title: Occupational therapists' perceptions of requirements for competent upper limb hypertonicity practice.
abstract: OBJECTIVE
  Hypertonicity practice is challenging due to the high degree of variability in presentation within and among clients. There is limited high-level evidence supporting interventions in practice. This study gathered therapists' views on requirements for competent practice. This information could be used to improve training in this area of practice to benefit clients.
  
  
  METHODS
  A pragmatic qualitative design was used. Five therapists who had undergone specialised training in hypertonicity practice were interviewed. Qualitative description was used to analyse data.
  
  
  RESULTS
  Therapists discussed (1) complexity, (2) time and energy and (3) requirements for competent practice as important aspects of hypertonicity practice. The first two themes illustrate the intensive nature of hypertonicity practice. The third theme encompasses the knowledge, skills, clinical actions and decision-making therapists require for competent practice.
  
  
  CONCLUSIONS
  Participants perceived that there is a dynamic relationship between knowledge and skills. They also believed that competent hypertonicity practice requires a client-centred approach and individualisation of interventions. Future training needs to focus on the development of therapists' clinical reasoning, which was required to individualise interventions and promote positive client outcomes. Implications for Rehabilitation Training in upper limb hypertonicity management in a clinical setting can assist therapists to understand the factors contributing to the complexity of this practice area. Training in a clinical setting is required to allow development of the range of skills needed for competent practice as it provides consistent exposure to clients over time. Practicing in a client-centred manner and making individualised intervention decisions should be emphasized as an overarching framework for developing relevant knowledge and skills in this area of practice. Future research needs to focus on identifying training techniques that will promote therapists' competence in decision making when working in upper limb hypertonicity practice.
authors.affiliation: School of Health and Rehabilitation Sciences, Division of Occupational Therapy, The University of Queensland , Queensland , Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Colclough
authors.forename: Jodie
authors.initials: J
authors.lastname: Copley
authors.forename: Merrill
authors.initials: M
authors.lastname: Turpin
authors.forename: Emma
authors.initials: E
authors.lastname: Justins
authors.forename: Rachel
authors.initials: R
authors.lastname: De Monte
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000534:rehabilitation*; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D009788:Occupational Therapy / Q000379:methods*; D010465:Perception; D059825:Physical Therapists / Q000193:education*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Competence; knowledge; skills; spasticity; upper limb hypertonicity; upper motor neuron syndrome