification. All attempts by hand therapists to get these items paid were either not successful, or successful once, only to be rejected for the very next patient claim. Additionally, liquid silicone (Kelocote) was being rejected as this was deemed a “pharmacy only” product.

I am very pleased to announce that we have been successful in our attempts to get these items officially approved.

I have been notified by the Clinical Lead: Allied Health that these items have been added to the list and this is on the website. View here: This process has been agonising slow and frustrating, but I feel that this positive outcome is important in two ways: 1.

2.

It provides something of a framework for change we can use in the future for discussions with compensable bodies 2. It encourages us to realise that change to policies is possible.

I am happy to discuss the process in further detail with other members or committees facing a similar situation in other states.

Kind regards Karen Fitt

Hand Therapy Awareness Week

By Jo Marsh

I spoke on the local community radio for the Adelaide Hills (Hills FM) for half an hour raising awareness of hand therapy in general, how to prevent common UL conditions and discussing my personal journey into and love for hand therapy.

I also had an article on page 2 of one of our local Adelaide Hills newspapers the Southern Argus. This article was also raising awareness of hand therapy, the role of hand therapists in the community and local hand therapy services.

Both clinics in the Adelaide Hills displayed print outs of the AHTA provided posters and an eye catching balloon display. (I used Office Works as recommended and found the whole process easy and inexpensive!!)

Feedback was great!

And many thanks to the AHTA for providing the media release and pictures with such clear instructions and ideas for use in print / web etc!!!

The third item under discussion and awaiting official approval is reimbursement for dressings. The current policy document states that the cost of dressings is covered by the consult fee.

Thank you to everyone who has followed up with WS and TAC and sent in clinical justification letters and the like.

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Course Reviews

From Fellow Members...

AHTA Advanced Trauma Course Review Kylie Bebel

In late June this year I had the exciting opportunity to leave a cold and wet Brisbane behind and travel to sunny and warm Darwin to immerse myself in three days of professional development. Both the weather and the course did not disappoint.

The Advanced Trauma Course has gone through a recent change moving from participant presentations to participation in an expert panel discussion. Preparation for the panel involved performing a literature review of at least 10 articles on a topic of your choice. Which makes it a little easier as hopefully it is an area that excites you making the search and actually reading the articles a little more enticing over settling down to a good novel or movie. I chose Bennett and Rolando Fractures as it was an area of practice on my ‘to do list’ and it correlated well with my current goal of reviewing the anatomy and biomechanics of the TMCJ I have already been working on this year. A month before the course, you receive an email detailing the topic choices and guidelines to assist you with your literature review. Get in early as you are requested to place multiple choices in order of desire and fingers crossed you are allocated your preferred preference. One month post completion of the course, an assignment based on your literature review is due. I have found the assignment helpful to concrete my knowledge regarding Rolando/Bennett fractures, so try to look at the assignment as ‘forced’ revision!

The course is split into topics where the course coordinator presents an overview of the condition covering anatomy, assessment, and treatment. This is followed by the expert panel, led by the course coordinators and supported by the participant responsible for that topic. It is

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nice and informal, taking the pressure off a little, not allowing those nerves to tongue tie you too much.

In our group there was a wonderful mix of experience in the room, from therapists new to hands to those who had a wealth of experience under their belts. The group was very positive and supportive resulting in some great group discussions regarding assessment and treatment. By the second day, we were all starting to come out of shells gaining more confidence and the discussions just got better and better. I definitely came away from the course with a few new ticks and tools up my sleeve and also a reignited passion for progression my skills in the area of hand therapy. I tend to find after courses or conferences that I am able to tick off some learning goals but always go home with an expanded ‘to do list’. That is the exciting aspect of working in hands, there is always something more to learn. A ‘pearl’ I have taken away with me is an ‘approach’ to reviewing a topic

or condition. During the panel discussions, Ben prompted us to report on the most common complications of the injury at 6 weeks and use that base to identify treatment strategies to prevent the complication. It seems so simple to approach your treatment in that way, and I think we all do it when we reflect on our own practice. But, I will now endeavour to formally approach my exploration of a condition in this way as I felt it really helped to ground my thinking.

During the three days, there were also some practical splinting demonstrations which I found very helpful. I always enjoy observing how different therapists approach a common injury and their splinting style. Most of my favourite splinting or treatment pearls have been a result of learning from another therapist; a slight change here and there can make such a difference to patient from increased comfort within their splint to improved outcomes. I have included a couple of splints I was able to snap on my phone (sadly, the photo of

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Course Reviews

From Fellow Members...

AHTA Advanced Trauma Course Review... continued Kylie Bebel

the traction splint was not the best, but you get the idea).

The course content built on knowledge I had gained from the fundamentals course I had attended earlier this year in March. I found the fundamentals course for me was a great refresher regarding anatomy, biomechanics, and healing phases The three days flew past and most of of the different tissues. us only started to fade in the very last The content of the fundamentals hours on the last day. Ben definitely course was not rehashed during the has a talent for teaching, he is able to spark and keep your interest with Trauma course, but that level of knowledge was expected. For asso- his relaxed teaching style while drawing on his vast experience to prociate members, the fundamentals

AHTA Fundamentals of Hand Therapy Course (Hobart) Review...

Mel Bennett

The course was an excellent weekend and I think nearly every state and territory was represented! Ben was a great presenter and very engaging. I particularly liked the analogies used over the weekend to remember concepts and structures.

I appreciated clinical reasoning discussions that acknowledged the different focus of health professionals, stemming from our training (eg. a good union achieved in surgery, but what is union without function). Guiding questions such as "is this condition stable or unstable?" and thinking ahead to "what will be the most prominent problem for this patient in 6 weeks" are probably basic for the experienced therapist but so valuable for me just starting out in hands.

I certainly wasn't expecting to be likening myself to a structure in the hand, but the question "what structure in the hand would you be and why" generated some interesting discussions and self reflection over the weekend! (I would say I am a fairly course is a prerequisite for the Trauvide real life examples. The course had a focus on being interactive with active person, so chose a muscle ma course which I definitely agree abductor digiti minimi as I am a team with. I have been working in hands the panel/group discussions at the for about nine years, but I have conclusion of each topic, helping to player, but not afraid to try going in new directions! Overall though, keep those neurons charged and found attending both courses this year has enabled me to fully refresh actively firing. A big thank you to Ben amount of range of topics and informy learning approach. The courses Cunningham and Katie Anderson for mation covered was really helpful to my practice and I would definitely have also helped by brain to recover a great course! recommend this course. from a one year break while I was on maternity leave … yes ‘baby brain’ does exist!

In the month since attending the trauma course I have had the opportunity to try out a few new treatment techniques on a number of my patients. Always a very rewarding outcome after attending a course.

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Member Contributions TMCJ Osteoarthristis: Review of the evidence and Current Practice Patterns Part one: Non-operative treatment

By Kylie Bebel The thumb is arguably the most important digit of the hand (Neumann 2003, Taylor 2000, Ellis 2013), accounting for 40% (Taylor 2000, Berger 2015, Hile 2015) of hand function.

The Trapeziometacarpal Joint (TMCJ) is the most common joint to be affected by premature degenerative changes (Taylor 2000), and the most common site in the upper extremity for surgery (Colditz 2000, O’brien 2013). The prevalence of TMCJ Osteoarthritis increases with age (Anakwe 2011) affecting 25% of men and 40% of women over 75 (Melville 2015, Valdes 2012).

With an aging population in Australia, TMCJ Osteoarthritis requiring both non-operative and operative treatment will become more prevalent (O’Brien 2014). The purpose of this article is to provide a snapshot of practice in this area by Australian therapists and compare the results to the current available evidence.

ciation (AHTA) members. The ATHA granted permission to administer the survey to current members (628 members at time of distribution) with a link to the survey created in Survey Monkey. To optimise response rate, the survey was sent out twice resulting in a total of 99 (15.76%) completed surveys. The majority of therapists (64.95%) worked in private practice, while 41.24% worked in government funded hospitals. Just over half (52.04%) of the therapists had more than 10 years hand therapy experience, with 21.42% having 5-10 years, 20.41% 2-5 years and 6.12% less than two years.

There was a near equal spit between full (49.48%) and associate (50.52%) ATHA members.

A systematic review of 23 randomized controlled trials (RCTs) conducted by Spaans et al 2015 is the most comprehensive review of nonoperative treatment for TMCJ The online survey discussed in Osteoarthritis. Unfortunately, it this article was conducted in highlights the need for further June 2015 to establish current research in this area. The contreatment trends amongst clusions of this systematic reAustralian Hand Therapy Asso- view are limited by the followPage 28

ing: (1) Only a few high-quality studies were available; (2) There is great variability in terms of population, intervention, and outcome; (3) The majority of studies were small in size with most including fewer than 30 participants; (4) Only one study had a follow-up greater than a year, with most of only weeks or months.

Ye et al 2011 performed a systematic review of 7 RCTs, 1 quasi-RCT and 2 cross over trials that compared a rehabilitation intervention with a control group using outcome measures for hand OA. There were very few high-quality clinical trials preventing firm conclusions and only one study was specific to the TMCJ. Valdes et al 2010 reviewed 21 studies between 1986-2009, excluding five systematic reviews previously published. Valdes included both randomised controlled trials and cohort studies regarding therapy-specific interventions for hand osteoarthritis. However, no specific recommendations can be made as only 9 of the 21 studies were specific to TMCJ osteoarthritis.

Three articles presented clinical reviews with papers by Anakwe et al 2001 and Neumann et al 2003 specific to TMCJ osteoarthritis and Beasley 2012 presenting a general overview of therapeutic management of Osteoarthritis and Rheumatoid Arthritis of the hand.

The majority of Australian Ther-

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Member Contributions Continued ... apists (70.88%) felt that nonoperative treatment modalities can achieve good (60.71%) to very good (10.71%) benefit, whilst 27.38% felt some benefit can be achieved and 1.19% felt limited benefit is achieved.

Splints (100%) and joint protection (97.78%) were the most popular treatment modalities (Graph 1), with heat (82.22%), assistive devices (76.67%), range of motion exercises (74.44%) and dynamic stability exercises (71.11%) following closely. 58% of therapists work on web space widening while taping, cold and therapeutic ultrasound were used by 24.44%, 15.56%, and 8.89% of therapists respectively. Low level laser therapy and multidisciplinary education classes were used least often.

Intra-articular TMCJ injection: 7 of the 23 RCTs reviewed by Spaans et al 2015 were specific to intra-articular injection concluding effects of steroids are achieved faster but are short lived, compared to hyaluronate, which starts slower but lasts longer. However, studies varied greatly in type of medication, number of injections, and amount of medication injected. The studies were also small and follow up times short with a maximum of 12 months in one study. Transdermal steroid delivery was not found to be effective.

Trellu et al 2015 performed a systematic review and metaanalysis of randomized controlled trials. Six trials with a total of 428 participants (mean

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age 63; 86% female) were included in the study and contributed to 3 meta-analyses comparing hyaluronic acid vs placebo, corticosteroids vs placebo and hyaluronic acid vs. corticosteroids. Although hyaluronic acid appeared better than placebo and may increase function while corticosteroid can reduce pain, the findings need to be confirmed due to limited patient numbers. Furthermore, only half of the studies used guidance for their injections which can lead to a 42% risk of extra-articular injection (Swindells 2010). There is insufficient evidence to guide how many injections may be safely given or over what time period (Anawake 2011).

64.04% of patients treated by Australian Therapists receive corticosteroid injections, 68.42% of which are ultrasound guided. Nearly half of therapists (48.28%) combine an injection with a period of immobilisation in a splint while 20.69% do not. 15.52% would like to but are not provided with the opportunity. Immobilisation times varied with 47.06% immobilising for 1-2 weeks and the remaining provided varied time frames (Graph 2). Custom thermoplastic splints were the most popular choice at 79.25% (Graph 3). Most included the TMCJ and MCPJ. The wrist was included at times and the IPJ was included rarely (Graph 4).

The majority of therapists indicating ‘other’ stated their choice of joint inclusion was

patient dependent.

Splints: 10 of the 23 RCTs reviewed by Spaans et al 2015 were specific to splinting, with authors concluding that there is some evidence to support splinting to reduce pain up to one year but does not influence hand function or strength. Comparison was made impossible’ (according to Spaans et al 2015) due to varied degrees of osteoarthritis, different length, make, and material of orthoses worn under different circumstances and for varied time periods with follow up periods ranging from 2 weeks to 7 years.

Only Neumann 2003 in a clinical review of TMCJ osteoarthritis discussed thumb position, recommending relative palmer abduction with slight flexion and medial rotation to maintain the web space and increase natural stability through joint congruency.

Splinting is used by Australian therapists 100% of the time (Graph 1). Style of splint varies (Graph 5) with custom TMCJ+MCPJ (86.67%) and ready-to-wear Push braces (67.78%) being the most popular, followed by Comfort Cool Thumb Spica Short (53.33%), custom TMCJ (41.11%) and custom thumb and wrist (36.67%) splints.

Joint Protection Education: There is no high level evidence for joint protection education (Spaans et al 2015 and Valdes

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Member Contributions Continued ... et al 2010). Despite this, Australian therapist’s must see clinical benefit of joint protection education as it is the second most common treatment modality (Graph 1) used (97.78%) with assistive devices fourth (76.67%).

strengthening resulted in some participants leaving the study due to increased symptoms, raising the importance of ensuring a stable pinch pattern during exercise. Evidence for dynamic strengthening is limited with only one pilot RCT of 39 patients by Davenport et al Exercise: 2012, one retrospective cohort Exercise for management of study of 35 chart reviews by TMCJ osteoarthritis requires fur- O’Brien and Giveans 2013, and ther research. 6 of the 23 RCTs one literature review by Valdes reviewed by Spaans et al 2015 and Heyde 2012 to design an were specific to exercise show- exercise regimen based on ing that joint mobilisation, radi- biomechanical principles. al nerve gliding and their use in combination with range of mo- 74.44% of Australian Therapists tion exercise, grip and pinch report using range of motion strengthening can reduce exercises, 71.11% dynamic stapain. However, the RCTs inbility exercises and 57.78% web cluded were very limited with space widening (5th, 6th and 7th small sample sizes of less than most common treatment mo60 participants and short follow dalities used) (Graph 1). up times making comparison and conclusions difficult. In Ye Low Level Laser Treatment et al 2001’s systematic review, (LLLT): three studies reviewed exercise Valdes et al 2010 found LLLT no but were not specific to TMCJ better than placebo for reducOsteoarthritis. Valdes et al ing pain, stiffness and hand 2010’s systematic review had 2 function but this systematic restudies of 80 patients that were view was not specific to TMCJ specific to TMCJ OA. Unfortuosteoarthritis. From the survey, nately, they explored exercise LLLT was a rarely used treatin combination with splints, ment modality by Australian heat and joint protection exer- therapists (Graph 1). cises. Anawake 2011’s clinical review had no specific recom- Local application of heat: mendations regarding exerValdes et al 2010 reported cise. Neumann et al (2003) sug- weak evidence to support gestions on TMCJ osteoarthritis heat to reduce pain. Zhang et exercise has not been conal 2007 reported expert opinion firmed by RCTs. level evidence to support use of heat especially before exerBeasley 2012 also presented a cise. AHTA survey showed that general overview not specific heat was the third most comto TMCJ osteoarthritis. Sadly, mon treatment modality one study cited in Beasley’s (Graph 1). paper using resistive pinch Page 30

Ultrasound: Within Australia, based on the survey results, therapeutic ultrasound is used by a small number of therapists (Graph 1). No studies looking at the use of ultrasound for TMCJ osterarthritis were found (Spaans et al 2015).

Conclusion: The results of this survey provided a snapshot of current practice in Australia regarding management of TMCJ osteoarthritis; however, the results need to be read with caution as the number of respondents only accounted for 15.76% of current registered AHTA members.

There is a great need and opportunity for further research both due to the lack of high quality well designed RCTs and an aging population within Australia increasing the prevalence of patients presenting with symptomatic TMCJ osteoarthritis.

In the next newsletter, operative management of TMCJ osteoarthritis will be discussed in relation to the current evidence and current Australian practice. A very big thank you to everyone who participated in the survey, I really appreciate the time people took to complete the survey. I hope you have enjoyed exploring the survey results. If you have any specific questions regarding the survey results please email me.

Kylie Bebel kyliebebel@gmail.com.

Occupational Therapist The Prince Charles Hospital

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Member Contributions Continued ...

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

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Member Contributions Continued ...

References: Neumann, D. and Bielefeld, T. (2003) The Carpometacarpal Joint of the Thumb: Stability, Deformity, and Therapeutic Intervention. J Orthop Sports Phys Ther 2003;33:386–399.

Taylor, J. (2000) Restoration of dynamic stability in early osteoarthritis of the carpometacarpaL joint of the thumb. British Journal of Hand Therapy; 5(2)

Ellis , H. (2013) Edward Hallarran Bennett: Bennett's fracture of the base of the thumb. Journal of Perioperative Practice; 23(3) Berger, A., and Meals, R. (2015) Management of Osteoarthrosis of the Thumb Joints. J Hand Surg Am;40(4):843-850.

Hile, D., and Hile, L. (2015) The Emergent Evaluation and Treatment of Hand Injuries.

Emerg Med Clin N Am 33:397– 408 Colditz, C. (2000) The Biomechanics of a Thumb Carpometacarpal Immobilization Splint: Design and Fitting. J HAND THER;13:228-235 O’Brien, V., and Giveans, R. 2013. Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: A retrospective study. Journal of Hand Therapy;26:44-52

Anakwe, R., and Middleton, S. 2011 Osteoarthritis at the base of the thumb. BMJ;343.

Melville, D. (2015) Imaging and management of thumb carpoPage 34

metacarpal joint osteoarthritis Skeletal Radiol 44:165 – 177

Beasley, J. (2012) Osteoarthritis and Rheumatoid Arthritis: Conservative Therapeutic ManageValdes, K., and Heyde, R. 2012. ment. J Hand Ther. 2012;25:163 An Exercise Program for Carpo- –72. metacarpal Osteoarthritis Based on Biomechanical Prin- Trellu et al. (2015) Intra-articular ciples. J HAND THER. Injections in thumb osteoarthri2012;25:251–63. tis: A Systematic review and meta-analysis of randomized O’Brien, V., and McGaha, J. controlled trials. Joint Bone (2014) Current practice patSpine terns in conservative thumb CMC joint care: Survey results. Swindells et al 2010. The benefit Journal of Hand Therapy; 27:14 of radiologically-guided steroid -22 injections for trapeziometacarpal osteoarthritis. Ann R Coll Spaans et al 2015. ConservaSurg Engl; 92: 680–684 tive Treatment of Thumb Base Osteoarthritis: A Systematic Re- Edmunds, J. (2011) Current view. J Hand Surg Am; 40(1):16 Concepts of the Anatomy of the Thumb TrapeziometacarYe et al (2011). Effects of reha- pal Joint. J Hand Surg bilitative intervention on pain, 2011;36A:170–182 function and physical impairments in people with hand os- Davenport et al 2012. Pilot ranteoarthritis a systematic review. domized controlled trial comArthritis Research and Theraparing specific dynamic stabilpy;13:28 ity exercises with general exercises for thumb carpometacarZhang et al 2007. EULAR evipal joint osteoarthritis. Hand dence based recommendaTherapy 2012; 17: 60–67. tions for the management of hand osteoarthritis: Report of a Wajon A, Vinycomb T, Carr E, Task Force of the EULAR Stand- Edmunds I, Ada L. (2015) Suring Committee for International gery for thumb Clinical Studies Including Thera- (trapeziometacarpal joint) ospeutics (ESCISIT). Ann Rheum teoarthritis. Cochrane DataDis 2007;66:377–388. base of Systematic Reviews, Issue 2. Art. No.: CD004631.

Valdes and Tambra. (2010) A DOI: Systematic Review of Con10.1002/14651858.CD004631.pu servative Interventions for Oste- b4. oarthritis of the Hand. Journal of Hand Therapy;23:334-51 Wolfe et al. (2014) A Systematic Review of Postoperative hand Anakwe, R., and Middleton, S. Therapy Management of Basal (2011) Osteoarthritis at the Joint Arthritis. Clin Orthop Relat base of the thumb. BMJ;343.

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Member Contributions Continued ... surgical preference stating better clinical outcomes as the leading reason. When asked about what factors contribute to less optimal outcomes, a contracted web space and MCPJ hyperextension were the two most commonly reported. Poor pinch pattern, adverse events, waited too long for surgery, hypermobility, and proximally migrated metacarpal all came a technique and surgeon prefer- close second regarding reaence resulting in no clear con- sons for optimal outcomes clusions regarding the clinical (Graph 2). efficacy of various therapy protocols. On average paK-wires were usually removed tients in these studies were between 4 and 6 weeks postsplinted for 4-8 weeks post tra- surgery for the 16.87% of surpeziectomy +/- ligament regeons who use k-wire fixations construction (LR) +/- tendon post trapeziectomy +/- surgerinterposition (TI). This changed ies. Majority (96.15%) of pato 4-5 weeks if a K-wire was tient’s in Australia are used, or 2-6 weeks post joint changed from a plaster to a prosthesis. There was minimal splint at some point post TMCJ description regarding type of surgery. Australian therapists splint and the type of exercises are consistently including the provided. Time to return to full wrist, MCPJ and TMCJ in postunrestricted activity was only operative splinting (Graph 3), mentioned in five articles rewith 95% of splints being of porting 5-12 weeks. custom thermoplastic design.

The remaining 5% of postSurvey Results: operative splints being custom Trapeziectomy +/- LR +/- TI or thermoplastic and neoprene in combination were the four combination (1.25%), or Manu most common surgeries perpollex or fibreglass. Splinting formed across Australia with regimes were variable with LRTI leading (Graph 1). TMCJ 25.32% preferring complete arthrodesis came next folimmobilisation. There was lowed by a number of less fre- great variability among those quent surgeries including met- therapists who allow the splint acarpal resection, artelon joint to be removed including reresurfacing, swanson joint removal for protected hygiene, placement, pyrocarbon imbath/shower, exercises, not at plant, fibre wire sling and Elrisk activity and light tasks ektra arthroplasty.

(Graph 4). 40% of therapists immobilised for 6 weeks with 40.7% of AHTA therapists had a the remaining 60% ranging

TMCJ Osteoarthristis: Review of the evidence and Current Practice Patterns Part Two: Operative treatment

By Kylie Bebel Welcome to part two of the Australian Therapy Survey that was conducted in June 2015 regarding TMCJ Osteoarthritis.

In the last newsletter we presented a snapshot of practice in relation to non-operative management of TMCJ Osteoarthritis and compared the results to the current available evidence. In this newsletter we are going explore operative management of TMCJ Osteoarthritis.

Current Evidence: A recent Cochrane Review by Wajon et al 2015 (670 participants) concluded that the 11 studies were not of high enough quality to be conclusive. No surgical procedure demonstrated superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or TMCJ imaging.

Wolfe et al 2014 performed a systematic review of postoperative therapy. 19 articles were included, all with small numbers of subjects. Postoperative management varied greatly depending on Page 35

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Member Contributions Continued ... from immediate day one, with popular variations being 2 and 4 weeks (Graph 5). Most of the time therapists commenced splint wean at 6 weeks (39.74%), the next most popular time to wean was at 4 weeks (19.23%). All therapists had commenced weaning the splint by 8 weeks postsurgery (Graph 6). When therapists commenced exercises varied greatly with majority (31.65%) stating timing was surgeon dependent (Graph 7).

There were clusters at 0-7 days, 2 weeks, 4 weeks and 6 weeks. Focusing on joints moved prior to 6 weeks postsurgery (Graph 8), looking at wrist range of motion, extension/flexion was most common. Looking at TMCJ range of motion, radial and palmer abduction were ranged mostly followed by circumduction and opposition. MCPJ extension/flexion was commended 68% of the time, whilst interestingly; the IPJ was ranged prior to 6 weeks only 79.45% of the time. This may be a reflection of how the question was proposed during the survey than actual reality; a follow-up survey would be required to clarify this point.

The results of this survey provided a snapshot of current practice in Australia regarding post -operative management of TMCJ osteoarthritis; however, the results need to be read with caution as the number of respondents only accounted for 15.76% of current registered AHTA members. There is a great need and opportunity Outcome Measures: for further research both due Research articles focusing on to the lack of high quality well the surgical technique tended designed RCTs and an aging to use ROM, pain (VAS), population within Australia instrength, PRWE, STHF, JHFT, SF- creasing the prevalence of 36, and. While research artipatients presenting with sympcles focusing of the posttomatic TMCJ osteoarthritis. operative therapy utilised ROM, Pain (VAS), Strength, Again a very big thank you to PRWE and DASH. everyone who participated in the survey, I really appreciate From the survey, Australian the time people took to comtherapists use ROM most often plete the survey. I hope you as an outcome measure at have enjoyed exploring the 94.81 percent (Graph 11). Pain survey results. If you have any (VAS), grip strength, three specific questions regarding point and lateral pinch the survey results please email strengths were also popular me at. being used more than 50 percent of the time. PRWE, DASH Kylie Bebel and QuickDASH appear to be kyliebebel@gmail.com used around 23-25% of the time, with MHQ least used.

Occupational Therapist The Prince Charles Hospital Increasing our use of outcome measures such as the DASH, QuickDASH or PRWE standardNearly half of therapists (45%) ly with all patients may assist us commence strengthening at 8 to engage in research. Howweeks post-surgery (Graph 9). ever, it is finding ways to rou22.5% make the decision to tinely administer these selfstrengthen based on the surreported questionnaires into geon and patient, while 12.5 % our daily practice whilst enacommence at 6 weeks or at bling time to assess and treat between 9-12 weeks postthe patient that is challenge. surgery. One therapist commenced strengthening at 4 Conclusion:

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weeks post-surgery. Theraputty and dynamic strengthening were commonly used (Graph 10), followed by therafoam then free weights. Theraband and slosh pipes were used least often. Majority of patient’s in Australia are discharged at 12 to 16 weeks post-surgery.

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References: Neumann, D. and Bielefeld, T. (2003) The Carpometacarpal Joint of the Thumb: Stability, Deformity, and Therapeutic Intervention. J Orthop Sports Phys Ther 2003;33:386–399.

Taylor, J. (2000) Restoration of dynamic stability in early osteoarthritis of the carpometacarpaL joint of the thumb. British Journal of Hand Therapy; 5(2)

Ellis , H. (2013) Edward Hallarran Bennett: Bennett's fracture of the base of the thumb. Journal of Perioperative Practice; 23(3) Berger, A., and Meals, R. (2015) Management of Osteoarthrosis of the Thumb Joints. J Hand Surg Am;40(4):843-850.

Hile, D., and Hile, L. (2015) The Emergent Evaluation and Treatment of Hand Injuries.

Emerg Med Clin N Am 33:397– 408 Colditz, C. (2000) The Biomechanics of a Thumb Carpometacarpal Immobilization Splint: Design and Fitting. J HAND THER;13:228-235 O’Brien, V., and Giveans, R. 2013. Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: A retrospective study. Journal of Hand Therapy;26:44-52

Anakwe, R., and Middleton, S. 2011 Osteoarthritis at the base of the thumb. BMJ;343.

Melville, D. (2015) Imaging and management of thumb carpoPage 43

metacarpal joint osteoarthritis Skeletal Radiol 44:165 – 177

Beasley, J. (2012) Osteoarthritis and Rheumatoid Arthritis: Conservative Therapeutic ManageValdes, K., and Heyde, R. 2012. ment. J Hand Ther. 2012;25:163 An Exercise Program for Carpo- –72. metacarpal Osteoarthritis Based on Biomechanical Princi- Trellu et al. (2015) Intra-articular ples. J HAND THER. 2012;25:251– Injections in thumb osteoarthri63. tis: A Systematic review and meta-analysis of randomized O’Brien, V., and McGaha, J. controlled trials. Joint Bone (2014) Current practice patSpine terns in conservative thumb CMC joint care: Survey results. Swindells et al 2010. The benefit Journal of Hand Therapy; 27:14- of radiologically-guided steroid 22 injections for trapeziometacarpal osteoarthritis. Ann R Coll Spaans et al 2015. ConservaSurg Engl; 92: 680–684 tive Treatment of Thumb Base Osteoarthritis: A Systematic Re- Edmunds, J. (2011) Current view. J Hand Surg Am; 40(1):16 Concepts of the Anatomy of the Thumb Trapeziometacarpal Ye et al (2011). Effects of reha- Joint. J Hand Surg 2011;36A:170 bilitative intervention on pain, –182 function and physical impairments in people with hand os- Davenport et al 2012. Pilot ranteoarthritis a systematic review. domized controlled trial comArthritis Research and Theraparing specific dynamic stabilpy;13:28 ity exercises with general exercises for thumb carpometacarZhang et al 2007. EULAR evipal joint osteoarthritis. Hand dence based recommendaTherapy 2012; 17: 60–67. tions for the management of hand osteoarthritis: Report of a Wajon A, Vinycomb T, Carr E, Task Force of the EULAR Stand- Edmunds I, Ada L. (2015) Suring Committee for International gery for thumb Clinical Studies Including Thera- (trapeziometacarpal joint) ospeutics (ESCISIT). Ann Rheum teoarthritis. Cochrane DataDis 2007;66:377–388. base of Systematic Reviews, Issue 2. Art. No.: CD004631.

Valdes and Tambra. (2010) A DOI: Systematic Review of Con10.1002/14651858.CD004631.pu servative Interventions for Oste- b4. oarthritis of the Hand. Journal of Hand Therapy;23:334-51 Wolfe et al. (2014) A Systematic Review of Postoperative hand Anakwe, R., and Middleton, S. Therapy Management of Basal (2011) Osteoarthritis at the Joint Arthritis. Clin Orthop Relat base of the thumb. BMJ;343.

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Expected Hand Therapy Competencies in Australia

By Amy Geach

In 2012, the AHTA looked into a profile study of their Members. Part of this study aimed to identify areas of competency for hand therapists in Australia, and rates at which these competencies develop. Prior to developing this study of AHTA Members, I discussed the project with Mary Kasch, who had previously looked at hand therapy competencies in the United States in 2003. Her work was based on the notion that

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a continuum of competency would allow organisations to: 





“Determine the characteristics of a minimally competent hand therapist.”

“Establish the content and educational experience level of continuing education programs for practicing hand therapists.”

And develop “evaluation

tools that might be used by hand therapists for self assessment, or by employers, supervisors or other professionals for the purpose of performance evaluation.” (Kasch, et al, 2003, p49).

Kasch, et al (2003), in their research, mailed a questionnaire to 539 CHT’s in the United States and 47 CHT’s in Canada. Their questionnaire rate of return was 71%, with respondents having an average of 11.5 years of experience in hand therapy. 44% of their respondents worked in hospital settings, and 24% worked in therapist-owned practices.

82% of the respondents were OTs, and 17% were PTs. Respondents had been asked to rate skill level in six main areas being:

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Clinical judgement/ clinical reasoning Scientific knowledge Technical skills Interpersonal and communication skills Professionalism Resource management

skipped the section of the questionnaire that asked  about hand therapy compe 4 = After more than five years tencies, leaving a total of 208  of specialised practice as a therapists responding to comhand therapist petencies as detailed above.  Of those that participated in  With permission from the main the study for the AHTA, 91% researcher, Mary Kasch, I unwere female, and 67% were Response choices they could dertook to replicate this study occupational therapists, with assign to each of the above to allow the AHTA to gather 32% being physiotherapists. Of skill areas were as follows: information and insight into those that responded, 33% hand therapy competencies had 9 years and under of post 1 = Before any specialised at a national level. graduate experience as a practice as a hand therapist therapist, and 67% had 10 In 2012, the AHTA profile ques- years and over of experience.

2 = During the first year of spe- tionnaire was emailed to all cialised practice as a hand Members of the AHTA. 140 As- The following table outlines the therapist sociate Members completed responses from AHTA Members the study, and 126 Full Memin 2012, and compares with 3 = During the second through bers. 58 Members, however, those from Kasch, et al (2003). 

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fifth years of specialised practice as a hand therapist

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Reference: Kasch, M., Greenberg, S., Muenzen, P. (2003). Competencies in hand therapy. Journal of Hand Therapy, 16 (p49-53).

Amy Geach Riverina Hand Therapy Wagga Wagga NSW Life Member Page 48

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What GP’s want!

Part two: Strategies to marketing used by allied health professionals

By Amy Geach

Last edition of the newsletter I wrote about why our correspondence letters to general practitioners are important avenues of marketing our services and building relationships with our referrers.

The take home messages that has come to light from past research into marketing to GPs, indicates that up to date, well set out letters (with headings), that define the problem, and answer their referral question are some of the areas that GPs are seeking in our correspondence as allied health professionals.

When asked about how they market to their direct referrers, the following were the most common  methods:

What are some of the other ways that people market to GPs? In my survey to AHTA Members in 2014 investigating marketing strategies and attitudes of hand therapists in Australia, I looked at results from 144 AHTA Members who completed the online survey.

When asked about which strategies therapists used for marketing in 2013-2014, results indicated the following most common print and digital methods:

How do these relate to past literature on the use of marketing strategies by allied health professionals to GPs? There is a paucity of detailed research in this area,  however what we can find are the following pieces of information.

      

     





In 2012, a study by Mitchell, et al, looked at the perceptions of general practitioners and dieticians at increasing referrals for diabetic consultations. The study involved telephone and online surveys with  Australian dieticians and general practitioners, with results suggesting that;

Business cards 80.77% Website 67.69% Brochures 47.69% Direct mailouts 30.77% Social media 29.23% Thank you cards 21.54%  Promotional items with your logo 16.92%

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Good patient correspondence 80.15% Face to face meetings 68.38% Use of outcome measures 27.94% Introductory material provided 28.68% Providing lunches 17.65% Referrer satisfaction survey 8.09%

A GP’s relationship with dietician was believed to be the main influencing factor for referral by 81% of survey

dieticians and 25% of interview dieticians Most common way of forming GP relationships was via face to face introduction (485%), introductory letters (37%) and patient feedback letters (25%).

Patient feedback via letter, fax or emails was the most popular relationships with GPs (77%) followed by phone calls (25%) Most commonly reported strategy was to make referral easier for GPs by providing pre-printed referral pads – BUT 37% of those mentioning use of them also reported that they didn’t find them helpful due to existing electronic systems Meeting GPs in person was believed to be the most effective activity in building relationships with GPs and increasing referral rates, followed by information sessions, updates on services and good contact/ communication.

The majority of GPs interviewed said it would make it easier to refer to colocated dieticians - the main reason suggested was that it acted as a reminder or provided better exposure “out of sight out of mind”

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In an Australian study of GP trends in 2013-2014, services that were co-located with GP practices were:    

Psychologists 55% Physiotherapists 40% Dieticians 43% Podiatrists 41%

A study in 2003 (Nicholas, et al), examined the role of the GP in helping manage nutrition via providing dietician handouts to clients. They reported that the use of handouts in GP practice promoting other services was most likely to be the most beneficial if the GP felt they should provide the handout and their work routines allowed. The authors of this study indicated that handouts have their greatest impact on client action when the GP spends time discussing the particular handout.

Another study earlier in 2000 by Lock and Kaner also looked at the use of handouts that were provided to GPs. Their study was conducted in the United Kingdom, and included 321 GPs who were undertaking a program to identify the effect of different marketing material. The study looked at which marketing methods were most useful in encouraging GPs to disseminate information to clients about alcohol intervention. Each GP was given a pack of information that included promotional pamphlets, guidelines for GPs, guidelines for receptionists, self help book for patients and stickers for patient files. The GPs were then divided in to three groups and the information packs were therefore marketing to the GPs using 1.

Postal marketing 2. Telemarketing and 3. Personal visit to GPs. 

The study has shown that,

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although personal marketing was the most effective strategy to promote dissemination of the program to GPs, the high travel and labour costs associated with this strategy resulted in telemarketing being more cost effective (GPs were called up to 10 times, when speaking to GP, there was a script to describe the program). Costs were 7 times cheaper to telemarket than to visit personally. Postal marketing was also more cost bearing than telemarketing. Whilst telemarketing was more cost effective overall, it was postal marketing that was the most successful method of persuading GPs to agree to use the programme, however perhaps because those who responded by mail were more motivated to do so. What the research has also shown is that both practice nurses and their respective GPs identify health promotion as a significant feature of the nurse role. Consequently, resultant work has focused on nurse-led early and brief alcohol interventions. This is definitely an area that hand therapy marketing can focus on, with more and more general practices have at least one practice nurse.

through the use of focus groups and interviews conducted with occupational physicians. The study concluded the following general observations: 





The physicians often forgot to approach eligible patients because they were more focused on their regular tasks and did not have enough time left at the end of their consultation to discuss recruitment Physicians suggested that having the material at hand visibly and receiving reminders and weekly newsletters via email would be helpful in the recruitment of clients to the study, as well as pop up screens reminding them to discuss recruitment with their clients, having one physician functioned as an ambassador for the centre, reminding other physicians about recruitment Physicians also reported that working at different locations and therefore not having the information in the same place at each location made it difficult to recruit.

There are so many advantages to marketing electronically now – it is often more cost effective, however it only works if our general practitioners are also using similar electronic media, such as email, at work for example. In 2014, a In a study of GPs in Australia in study by Lee, et al, investigated 2013-2014, 23% of general practhe preferred ways that GPs want tices across the nation had 2 to learn in the digital era. They practice nurses, and 18% had 3 took a random sample of 2500 practice nurses.

GPs in Australia and asked them to respond to questions on GPs Arends, et al., (2014), studied the preferences for continuing medimost effective way to engage cal education (CME) activities. In occupational physicians in rethis study, results indicated: cruitment of research participants

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



Most GPs showed a preference for learning in a group as opposed to learning on their own Specifically lecture based CME was preferred most often (83% of GPs preferred to learn in a group in a face to face format with an expert) Older GPs were less likely to prefer online learning, particularly online self education, as were GPs working in solo practices – therefore the combination of solo GPs and online learning is less favourable More than half of GPs surveyed have a preference for CME to be delivered online as more flexible. It is also highly regarded amongst younger GPs.

doubles every 20 years. Mobile devices can now smooth the connection pathway between the doctor and the required knowledge according to Bullock (2014) and web based technology can be used to create new opportunities for collaborative learning and knowledge construction enabling learners to be more participative, engaged and social as well as mobile.

execute our marketing plans. It is very possible that tweaking a few of our strategies, or the nature in how we deliver them to the GP, can perhaps encourage greater recognition of our services from the GPs perspective and therefore go on to enhance the therapist-GP relationship and future referral patterns.

In the next edition of the newsletter, I will discuss the third part to Are GPs on mobile and internet this series, which is looking at the devices however to get this infor- statistics for GP referrals to allied mation? Another study from 2014 health from 2013-2014, and fur(Moore & Jayewardene) surther results on how hand theraveyed 334 doctors in the United pists in Australia use marketing  Kingdom on their use of strategies and their beliefs on smartphones at work. Their results how marketing can help our proindicate 83% of doctors use fession. smartphones to access textbooks at work, 73% use them as clinical Amy Geach decision tools and calculators, Director Riverina Hand Therapy with a total of 81% of those surand Maida Learning Bullock (2014) supports the ideas veyed agreeing that they use amy@maidalearning.com.au that technology can be used well their smartphone at work. www.maidalearning.com.au to support learning in the clinical workplace for GPs and to share In Australia, results of GP prefercorrespondence and information ences from 2013-2014 indicate with other health professionals. It that 77% of GPs use computers for is also though, harder as individu- internet at work, and 61% use al hand therapists to market to computers for email at work GPs in this instance when everyone else is trying to do it as well.

Whilst we need to take an individNowadays, the need for access ual approach to how we market to repositories of information is our own services and also how increasingly necessary with the our local general practitioners explosion of knowledge. It has might prefer our marketing matebeen suggested that the inforrials, the above studies can give mation from biomedical research us food for thought on how we

Correction CORRECTION: As drawn to our attention by Liz Ward in Newsletter Edition 103, the article "What Do They Want From Me Now - tips on report preparation" incorrectly omitted the acknowledgement that it was prepared with the assistance of information from a seminar presentation given by Slater and Gordon Lawyers. We would like to correct this omission. Liz found the advice a useful resource for her practice, and wanted to share this with other members, but always remember to seek your own independent legal advice in matters affecting your practice.

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A Patients Perspective

By Julie Condon

I am a 34 year old male with a complicated wrist injury sustained from a non-eventful fall in my driveway in 2014. That is my basic story that easily explains the scenario.

critical in my world is that I am a widower, I have two children at home, I have limited family support, I cannot just be another patient on the ward and I have responsibilities. This is where good medical practitioners shine, they As a patient who used the public ask you questions and are not system during my first admission in buried in the chart at the end of June 2014 and a patient who has the bed, and this is where a perused the private system to access son demonstrates empathy and specialist surgeons, I have seen compassion. the good and the bad of both sides of hospital care. My journey I understand the system is hectic started when I fell backwards off and that staff are stretched, I also the tray of a trailer and I used my appreciate how fractured the right hand to brace my fall, this health system is and that there is resulted in a distal radial coma disconnect amongst hospital pound fracture and debris into departments. That is the bad side the wound from the ground con- I saw, although very frustrated, in tact. As difficult as this injury pain and deeply concerned would have been to recover from about my children I accepted on its own, the radius also severed that the system was broken and flexor digitorum profundus (FDP) staff do the best they can so I tolas it exited my wrist, 100% to my erated the experience and was a middle finger and 30% to my ring good patient. and little finger.

When I started seeing the allied To date I have had 11 surgeries to health staff there was a differrepair the damage. ence in the care. The chart was never the first thing in their hand, While admitted in the public systhere was always conversation tem I was constantly bumped off and compassion, a level of attenthe surgery list, I had a plate intion that was lacking until this stalled the day after the fall with point. I know the hand therapists a vac drain to prevent infection, I are especially in short supply but I had the first drain for 6 days and never felt rushed or like I was just spent 8 days in hospital after the another UR number in the day. I initial fall. I was constantly aswas expertly fitted for my first sessed as non-critical, what was splint after surgery, placed into a Page 52

neutral finger position for my severed FDP injury and braced for the fracture.

During my first stay in hospital I lost 8 kilograms, I felt like I was constantly fasting, after 8 days I couldn’t wait to get home. I started passive treatment to get my fingers working again after I was discharged, the wrist was left alone because it was so damaged. My hand therapist at The Townsville Hospital was nothing short of amazing, thanks to her I have full function and movement in my fingers and a great recovery. We both worked very hard and pushed to achieve a fantastic outcome to give me a level of normality in my hand.

My wrist has been a different story, after a follow up x-ray and CT a number weeks after my wound had healed beautifully, a screw was identified as impeding the wrist joint and needed to come out. This was scheduled as simple day surgery to remove the screw and clear some scar adhesion around FDP to increase my finger movement. When the scar was opened and the plate was exposed there were signs of significant infection, swabs identified osteomyelitis. When I woke up I was back on the ward with a vac pump in my arm, this was not simple day surgery.

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I spent another 8 days in hospital getting wash outs in between getting bumped off the surgery lists, again the hand therapists provided a level of care and attention during this period to ensure that we lost no progress on all of the hard work we had already done. After I was discharged the second time the issues with my wrist seemed to compound and continue to get harder to overcome. Although we were making fantastic progress with my fingers and hand, my wrist was almost locked and provided nothing but frustration and discomfort. New X-rays identified that the radial head and lunate had fused, I was now 5mm ulna positive and the original fracture had barely healed due to the infection and placement of the plate. This meant that any wrist therapy was not going to happen until there was more stability in the fracture and the ulna issues were sorted.

movement, it was uncomfortable but I tried to return to a level of normality. Eventually the fused section of the radial head broke away from the radius and is having a happy union with lunate.

The other metacarpal bones sit slightly out of place and my scans The next round of treatment incontinue make specialists and volved an overnight stay in a pri- practitioners scratch their head vate hospital to have the plate and say “Well that’s interesting”. I removed and a bone graft taken used it normally and had eventufrom my hip and placed into my ally reached a point where I was wrist. Again my beautifully healed reasonably satisfied with where it scar was opened up, some scar was at. adhesion removed, plate removed and the bone graft I started to see a private OT and placed to assist with the fracture try to push my wrist and hopefully healing. The private system was get more gain, it was here that I very quick and easy, I was sent was referred to a private surgeon back to the OT staff at TTH and in Brisbane after we looked over we continued with hand therapy scans and x-rays. In May this year and no wrist movement. I was I had 9mm removed from my ulplaced into a brace to complete- na and had a plate inserted, I am ly restrict wrist movement for 6 almost back to pre op levels of weeks, the wound healed again movement. and I waited for some stability in the wrist so I could finally get an I am back in splints and braces osteotomy and have some relief and back doing exercises and in my wrist. recovering from surgery. My discomfort levels are getting better Even with the complications in and I can see that with therapy I the wrist I did manage a level of will get past my pre op levels and Page 53

get more functional use, it is just time, patience and doing the exercises ahead. My better experiences during this process have been a small number of wonderful nurses, some clever surgeons and the amazing OT’s that have helped me get to this point. I understand that I am a patient or client, if you look past my injury I am a person who leads a very busy life and runs a household, when I walk out the door I don’t leave my injury behind and continue about my day. I have daily frustration and live with the pain that occurs when I hold a pen the wrong way, I work full time and have adapted ways to function the best I can.

Take the time appreciate that an injury has a human attached, as a patient I know that I certainly appreciate being treated as a person and not an injury, that is what makes a lasting impression.

This article was submitted by Julie Condon on behalf of her patient.

The patient's name has been withheld for confidentiality reasons.

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Zone III extensor tendon injury of the finger

By Catherine Chong

Anatomy

muscles, before joining again to form the terminal tendon at the The anatomy of the finger is intri- base of the distal phalanx cate and an understanding of this (Wehbe 1995). is important in deciding appropriate treatment and dealing with Other structures to note are the common complications when dynamic and static components treating zone III extensor tendon of the extensor mechanism. The injuries (Evans 1995). The topolumbricals originate from the flexgraphic division of the extensor or digitorum profundus tendon tendons were proposed by and send two slips to the extensor Kleinert and Verdan where zone mechanism: one dorsally to the III lies over the proximal interpha- central slip and the other to the langeal joint (cited in Towfigh & lateral slip to form the lateral Gruber 2005). The extensor tenband (Wehbe 1995). The palmar don travels over the metacarpal interossei muscles send one slip to phalangeal joint and divides into the neighbouring phalanx, and three parts (Wehbe 1995). The similar to the lumbricals, send a central slip inserts into the base of slip to the central slip and then the middle phalanx, the lateral the lateral band acting to flex the slips travel along each side of the metacarpal phalangeal joint and proximal interphalangeal joint adduct the fingers (Wehbe 1995). forming the lateral bands, along The dorsal interossei are similar with the lumbricals and interossei again but act to extend the met-

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acarpal phalangeal joint while abducting the fingers (Wehbe 1995). The triangular ligament holds the lateral bands over the dorsal side of the middle phalanx (Wehbe 1995) preventing them from subluxing volarly. Conversely the transverse retinacular ligament prevents the lateral bands from subluxing dorsally (Wehbe 1995). The oblique retinacular ligament (ORL) originates on the flexor sheath (C2 pulley) of the proximal interphalangeal joint and inserts to the lateral bands on the dorsum of the distal interphalangeal joint (Wehbe 1995).

Image 1 (Prosner and Green 2013) Injuries to the central slip can develop by a number of mechanisms including severe sprains, dislocations, blunt trauma, industrial accidents and traction injuries (Towfigh & Gruber 2005).

Closed injuries occur when the patient often describes sudden forced PIP joint flexion to a joint that is being actively extended (Prosner & Green 2013). The central slip can also be injured with an open injury or laceration, following infection, chemical or thermal injury or as a result of inflammatory arthritis (Prosner & Green 2013). The boutonniere

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Member Contributions Continued ... deformity also known as buttonhole deformity develops as a result of weakness and loss of the extension of the PIP joint and hyperextension of the DIP joint (Prosner & Green 2013). The passive mobility of the finger is unaffected at first but becomes a fixed deformity with time (Towfigh & Gruber 2005). Contractures of the ORL, volar plate and collateral ligaments of the distal interphalangeal joint result in a fixed deformity (Prosner & Green 2013).

tral slip is intact but if it is not flail Treatment Approaches then a central slip lesion is indicated (Vermaak & Deveraj 2013).

Short Arc Motion Image 2 (Prosner and Green 2013)

Westerheide et al (2003) used diagnostic ultrasound on cadavers to assess whether ultrasound was accurate in diagnosing central slip lacerations. 12 cadavers’ fingers were used where 6 had lacerations of the central slip and 6 shams were cut and sutured then Special Tests examined by ultrasound. The study found that all 12 were idenElson’s test is used to assess the tified correctly as either controls integrity of the central slip. The with intact central slips or with diagnostic test is completed by transacted central slips. The aupositioning the PIP joint in 90 dethors suggested diagnostic ultragrees of flexion (Prosser & Green sound is a useful and non-invasive 2013). The resting position of the way to detect central slip rupDIP joint is compared to the other tures in suspected cases and preside and the patient is instructed vents complications such as bouto extend the PIP joint against re- tonniere deformity and prosistance. A positive test is when longed therapy. This further reinextension of the PIP joint is weaker forces that early detection of and DIP joint extension is obcentral slip ruptures and appropriserved (Prosser & Green 2013). ate therapy is crucial in preventAnother test described by Vering complications, however, maak and Deveraj (2012) is the mechanism of injury and clinical observation of the DIP joint when presentation do provide a lot of the PIP joint is passively flexed . If useful information when assessing the DIP joint is flail then the centhese patients.

Immediate active short arc motion (SAM) described by Evans (1995) arose in response to common problems associated with complex extensor tendon injuries and existing immobilisation protocols. She described her rationale for the program was to provide some controlled stress and motion to stimulate strength with healing and to reduce common complications such as adhesions, loss of digital flexion, extensor lag, joint contracture and prolonged treatment time. Evans (1995) advocates anecdotally that patients that are referred for early motion within 24-48 hours postoperatively obtain the best results in terms of range of motion and length of treatment. Using the work of Brand and the radian concept, Evans (1995) theorises that 30 degrees of PIP joint motion equals approximately 3.75mm of glide and that placing the wrist in 30 degrees of flexion reduces the load on the EDC by reducing resistance of the extrinsic finger flexors. The MP joint is positioned at 0 degrees and the DIPJ is unrestrained during the active PIP exercise (Evans 1995).

The PIP joint is then manually stabilised and the DIP joint is flexed independently if the lateral bands are unrepaired (Evans 1995).

More caution is used if the lateral bands are repaired (Evans 1995).

Evans (1995) compared the results of open and repaired zone III extensor tendon injuries over a 7 year period, which consisted of 64 digits in 55 patients. For the first two years the data was analysed retrospectively then prospectively for following 5 years.

One group was treated with 3-6 weeks of immobilisation followed

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Member Contributions Continued ...

by PIP motion and the other group with the SAM protocol.

Both groups were then subdivided into either simple (central slip with or without lateral band repair) or complex injuries (laceration with cartilage ligament, bone or distal joint injury).

Her results show that groups were equal in regards to gender and complexity of injuries. The SAM group had better outcomes in regards to extensor lags at discharge (2.96 degrees compared with 8.13 degrees) and better TAM results (131.5 degrees compared with 110.7 degrees). The SAM group also recovered quicker than the immobilisation group (51.38 days compared with 76.07). Not only is SAM superior in overcoming common postoperative complications, it is also a cost effective way to treat patients compared with the traditional immobilisation protocol.

K-wire A study by Towfigh and Gruber (2005) looked at the results of 114 patients who had surgery for zone III extensor tendon injuries. These included open injuries with or without tissue loss, closed lesions with complete division of the extensor mechanism, passively correctable boutonniere deformities and injuries that had failed conservative management. The authors described a number of operative techniques, which were customised depending on the type of injury and may or may not have included k-wire(s) insertion.

Therapy management included immobilisation in a POSI splint for 2 weeks, splint immobilisation of the PIP joint only at 3-4 weeks, removal of the k-wire if inserted at 4 weeks and active physiotherapy until range of motion was restored. Capener splints were also provided if required. The results Page 56

showed that 21% of patients had excellent results, 47.4% had good results, 19.3% had satisfactory results and 12.3% had poor. Towfigh and Gruber (2005) did not provide TAM or degrees of extensor lags so it was difficult to compare their results to those of Evans. They concluded that patients who were treated immediately and who had simple injuries had better outcomes compared to those who had delayed or complex injuries. This article emphasised the different types of operative techniques rather than the benefits of therapy. It did, however, highlight that early management and complexity of injury directly affect the final outcome and can be useful in providing prognostic opinion.

A smaller but similar study to that of Pratt (2003) is one by Maddy and Myerdierks (1997) who retrospectively reviewed 7 digits over an 18 month period. The PIP joint was immobilised and blocked DIP joint flexion exercises given from day 1-7 postoperatively. A Capener splint was provided at approximately 26 days after injury and composite MP, PIP and DIP joint flexion was commenced.

Patients were instructed to allow the splint to extend the joint after each repetition. Ten repetitions were prescribed every 1-2 hours and splint worn full time for approximately 7.4 weeks. Night extension splinting continued an additional 4.7 weeks. Maddy and Myerdierks (1997) observed that all digits actively extended from 0 to +5 degrees, except one Dynamic Splinting that had a -5 degree lag. All 7 digits had excellent results. 3 paPratt et al (2003) completed a tients returned to full duties at 7.5 prospective study on surgically weeks. It would be interesting to repaired open central slip injuries see whether consistently good to treated with 3 weeks of PIP joint excellent results are achieved immobilisation followed by 3 with Capener splinting in a larger weeks of controlled mobilisation study. The current evidence within a Capener splint. An exshows good results are achieved tension splint was provided for with exercise within the Capener night use and patients were mon- splint. itored weekly. Scar management was provided as soon as Conclusion the wound was healed and strengthening commenced at 6 An anatomical understanding is weeks postoperatively. 31 fingers helpful when considering recovwere assessed and results showed ery and treatment of zone III exthe mean flexion of the PIP joint tensor tendon injuries. Common was 94 degrees. Mean DIP joint complications include an extenflexion was 57 degrees. An exten- sor lag, boutonniere deformity sion lag was noted in 5 fingers and tightening of surrounding with a mean of 6 degrees. This structures such as ORL and intrinstudy showed an alternate way sic muscles. Common mechato treat extensor tendon injuries nisms of injuries and objective exparticularly with patients who aminations such as Elson’s test have difficulty adhering to an ex- assist with accurate diagnosis of ercise regime such as the one these injuries. The treatment approposed by Evans (1995). Miniproaches have changed to commal follow-up was required with bat the complications observed good to excellent results. with immobilisation protocols such as SAM and Capener splint-

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Member Contributions Continued ... ing. Timing of treatment and the nature of the injury both directly affect the final outcome for this patient population.

AHTA Google Group 

Would you like to discuss ideas and issues with other hand therapists?



Do you love the idea of having access to an entire network of like-minded individuals?

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Would you love to access a wide range of topics relative to your industry and even create your own topics?

References Evans R.B. (1995). Immediate short arc motion following extensor tendon repair. Hand Clinics, 11, 483-510.

Maddy L.S. & Meyerdierks E.M. (1997). Dynamic extension assist splinting of acute central slip lacerations. Journal of Hand Therapy,10, 206-212.

Pratt A.L, Burr N. and Gobbelaar O. (2002). A prospective review of open central slip laceration repair and rehabilitation. Journal of Hand Surgery, 27B, 530-534.

Prosner, M.A. & Green S.M. (2013).

Diagnosis and treatment of finger deformities following injuries to the extensor tendon mechanism.

Hand Clinics, 29, 269-281.

Towfigh H, & Gruber P, (2005), Surgical treatment of the boutonniere deformity. Operative Orthopadie und Traumatologie, 1, 6687 Vermaak, P. & Devaraj V. (2012).

Don’t slip up! A modified technique for assessment central slip injuries. Journal of Hand Surgery.

Published online 22 February 2012.

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Wehbe, M.A. (1995). Anatomy of the extensor mechanism of the hand and wrist. Hand Clinics, 11, 361-366.

Westerheide E, Failla J.M., van Holsbeek M, Ceulemans R (2003).

Ultrasound visualization of central slip injuries of the finger extension mechanism. The Journal of Hand Surgery 28A: 1009-1013.

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Professional Development International Conferences 2015 8th–11th October, 2015 American Society of Shoulder and Elbow Therapists Annual Conference Asheville, USA http://www.asset-usa.org/ Annual_Conference_GroveParkInn2015.html 8th-11th October, 2015 Annual Meeting of American Society of Hand Therapists Denver, USA http://www.asht.org/education/asht-annualmeeting 15th-16th October, 2015 British Society for Surgery of the Hand Spring Scientific Meeting London, UK http://www.bssh.ac.uk/education/scientificmeetings 6th – 9th November, 2015 New Zealand Association of Hand Therapists Incorporated Hand Therapy Annual Conference Rotorua, New Zealand http://www.nzaht.org.nz/courseconferences.php

15th-18th September, 2016 Annual Meeting of American Society of Hand Therapists Washington, DC, USA http://www.asht.org/education/asht-annualmeeting 6th October, 2016 American Shoulder and Elbow Surgeons Open Sympsium Boston, Massachusetss, USA http://www.ases-assn.org/?p=meetings&type=Other Meetings&meeting_id=54 24th-28th October, 2016 IFSHT Joint Congress Buenos Aires, Argentina: http://www.ifsht.org/en/content/2016-ifsht-triennialcongress

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Australian Meetings 2015-2016 20th - 23rd August, 2015 NSW Hand Surgery Association Annual Conference Millenium Hotel, Queenstown, NZ http://www.tayloredimages.com.au/events.php 16th – 18th October, 2015 Australian Hand Therapy Association National Conference: Broadening horizons- trends in upper limb therapy Scarborough Beach, WA http://www.ahta.com.au/

20th - 22nd November, 2015 Queensland Hand Surgery Society Conference, TBA http://qhssasm.aoa.org.au/ 30th March – 2nd April, 2016 Australian Hand Surgery Society & American Society for Surgery of the Hand 2016 Combined Meeting Doltone House, Hyde Park, Sydney http://www.tayloredimages

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Mentor List A number of AHTA Members have made themselves available to act as mentors to hand therapists wishing to apply for Full Membership of the AHTA.

Please contact one of the mentors in your state or territory for assistance with your application.

Contact should be established 3-6 months prior to submitting the application to ensure adequate time frames for professional dialogue between the therapist and mentor. The purpose of this is to: Help you locate a mentor (or be a mentor) if you do not already have one; and Review your application to ensure it is complete and accurate before submitting

AHTA Mentors 2015

QLD Katie Whittle

cradwhit@me.com

Phone: (07) 3139 4259

hamish@andersonhandtherapy.com.au

Phone: 0413 426 474

hfitzgerald@inhand.net.au

Phone: 0412 288 593

suzanne_caragianis@bigpond.com

Phone: (08) 8277 9667

cathymerry@hotmail.com naomiw@sapphirephysio.com.au

Phone: (02) 4626 1333 Phone: (02) 6492 0023

VIC Hamish Anderson

WA Helen Fitzgerald

SA Suzanne Caragiannis

WA Cathy Merry Naomi White Page 60

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Library Resource List The AHTA’s DVD content is available through the website. Simply log in as a Member and click on the Videos link on the top right side of the page.

Please email Dion Sandoz (AHTA Knowledge & Resources Officer) on resources@ahta.com.au if you have any issues viewing the AHTA DVD’s.

All other library items can be borrowed on request by emailing the AHTA Knowledge and Resources officer. Library loans are for 1 week only.

There is no hire fee. Members are responsible for return postage to Dion Sandoz.

2 CPD points are awarded to members who complete a short review of a resource item by answering a few questions for the newsletter. A certificate will be emailed to members on receipt of the review.

Exploring Hand Therapy (Treatment 2 Go) DVDs (Available Online):

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A Royal Pain in the Thumb Basics and Beyond: Part 1 and 2 everything you need to know - Shoulder to finger (For loan) Burns: Stop, Drop and Rehab Clinical Activities Made Simple Cervical exam: The Physician’s approach and MP Arthroplasty Distal Radius Fractures: Slip, fall broken wrist Elbow: Unlocking the hinge to function Ergonomics: tips, tricks and trivia Hand Therapy Boot Camp Intrinsics: Unravel the mystery Joint Mobilization of the Upper Extremity Lateral Epicondylitis: A therapists approach to conquering pain Mirror Mirror on the Wall: Motor Imagery Program Myofascial Therapy: With emphasis on trigger points of the upper extremity Oedema: Here today, gone tomorrow Office Ergonomics: Take Control!

Physical Agent Modalities: Occupation based implementation of electrical and thermal agents RSD: Tips, tricks, trends and trivia Shoulder Pathology: A detailed approach to examination and treatment

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Sports Injuries: Off the Sidelines and into the game Stiff Hand: Explanations and Solutions Stiff Joints: Tips, tricks and trivia Wound Healing for the Hand Specialist: Heal ‘em up Quickly!

Wrist Secrets: Parts 1, 2 and 3 X-Rays: Basics and beyond

Other Educational CD/DVD’S:

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Explain Pain Audio (NOI) Interactive Hand (PCs not MACs)- Therapy edition DVD

by Judy Colditz, D Mcgrouther, J Harris The Neurodynamic Techniques DVD plus handbook (NOI) Oedema Management in Hand Therapy: Kerry Stingel: 2013 (Flash drive) Pollicization: Educating Hand Surgeons: Making a Thumb: The story of pollicization

AHTA History: On AHTA website

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Journals (For Loan):

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Organising academic conferences. Amy and Lynn Zelmer.

Green Guide No 11. (1991) Therapeutic Hand Splints Vol 1

by Paul Van Lede & Griet Van Veldhoven (donated 2000)

American Journal of Hand Therapy (Oct 1987 to 2008 but missing 1994 no 3 and 1996, no 2).

British Journal of Hand Therapy (Jan 2005 to 2008): * Up to August 2007 available from librarian * Summer 2007 Volume 12, Nos 2, 3 and 4 * Summer 2008 Volume 13, Nos 2, 3 and 4 * Winter 2008 Volume 13, No 4. from the AHTA office manager

AHTA Interest Group Meetings: DVD’S /CD’S:

Books:

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American Journal of Hand Therapy (1995 Onwards) American Journal of Hand Surgery (1995 Onwards) Hand Clinics (2002 Onwards)

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Online Journals (Available through Science Direct via the AHTA website):

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AHTA National Conference (Adelaide 2006): Level 1 splint workshop (photo’s) and How to make a leather splint by Emily Myers NSW IG Meeting (February 2003): CRPS by Lorimer Moseley NSW IG Meeting (2004): Principles of Tissue Healing by Tracey Clark, Lara Phillips, Julia Wild, Sue Shaw NSW IG Meeting (August 2005): Musculoskeletal Ultrasound by Dr John Korber NSW IG Meeting (August 2006): Wrist Anatomy Workshop by Dr Alok Jhamb NSW IG Meeting (February 2007): PIP Joint by NSW IG Member Presentations NSW IG Meeting (March 2007): Focal Dystonia by Bronwyn Ackerman NSW IG Meeting (July 2007): Review of International Conference, Sydney NSW IG Meeting (July 2007): Nerve gliding for CTS and Review of IFSHT paper by Michel Coppieters NSW IG Meeting (September

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Library Resource List   

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2007): Leather Splinting by Penny Barrett NSW IG Meeting (February 2008): Various NSW IG Member Presentation NSW IG Meeting (June 2008): Hand Therapy Products & Casting by 3M & Ausmedic NSW IG Meeting (2008) Extensor Tendons by Emma Carr (No DVD, available for download on pdf from the library AHTA Website) NSW IG Meeting (April 2009): Developing Country Projects

by Dr Grace Warren NSW IG Meeting (June 2009): Ultrasound of the Hand by Dr John Korber NSW IG Meeting (October 2009): The TFCC- Surgery and Therapy by David Yee NSW IG Meeting (February 2010): WorkCover and Hand Therapy by Dr Rob Boland NSW IG Meeting (May 2010): Kinesiotape in Hand Therapy

by Alison Taylor NSW IG Meeting (June 2010): Carpal Tunnel Syndrome by Dr Rob Boland NSW IG Meeting (October 2010): Neuropathic Pain and CRPS by Dr Robert Adler NSW IG Meetings (February 2013 onwards): Available at: www.handgroup.net Qld IG Meeting (March 2004): The Wrist and Hand in SportTaping, Active Stability and Fine Motor Acquisition by Chris Brady (x 2 DVD’s) Qld IG Meeting (July 2004): The Psychological Components of Pain Management and Adjustment to Injury by Mandy Vance and Louise Williams (Summary in Powerpoint format available via email) Qld IG Meeting (March 2005): Mirror Therapy for Acute CRPSGraded Motor Imagery by Mark Cruickshank Qld IG Meeting (February 2006): Plaster of Paris: The forgotten splinting material by Vanda Carius Qld IG (May 2006): Anaesthet-

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ics Perspective on CRPS management by Dr Mark Walden Qld IG Meeting (2008): Manual Oedema Mobilisation by Angela Thynne Qld IG Meeting (December 2010) Multi-Trauma by Cherie Aceto & Emma Taylor Qld IG Meeting (2011): Throwing Injuries by Dr Matt Hislop SA IG Meeting (February 2014) Examination of the Wrist by Malcolm Wicks WA IG Meeting (2007): Manual Oedema Mobilisation by Sandy Artzberger WA IG Meeting (February 2010): Anatomy of the Extensor Tendons- Clinical reasoning strategies, plus quiz questions

by Specialised Hand Therapy WA IG Meeting (May, 2010): Pain WA IG Meeting (May 2012): CRPS- Handout only, also available via webinar format by Jeannie Davis

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Cochrane Reviews:

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Birgitta Rosen Papers on the one CD:

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AHTA 0401 A New Model Instrument for outcomes after nerve repair. Birgitta Rosen and Goran Lundborg (2003) AHTA 0402 Behavioural treatment of post traumatic and vibration- induced digital cold sensitivity. Ingela Carlsson, Ragnhild Cederlund, Jan Holmberg and Goran Lundborg (2002) AHTA 0403 Early use of artificial sensibility in hand transplantation. Marco Lanzetta et al (2003) AHTA 0404 ASHT Clinical Assessment Recommendations: Sensibility Testing. Janet Stone (undated) AHTA 0405 A new tactile gnosis instrument in sensibility testing.

Birgitta Rosen and Goran Lundborg (1998) AHTA 0406 Sensory reeducation today and tomorrow: A review of evolving Concepts. Birgitta Rosen, Christian Balkenius and Goran Lundborg

(2003) AHTA 0407 Early use of artificial sensibility to improve sensory recovery after repair of the median and ulna nerve. Birgitta Rosen, Goran Lundborg (2002) AHTA 0408 Outcome assessments in hand surgery: When are they meaningful? Robert Szabo (2001) AHTA 0409 Sensory relearning after nerve repair. Bigitta Rosen and Goran Lundborg (2001) AHTA 0410 Inter-tester reliability of a tactile gnosis test: The STI Test. Bigitta Rosen (2003) AHTA 0411 Sollerman hand function test: A standardised method and its use in tetraplegic patients. Christer Sollerman and Arvis Ejeskar (1994)

Silicon gel sheeting for preventing and treating hypertrophic and keloid scars (Review). O’Brien & Pandit.

2008, issue 3.

Journal Articles: (Can be photocopied, faxed/posted, emailed from librarian)

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A walk through the anatomy of the hand and forearm. Daniel C. Riordan. Journal of Hand Therapy 1995; April-June: 68-79.

Achieving a successful and sustainable return to the workforce after ABI: A clientcentred approach. Lisa O’Brien. Brain Injury 2007; 21(5): 465478.

Adherence to therapeutic splint wear in adults with acute upper limb injuries: a systematic review. Lisa O’Brien. Hand Therapy 2010; 15(1): 3-12.

An advice and exercise program has some benefits over natural recovery after distal radius fracture: a randomised control trial. Sandra Kay, Margaret McMahon and Kathy Stiller. Australian Journal of Physiotherapy 2008; 54: 253259.

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Library Resource List 

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Assessment of the severity of hand injuries using hand injury severity score, and its correlation with the functional out come. Saxena P., Cutler L., Feldberg L., Injury: International Journal of the Care of the Injured, 2004, 35, 511-516.

Biologic Aspects of Flexor Ten-  don Laceration and Repair.

Beredjiklian, Pedro. JBJS,

Current Concepts Review, 2003.

Casting, Splinting and Physical and Occupational Therapy of Hand Deformity and Dysfunction in Cerebral Palsy. Judith Wilton, Hand Clinics, 19 (2003) 573-584.

Clinical Care Update. Technique addresses computer related RSI. Kahan, N. J. Occupational Medicine, Vol 8, No17. 2002 Part 1. Part 2: Vol 8, No 18 2002.

Clinical examination of the wrist. Terri Skirven. Journal of Hand Therapy 1996; 9: 96-107.

Clinical provocative tests used in wrist pain. LaStayo and Howell. Journal of Hand Therapy 1995; 1: 10-17.

Comparing Three Post Operative Treatment Protocols for Extensor Tendon Repairs in Zones 5 and 6 of the Hand.

Hall, Lee, Page, Rosenwax and Lee. The American Journal of Occupational Therapy 2010; 64 (5): 682-688.

Consensus statement Describes Dressings for Acute and Chronic wound Management.

Barclay,L. Archives of Dermatology 2007, 43: 1291-1294, 1297-1304.

Determinants of compliance with hand splinting in an acute brain injured population. O’Brien & Bailey. Brain Injury 2008; 22(5): 411-418.

Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones 5 and 6 extensor tendon repairs. Hirth, Bennett,

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Mah, Farrow, Cavallo, Ritz and Findlay. Journal of Hand Therapy 2011; 16: 86-94.

Effects of Stress Healing on Wounds: Intermittent Noncyclical Tension. Arem, A., Madden, J., Journal of Surgical Research, Vol 20, No2, 1976.

Extensor Retinaculum Impingement in the Athlete: A New Diagnosis. Van Heest A, Luger N, House J, Vener M AJSM Preview 2007.

Immediate Cotrolled Active Motion Following Zone 4-7 Extensor Tendon Repair. Howell, Merritt and Robinson. Journal of Hand Therapy 2005; 18: 182190.

Impact of Taping After Finger Flexor Tendon Pulley Ruptures in Rock Climbers. Isabelle Schöffl, Frank Einwag, Wolf Strecker, Friedrich Hennig, and Volker Schoffl. Journal of Applied Biomechanics, 2007; 23:52-62 2007.

It’s Not Just a Finger. Combs, J. Journal of Athletic Training 2000, 35: (168-1782).

Moon Socks for Mallets. Thomas C. American Journal of Hand Therapy 2006; 19 (13): 365-367.

Patient Experience of Distraction Splinting for Complex Finger Fracture Dislocations. O’Brien & Presnell. Journal of Hand Therapy 2010; 23: 249-260.

Pre and post surgical therapy and management of a patient with intrinsic minus hands. Donna Breger. Journal of Hand Therapy 1989; July-September: 177-185.

Prevocational Group Intervention Program for Building Motivation in Mature Aged Unemployed People with a Disability.

Lisa O’Brien. Journal of Rehabilitation 2007; 73(1): 22-28.

Prospective Analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment.

Weiss, LaStayo, Mills,and Bramlet. Journal of Hand Therapy 2000; 13(3): 218-227.

Provocative wrist tests and MRI

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are of limited diagnostic value for suspected wrist ligament injuries: a cross sectional study.

Prosser, Harvey,LaStayo, Hargreaves, Scougall and Herbert.

Journal of Physiotherapy 2011; 57: 247-253.

Reliability and validation properties of the Malaysian language version of the Occupational Self assessment version 2.2 for injured workers with musculoskeletal disorders. Murad, Farnworth & O’Brien. British Journal of Occupational Therapy 2011; 74(5): 226-232.

Secondary defects of the hand with intrinsic paralysis: prevention, assessment and treatment. J. Wil Brandsma. Journal of Hand Therapy 1990; January – March: 14-19.

Sensible manual muscle strength testing to evaluate and monitor strength of the intrinsic muscles of the hand.

Brandsma and Schreuders.

Journal of Hand Therapy 2001; 14: 273-278.

Shoulder muscle recruitment patterns during a kayak stroke performed on a paddling ergometer. Trevithick B., Ginn K., Halaki M., Balnave R. Journal of Electromyography and Kinesiology 17 (2007) 74-79.

Shoulder Pain and Disability Index. Breckenridge and McAuley. Journal of Physiotherapy 2011; Vol 57: 197.

Single blind, prospective, randomized controlled trial comparing dorsal aluminium and custom thermoplastic splints to stack splint for acute mallet finger. O’Brien and Bailey. Archives Phys Medical Rehabilitation 2011; 92: 191-198.

Strength measurements of the intrinsic hand muscles: a review of the development and evaluation of the Rotterdam intrinsic hand myometer.

Schreuders et al. Journal of Hand Therapy 2006; 19: 393402.

The Distal Radioulnar Joint: anatomy and management of disorders. Jaffe, Chidgey, and

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Library Resource List LeStayo. Journal of Hand Therapy 1996; 9: 129-38.

The Effect of Passive Mobilisation following Fractures involving the Distal Radius: a randomised study. Sandra Kay, Naomi Haensel and Kathy Stiller. Australian Journal of Physiotherapy.

The Efficacy of Ultrasound in the Evaluation of Dynamic Scapholunate Ligamentous Instability. (2004) Journal of Bone and Joint Surgery (Am) 86: 1473-1478.

The Thumb “Strap Splint” for Dynamic Instability of the Trapeziometacarpal Joint. Anne Wajon. Journal of Hand Therapy 2000; July-Sept: 236-237.

Twelve weeks of nightly stretch does not reduce thumb web space contractures in people with neurological condition: a randomised controlled trial. L Harvey, L., De Jong, I., Goehl, G., Marwedal, S. Australian Journal of Physiotherapy, Vol. 52, 2006.

1990: Wrist and soft splinting.

Glenelg, SA 1991 May: Update hand injuries and  dynamic splinting. Sydney, NSW 1991 Nov: The Stiff Hand/RA Hand.

Judy Colditz. Sydney, NSW 1992 1993: Combined AHSS/AHTA: Flexor Tendons & Mutilating Injuries Blue Mountains, Sydney.

1994: Comprehensive approach to the wrist. Noosa, QLD. 1995: Joint replacements in the up per limb. Melbourne VIC 1996: Nerve and the Upper Quad  rant. Cairns QLD. 1997: Wrist Functional Capacity Eval uation, Shoulder & research  Sydney 1998: Biomechanics of the Upper   Limb – Perth WA 1999: Sporting Injuries of the Hand and Upper Limb - Sydney 2000: Acute Upper Limb Trauma – AHTA Newsletters: Melbourne VIC 2001: Pain Management – Glenelg,  All newsletters are accessible SA on the AHTA Website: 2002: Cumulative Trauma – Main 1993 to Oct 2007 Beach QLD 2007 to current (located at 2002: Jane Fedorczyk workshops AHTA Office) Abstracts of Interest: Gold Coast, Qld 2003: Combined NZHT/AHTA – Memorabilia:  Biomechanical Comparison of Queenstown, NZ Ulnar Collateral Ligament re2004: Nerve Injury and Repair – Fre  Photos from conferences construction techniques mantle, WA IFSHT opening ceremony DVD Ruland, R et al AJSM 36:1560-  2005: Hands On Trauma – Coogee 1570 2008 Sydney 2007/photos Beach, NSW  Closed Treatment of non rheu-  Notes/ photo’s for AHTA poster 2006: Get A Grip on Arthritis - Ade matoid extensor tendon dislo-  Poster on ‘Do you want to laide SA cation at the MCP joint. Cataknow more that the basics 2007: IFSHT/IFSHS - Sydney lano L. et al JHS 31:2;242-245  History of American Society of 2006 hand Therapists pre certificaInternational Proceedings: tion Theses:  ASHT Newsletters 1986 1992: Paris 2nd IFSHT 1995: IFSHT Helsinki 3rd IFSHT  Adherance Behaviour in an Conferences: Abstract books/ 2007: IFSHT/IFSHS Sydney Hand In Acute Paediatric Hand Trauma proceedings/notes: Hand: with opening ceremony Population: A pilot study invesdisc tigating parental report of ad- 1984: herence levels and influencing 1986: Combined Australian Tapes: factors Tanya Cole (Masters Hand Club/AHTA: Ten Thesis) 2014 don repairs & manage 2004: Nerve Injury and Repair – Fre ment. Sydney NSW. mantle, WA: Course Notes: 1987: Management of small joint 5/11/04: session2, 3, 4. injuries. Melbourne VIC. 6/11/04: session 1, 2, 3, +workshop  AHTA National conference 1987: RA and wrist instability. Ade 7/11/04: session 1 March 2002 laide, SA. Jane Fedorczyk (international 1988: Anatomy and General hands. speaker) (P/P presentations): Brisbane QLD.

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* Examination and Intervention for lateral epicondylitis * Management of neurogenic pain in the hand and upper quadrant * Overview of CTD: Epidemiology and Evidence of Tissue Changes * The Use of Physical Agents in the Management of CTD: Reflections on * Evidence and Neuroscience * Evidence of Neuroplastic Changes in the Dorsal Horn of the Spinal Cord in * An In Vivo Voluntary Repetitive Motion Injury Model “Welcome to Explain Pain” Sydney 2007 by David Butler Current Concepts in Diagnosis and Management of CRPS. Damien Finniss.

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

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AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Contact us Office Contacts

Australian Hand Therapy Association National Office Address:

Email: Phone:

PO Box 84 SOUTHERN CROSS WA 6426 info@ahta.com.au (08) 9049 1666

DIXON

SARAH

Executive Support Manager

NOLLER

KATE

Executive Support Assistant / Programme Manager

Management Committee CLARK President

TRACEY

(NSW) president@ahta.com.au

Phone: (02) 8080 4362

presidentelect@ahta.com.au

Phone: (08) 8211 8002

treasurer@ahta.com.au

Phone: (08) 9266 3970

secretary@ahta.com.au

Phone: (07) 5443 5474

REID CATHERINE (VIC) Communications

communications@ahta.com.au

Phone: (03) 5562 4442

CONDON JULIE Education

education@ahta.com.au

Phone: 0417 760 970

SANDOZ DION (NSW) Knowledge and Resources

resources@ahta.com.au

Phone: (02) 4922 3059

CURRENLY VACANT Marketing and Promotions

info@ahta.com.au

Phone: (07) 3139 4259

FLYNN KYLIE Membership

membership@ahta.com.au

Phone: (02) 9845 6500

stateaffairs@ahta.com.au

Phone: (03) 5331 3066

BURFIELD HELEN President Elect

(SA)

PARSONS Treasurer

(WA)

DAVID

WHITTLE KATIE Secretary

(QLD)

(QLD)

(NSW)

KAESS JENNIFER (VIC) State and Territories Affairs Page 70

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Divisional Coordinators 2014 - 2015 ACT DALLA - POZZA (Main Contact)

ELIZABETH

The Canberra Hospital Yamba Drive GARRAN ACT 2605

Phone: (07) 3139 4259

COOK (Main Contact)

NICOLA

MGS Hand Therapy 1 Whistler Street MANLY NSW 2095

Phone: (02) 9976 2666

CHIM (YUEN)

MICHELLE

North Shore Hand Therapy Level 4, Suite 2, Westbourne Street ST LEONARDS NSW 2065

Phone: (02) 9460 7788

SMIT

NADIA

Macquarie Hand Therapy Suite 403, Macquarie University Clinic 2 Technology Place MACQUARIE UNIVERSITY NSW 2109

Phone: (02) 9812 3982

TRICARDOS

VICTORIA

South Western Sydney Hand Centre Fairfield Hospital Cnr Polding Street and Prairievale Rd PRAIRIEWOOD NSW 2168

Phone: (02) 9616 8713

WISE (Main Contact)

VIRGINIA

The Alfred Hospital 55 Commercial Road PRAHRAN VIC 3004

Phone: (03) 9076 2920

COLE

TANYA

The Alfred Commercial Road PRAHRAN VIC 3181

Phone: (03) 9076 3526

O’BRIEN

LISA

N/A

Phone: N/A

ROBINSON

LUKE

The Royal Melbourne Hospital Gratan Street PARKVILLE VIC 3050

Phone: (03) 9342 7400

JAYNE

Alice Springs Hospital Gap Road ALICE SPRINGS NT 0870

Phone: (08) 8951 7789

NSW

VIC

NT DONOVAN (Main Contact)

Page 71

AHTA 2015 Issue Issue 104 104 AHTA Newsletter Newsletter Jul—Sep Jul - Sep 2015

Divisional Coordinators 2014 - 2015 Continued

QLD MCKILLOP (Main Contact)

AMANDA

Advance Therapy Solutions Suite 8 1407 Logan Road MT GRAVATT QLD 4122

Phone: 1300 420 556

BLACK

FRANCES

QLD Health 45 Richmond Street GORDON PARK QLD 4031

Phone: (07) 3636 7100

COFFEY

MARGO

QLD Health 3/119 Baringa Street MORNINGSIDE QLD 4170

Phone: N/A

NASH

CHARLOTTE

EKCO 5 Tees Street YEERONGPILLY QLD 4105

Phone: N/A

MINCHIN (Main Contact)

KATHY

Cranford House 339 South Terrace ADELAIDE SA 5000

Phone: (08) 8232 1788

DEUT

KAVEETA

Flinders Medical Centre Bedford Park ADELAIDE SA 5048

Phone: (08) 8204 5498

ASMAN (Main Contact)

CAROLYN

Launceston General Hospital Charles Street LAUNCESTON TAS 7250

Phone: (03) 6348 7216

KALIS

MARLENE

In Balance Physiotherapy 18-20 Paterson Street LAUNCESTON TAS 7259

Phone: (03) 6334 4766

WILSON (Main Contact)

STUART

Hand Works Occupational Therapy Suite 16, Lvl 1, Wexford Medical Centre 3 Barry Marshall Pde MURDOCH WA 6150

Phone: 1300 887 798

MCAULIFFE

LANI

Hand Works Occupational Therapy Suite 16, Lvl 1, Wexford Medical Centre 3 Barry Marshall Pde

Phone: 1300 887 978

ROBERT

YVETTE

Inhand Occupational Therapy Princess Margaret Hospital 4/44 Barnfield Road CLAREMONT WA 6010

Phone: (08) 9284 5885

SA

TAS

WA

Page 72

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