Supporting work participation for adults with hand and upper limb conditions: a survey of the British Association of Hand Therapists

Abstract

Purpose: The aims of this study were to describe the reported provision of work participation support for adults with hand and upper limb conditions by UK hand therapists, and to identify potential training needs in this area. Method(s): A previous survey of the Australian Hand Therapy Association was adapted for the UK. The electronic questionnaire (Jisc) was distributed to members of the British Association of Hand Therapists. Eligible individuals were UK-based physiotherapists or occupational therapists whose role included the assessment and/or treatment of patients >=18 years with hand or upper limb issues. Quantitative data were analysed using descriptive statistics (R 4.3.1), and open text responses were analysed using content analysis. Reporting followed the Checklist for Reporting Of Survey Studies. Ethics approval was provided by Queen Mary University of London (QME23.0112). Result(s): The survey ran from October-November 2023. There were 123 participants (17% response rate). Most respondents were female (87%), had >10 years of experience in hand therapy (64%), worked in the national health service (89%) and managed a mixed caseload of patients with traumatic and non-traumatic upper limb conditions (48%). Forty percent of respondents were physiotherapists, 60% were occupational therapists. The most frequently reported work participation interventions were discussing graded return to work (92%) and signposting patients to speak with their doctor (79%) or occupational health (77%). The Allied Health Professionals Health and Work Report and Fit Note were not regularly used (33% and 26%, respectively). Respondents reported low levels of confidence in issuing these documents (median 4/10 [IQR 0-7] and 2/10 [IQR 0-8], respectively). Reported satisfaction was 5/10 (IQR 4-7) for both the amount of involvement in supporting patients with work participation, and the quality of the work participation service that they were able to provide. Reported barriers to providing work recommendations included a perceived lack of time, skills, knowledge and training. Facilitators included the patient initiating the discussion of work as a rehabilitation goal. Conclusion(s): UK hand therapists reported using a range of work participation interventions with their patients. However, few individuals reported providing written work recommendations, including AHP Health and Work Reports or Fit Notes. Open text responses highlighted examples of organisations that did not permit Fit Note certification, despite changes in government legislation more than a year before the survey opened that added physiotherapists and occupational therapists as Fit Notes providers. Overall, therapists reported low levels of confidence in issuing these documents and desired targeted training, alongside broader learning opportunities in relation to musculoskeletal conditions and work. Impact: Development opportunities for UK hand therapists include: i) Increasing patient awareness that they can ask for work-related advice and documentation from hand therapists. Ii) Promoting existing health and work training. Iii) Developing hand therapy-specific resources. iv) Ensuring access to electronic Fit Notes, so that these can be used to support patients. International opportunities include the extension of this survey to other nations, with a focus on generating exemplar work participation strategies to inform further research. Funding acknowledgements: This research was funded by a Chartered Society of Physiotherapy Charitable Trust Postdoctoral Research Grant (PRF-22-POD04). Keyword 1: Work participation Keyword 2: Hand Therapy Keyword 3: Musculoskeletal Copyright © 2025