Posters

Hand Therapists; we need to talk about alcohol

Van Middelaar, A1
1Counties Manukau Health

Purpose: Hand Therapists (HT’s) frequently treat patients with injuries resulting from alcohol harm but seldom assess the underlying problem of alcohol abuse. There is robust evidence that brief alcohol interventions are effective at reducing hazardous drinking. In 2019 the HT team at Counties Manukau Health (CMH) joined a DHB initiative to provide assessment for alcohol use, brief intervention, and referral to treatment when appropriate. The purpose of this review is to describe the team’s experiences with alcohol screening and determine if HT’s can play a role in reducing alcohol harm in New Zealand.

Methods:
HT’s were given 4 hours of training in “The Alcohol ABC Approach” with an experienced drug and alcohol counsellor. Staff learned how to ask about alcohol use, how to give brief advice and how to refer for counselling. The Alcohol Use Disorders Identification Test (Audit C) was imbedded in the electronic documentation used by HT’s. Staff started alcohol screening with patients in October 2019. Two follow-up debrief sessions were held for staff with the counsellor after implementation. Data was collected monthly to evaluate how many patients had completed alcohol screening, Audit C scores, and equity gaps.

Main findings:
HT’s at CMH complete alcohol screening with an average of 193 patients per month (54% of all new referrals). Demographic information and equity gaps will be described. Staff initially found the conversations uncomfortable but gained confidence with practice. Most patients were open to having conversations about alcohol in the context of HT.

Principal conclusions:
HT’s can play a role in addressing hazardous drinking in NZ by including alcohol screening as part of taking a medical history, providing brief advice and referring for alcohol counselling services when appropriate.

Review of outcomes for zone IV extensor tendon repairs

Wang, A1, Collocott, S1,2
1Counties Manukau Health
2Taukau Physiotherapy

Purpose: Management of zone IV extensor tendon injury is ambiguous and there is no consensus as to the optimal treatment protocol. In current literature, zone IV injuries are variously managed with the same protocol as zone V or zone III injuries. At Counties Manukau Health (CMH), short arc motion (SAM) protocol is used for treatment of zone III and zone IV injuries. Recently, promising evidence has emerged for the use of relative motion extension protocol for management of zone IV extensor tendon injuries. Therefore, we undertook a retrospective review of CMH patient outcomes as a first step to investigate the optimal treatment protocol for zone IV extensor injuries.

Methods:
A retrospective review of clinical notes was conducted to review the outcomes of zone IV extensor tendon repairs between March 2012 and March 2020 at CMH.

Main findings:
47 patients were included. The majority of patients followed a SAM protocol and received 10 or less hand therapy treatments. No patient required further surgery. Average active proximal interphalangeal joint extension/flexion was 7°/89°. Average active distal palmar crease was 1 cm. There were 2 complications, one patient with scar adhesion and another with superficial wound infection.

Principal conclusions:
No patients with zone IV extensor tendon repair had a serious complication that required further surgery. Due to the retrospective nature of this study, there was a lot of missing data in terms of range of motion, grip strength, and patient reported functional outcomes. Therefore, a multi-centred, prospective review of outcomes for zone IV repairs is proposed.