Physical and occupational therapy referral and use among systemic sclerosis patients with impaired hand function: results from a Canadian national survey.
OBJECTIVE
Contractures and deformities of the hand are major factors in disability and reduced health-related quality of life in systemic sclerosis (SSc). Physical (PT) and occupational therapy (OT) have been emphasised to address impaired hand function, but little is known about the extent they are employed. The objective of this study was to determine the proportion of Canadian SSc patients with hand involvement who are referred to and use PT or OT services and factors associated with referral.


METHODS
Participants were respondents to the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities who rated ≥1 of 5 hand problems (hand stiffness, difficulty making fist, difficulty holding objects, difficulty opening hand, difficulty with faucet) as occurring at least sometimes with moderate or higher impact. Patients indicated if their physicians recommended PT or OT and if they used these services. Multivariate logistic regression assessed independent predictors of PT or OT referral.


RESULTS
Of 317 patients with hand involvement, 90 (28%) reported PT or OT referral, but only 39 (12%) reported using these services. PT or OT referral was associated with more hand problems (odds ratio [OR]=1.24, 95% confidence interval [CI] 1.02-1.51, p=0.031) younger age (OR=0.96, 95% CI 0.94-0.99, p=0.004) and not being employed (OR=0.50, 95% CI 0.26-0.97, p=.0041).


CONCLUSIONS
Few SSc patients with hand involvement are referred to PT or OT, and even fewer use these services. High-quality randomised controlled trials of PT and OT interventions to improve hand function in SSc are needed.
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. marielle.bassel@mail.mcgill.ca
Marielle
M
Bassel
Marie
M
Hudson
Murray
M
Baron
Suzanne S
SS
Taillefer
Luc
L
Mouthon
Serge
S
Poiraudeau
Janet L
JL
Poole
Brett D
BD
Thombs
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D006225:Hand / Q000502:physiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000453:epidemiology* / Q000628:therapy*; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000453:epidemiology* / Q000628:therapy*