Original Article

Hand Therapy
0(0) 1–10
Developing occupation kits in a ! The Author(s) 2020
Article reuse guidelines:
Hand Therapy Student Experiential sagepub.com/journals-permissions
DOI: 10.1177/1758998320912680
Learning Clinic journals.sagepub.com/home/hth

Logan Berlet and Vicki Kaskutas

Abstract
Introduction: Combining occupation-based and biomechanical approaches is effective to increase function after hand
injury. This project developed and evaluated occupation kits as a means to increase occupation-based practice.
Methods: Descriptive study that utilized existing Disabilities of the Arm, Shoulder and Hand data from 642 patients
treated by hand surgeon and patients in our Hand Therapy Student Experiential Learning Clinic (HTSELC) to identify
difficult activities. These data informed the selection of occupational areas to address with the kits. Biomechanical
demands of each kit developed were quantified by 10 student therapists using the Abilities Questionnaire. Fourteen
occupational therapists reviewed and rated the usefulness of each kit by survey. Kits were piloted in the HTSELC, and
student therapists documented the percentage of time delivering each intervention type: activity/occupation, prepara-
tory methods and tasks, education, advocacy, and group. The degree of occupation-based practice was compared using
intervention type percentages before and after introduction of the kits.
Results: Ten kits were created to address most occupation categories within occupational therapy’s scope of practice.
Kits include procedures, safety precautions, and a standardized scale to objectively measure performance. Clinicians
noted that kits reflected each occupation well (3.7/5) and 45% reported they were likely to use the kits. After the kits
became available in the HTSELC, the percentage of interventions at the occupation/activity level increased from 19% to
26% and biomechanical interventions, including preparatory methods and tasks, decreased from 61% to 49%.
Conclusion: This research suggests that occupation kits can be a first step to help therapists deliver occupation-based
interventions in hand therapy settings.

Keywords
Activities of daily living, hand therapy, occupation, occupation-based intervention, occupational therapy
Date received: 11 November 2019; accepted: 20 February 2020

Introduction consider all aspects of an individual and the context in

Hand injuries account for over one-third of all injuries
and one-third of all workplace injuries in the United
States.2 The individual typically cannot use the injured
arm during recovery, leading to a loss of independence
and inability to perform meaningful occupations,
which has been associated with depression and lower
physical and mental quality of life.3,4 Thus, return to
meaningful occupations and functional independence
should be at the forefront of the rehabilitation process.
Occupational therapists (OTs) are trained to use
assessments and interventions that are client-centered
and occupation-based, with the goal of therapy being
return to meaningful occupations.5 OTs are expected to
1 which they live during rehabilitation. However, there is
often a disconnection between the theoretical underpin-
nings of occupational therapy (OT) and typical hand
therapy clinical practice.6 Hand therapy is traditionally
based on the biomechanical model,7 which focuses on
isolated aspects of human functioning, such as body
Program in Occupational Therapy, Washington University School of
Medicine, St. Louis, MO, USA
Corresponding author:
Logan Berlet, Washington University School of Medicine, 4444 Forest
Park Avenue, St. Louis, MO 63108, USA.
Email: lberlet@wustl.edu
2 Hand Therapy 0(0)
functions and structures alone.8 Research suggests that
a more comprehensive and occupation-based approach
to hand therapy will produce better outcomes when
compared to this isolated biomechanical approach.9
An occupation-based treatment approach is defined
as using assessments and interventions that are clinical-
ly relevant, purposeful, oriented toward functional
abilities, meaningful to the individual, and client-
centered.10,11 In hand therapy, this treatment approach
balances biomechanical principles with the value of
occupation, both of which are important when address-
ing how an individual functions in daily life.12,13
Occupation can be used as both a means and an
end.11,14,15 Occupation as a means uses occupation as
a therapeutic agent of change to increase performance,
while occupation as an end refers to the occupation as a
goal to be attained by the patient.11,14 However, it is
important to note that occupation should also be incor-
porated with other forms of intervention to best sup-
port occupational performance.14 Research indicates
that combining occupation-based interventions and
biomechanical principles results in significant improve-
ment in performance of daily activities, satisfaction
with performance, and active motion of the upper
extremity when compared to biomechanical exercises
alone.15,16 For example, playing card games and
making origami were shown to improve hand move-
ment more than biomechanical rote exercise alone in
patients with hand injuries.17,18 In addition, patients
report being more motivated while performing
occupation-based interventions, rather than exercise
alone.9,19 Patients report they value engagement in
occupation as a more important outcome than
improvement in objective measurements.20 Thus, evi-
dence suggests that OTs practicing hand therapy
should blend biomechanical and occupation-based
treatment approaches.9,15,19
Despite the push toward occupation-based hand
therapy, many hand therapists still do not use these
interventions.10 Results of a survey of 98 hand thera-
pists demonstrated the gap between evidence and
implementation regarding occupation-based practi-
ces.21 Ninety-eight percent of respondents indicated
that they believe helping patients improve function in
daily activities is an important part of hand therapy;
however, only 50% of patients seen by these therapists
receive occupation-based assessment or intervention.21
Research identified four primary reasons hand thera-
pists do not deliver occupation-based care: insufficient
time, lack of equipment, productivity and reimburse-
ment demands, and reliance on protocols and treat-
ment prescriptions.6,10,19,21 Hand therapists affirm the
value of using occupation-based assessments and inter-
ventions and would like to incorporate them more sys-
tematically into their practice, but they do not have the
tools to do so.19,21 Bridging the gap to provide skilled,
holistic, client-centered care is a challenge that many
practicing therapists face.22
Occupation kits address the barriers hand therapists
report when integrating occupation-based assessments
and interventions because of their low cost, ease of
transport, and focus on performance of occupations.6
These kits can be used as an accessible and easily rep-
licated assessment and intervention tool to promote
occupation-based hand therapy. Kits are constructed
from a variety of everyday items used while engaging
in meaningful activities6 to facilitate the participation
in occupations relevant to the patient. The items are
placed in containers for ease of access, storage, organi-
zation, and transport. Occupation kits are used in a
variety of clinical settings, including nursing homes
and acute rehabilitation settings,23 but are not com-
monly used in hand therapy settings. Previous projects
or studies in hand therapy have developed purposeful
activity kits6 or gathered materials to simulate activities
in clinic;9 however, these addressed only a portion of
occupations, addressed performance at the biomechan-
ical skill level, or the development process lacked sci-
entific rigor.6,9,15
The purpose of this study was to facilitate client-
centered occupation-based assessment and intervention
with patients seen in a Hand Therapy Student
Experiential Learning Clinic (HTSELC) with the
long-term aim of increasing the uptake of occupation-
based care into the field of hand therapy.
Methods
The study was completed in three phases: (1) identify-
ing target occupations, (2) developing the occupation
kits, and (3) evaluating the occupation kits. Figure 1
gives a schematic representation of the research
process.
In this descriptive study, we analyzed pre-existing
data to identify target occupations, conducted surveys
to quantify each kit’s biomechanical demands and per-
ceived usefulness, and collected data using descriptive
statistics to measure changes in the use of occupation in
a pilot sample of patients.
Setting
This research was conducted at an OT program at a
private university on a large medical center campus in
the Midwest United States. In addition to providing
OT education, clinical services are offered in both
hand therapy and community settings. The community
practice therapists work with a variety of diagnoses
across all age spans, whereas the hand therapists
work in a medical center clinic with a focus on upper
Berlet and Kaskutas
Figure 1. Diagram of research flow.
extremity rehabilitation. The occupation kits were cre-
ated within an HTSELC in the OT program, which
provides pro-bono hand therapy services to uninsured
and under-insured patients.
Operational definitions
We used the American Occupational Therapy
Association’s Occupational Therapy Practice
Framework (OTPF) 3rd edition5 for grounding defini-
tions. The OTPF5 defines occupation as “daily life
activities in which people engage in context” (p.S6)
and activities as “components of occupations” (p.
S29). In this paper, we are defining occupations
within the occupation kits as both occupations and
activities. Some of these occupation kits involve perfor-
mance of an occupation, while some involve perfor-
mance of an activity. All the occupations and
activities developed in this project are considered sim-
ulations as they occur outside of the patient’s context.
Identifying target occupations
We examined Disabilities of the Arm, Shoulder and
Hand (DASH) data for two cohorts of patients seen
by hand surgeons, including 627 patients treated for
peripheral nerve disorders between December 2010 to
October 20134 and 15 patients with a variety of diag-
noses treated in our HTSELC from January 2018 to
May 2018. Frequencies were computed for the difficul-
ty rating of each item on the DASH (no difficulty, mild
difficulty, moderate difficulty, severe difficulty, unable
to complete). Activities most frequently rated as severe
difficulty and unable to complete were identified as
target occupations.
We also examined intervention coding data from 70
treatment sessions provided by student therapists in the
HTSELC to identify activities and occupations (based
3
upon the OTPF5) most commonly addressed in treat-
ment sessions. Diagnoses for patients seen during these
70 sessions include hand fracture(s), flexor or extensor
tendon lacerations, peripheral nerve injuries, osteoar-
thritis, trigger finger release, and medial epicondylitis.
Occupations most frequently addressed were identified
as target occupations.
To ensure that we developed kits addressing the
wide array of occupations within the scope of OT prac-
tice, we compared DASH and intervention coding data
to the categories of occupation described in the OTPF.
These categories include activities of daily living
(ADLs), instrumental activities of daily living
(IADLs), rest and sleep, education, work, play, leisure,
and social participation.5 If necessary, DASH activities
were expanded to represent the larger occupation, for
example, “putting on a pullover sweater” is in the
dressing occupation kit.
Developing the occupation kits
We performed a task analysis for each target occupa-
tion. The first author developed a draft of instructions,
which included sequencing steps of the task, determin-
ing supplies, specifying safety concerns, and identifying
environmental set-up necessary to place each occupa-
tion into a feasible context within the clinical setting.
The second author reviewed and edited the instruc-
tions. After consensus was achieved between the
authors, 10 OT graduate students in our HTSELC
reviewed each kit and completed a three-question
open-ended survey developed by the researchers
regarding supplies and sequence of steps for each occu-
pation kit. Feedback from the survey was incorporated
into the final instructions.
To quantify the skill level required to perform each
occupation as described in the kit, 10 OT graduate
4 Hand Therapy 0(0)
Figure 2. Sample item from O*NET’s Abilities Questionnaire.
O*NET: US Department of Labor for the Occupational Information Network.
students completed a portion of the Abilities
Questionnaire24 developed by the US Department of
Labor for the Occupational Information Network
(O*NET). O*NET was created as a comprehensive
system designed to describe jobs, provide a common
language to describe different jobs, and compare
skills and knowledge necessary across different jobs.25
The validated O*NET rating scales have been used to
describe the necessary skills or abilities needed for jobs
on the O*NET database.25 The Abilities Questionnaire
requires raters to assign the level of skill an activity or
task using a 7-point behavior anchor scale, with 7 rep-
resenting the highest skill level and 1 the lowest.
Behavioral anchors, often used in work literature, pro-
vide behavioral examples of activities or tasks represen-
tative of ratings on the scale26 as noted in Figure 2. The
scale on the Abilities Questionnaire is anchored at three
points with specific examples to give respondents
common benchmarks in assigning scores.27,28 The 10
upper extremity physical abilities included on
O*NET’s Abilities Questionnaire were measured,
including strength, flexibility, and dexterity ratings.
See Supplementary Table 1 for the 10 physical abilities
and definitions. We computed the mean skill level for
the 10 physical abilities rated for each of the 10 occu-
pation kits developed and included these skill ratings in
each kit to alert the clinician of the biomechanical
demands represented in the kit.
Evaluating the occupation kits
We sent a web-based link asking the 30 OTs employed
by our OT program’s clinical practice division to eval-
uate the 10 occupation kits, including hand therapists
and community practice therapists. Therapists
reviewed written materials for each kit and rated how
well the kit reflected the target occupation on a 5-point
ordinal scale, with 1 representing “not at all” and 5
“extremely well.” They also rated likelihood to use
the kit in practice on a 5-point ordinal scale, with 1
indicating low likelihood and 5 high likelihood. After
completing the ratings for each kit, therapists were
asked to order the 10 kits from least to most useful
for clinical practice. This was converted to a 5-point
scale for ease of interpretation, with 1 indicating least
useful and 5 indicating most useful.
In-person piloting of the occupation kits was per-
formed in the HTSELC during routine patient care.
After treatment sessions, students logged which kit
they used and rated how important the kit was in
achieving the goals for the treatment session on a
3-point scale, with 1 indicating “very important,”
2 “somewhat important,” and 3 “not important.”
Lastly, we compared intervention types used in the
HTSELC before and after the occupation kits were
available, with intervention types defined by the
OTPF as activity and occupation, preparatory methods
and tasks, education, advocacy, and group.5 Students
documented the percentage of the session spent deliv-
ering each intervention type during treatment sessions.
A senior student mentor and a licensed OT reviewed
for accuracy. Differences were discussed and consensus
was achieved. We modified the kits based on verbal
feedback from student use in an iterative process to
strengthen the usability of the final product.
Data management
Data used throughout this project were entered by
trained student therapists into REDCap29 on a secured
university server. All HTSELC data were double
entered by trained research assistant for accuracy
(error rate was 0.0032) and 10% of the data were
double-entered for the peripheral nerve disorder
study.4 Data from the Abilities Questionnaire were
entered into a Microsoft Excel database (2018) and
double checked by a trained research assistant.
Berlet and Kaskutas 5

Quantitative data from the clinician survey were stored Table 1. Categories of occupation and mean O*NET ratings for
on Qualtrics.30 the 10 occupation kits developed.

Mean
Data analysis Categories of ONET
Occupation kit occupation ratinga
Data were extracted from REDCap, Excel, and
Qualtrics into IBM SPSS version 25 for data analysis.31 Dressing ADL 2.03
Frequencies and percentages were calculated for each Feeding ADL 2.02
DASH item’s difficulty rating and for intervention Fine Motor Leisure Leisure; Social participation 2.41
coding data from 70 treatment sessions. Mean scores Gross Motor Leisure Leisure; 2.89
of each item on the Abilities Questionnaire were com- Social participation
puted for each kit. Central tendencies, including means Laundry IADL; 1.96
and ranks, were calculated for data generated from Work
Lifting and Carrying Jobs IADL; 2.35
the clinician survey. The differences between commu-
Work;
nity practice clinicians and hand therapists were deter- Leisure
mined with Mann–Whitney U test. A p-value less Light Cleaning IADL; 2.16
than 0.05 was accepted as statistically significant. The Work
mean percentage of time spent on each intervention Meal Preparation IADL 1.84
type was calculated to determine changes in interven- Paperwork IADL; 1.52
tion type before and after the introduction of occupa- Education;
tion kits. Work
Technology Use IADL; 1.95
Work;
Results Social participation

Identifying target occupations

a
Highest skill level ¼ 7; lowest skill level ¼ 1.
ADL: activities of daily living; IADL: instrumental activities of daily living;
The 10 DASH activities that 15 patients in the O*NET: US Department of Labor for the Occupational Information
HTSELC rated most difficult during initial evaluation Network.
include recreational activities that transmit impact
through their arm, shoulder or hand, gardening or
yardwork, washing their back, recreational activities
that require moving their arm, shoulder or hand,
heavy household chores, opening a tight or new jar,
using a knife to cut food, carrying a heavy object, pre-
paring a meal, and putting on a pullover sweater. The
10 DASH activities reported as most difficult by 627
patients with a peripheral nerve disorders include rec-
reational activities that transmit impact through their
arm, shoulder or hand, recreational activities that
require moving their arm, shoulder or hand, opening
a tight or new jar, gardening or yardwork, heavy
household chores, carrying a heavy object, changing a
lightbulb overhead, washing their back, reaching for an
item overhead, and using a knife to cut food. The occu-
pational areas most commonly addressed during 70
treatments in the HTSELC were work, leisure, health
management, and social participation. Figure 3. Image of meal preparation occupation kit.

Developing the occupation kits

Based on the results above, we developed kits to
address the following 10 occupations: dressing, feeding,
fine motor leisure, gross motor leisure, laundry, lifting
and carrying jobs, light cleaning, meal preparation,
paperwork, and technology use. Each occupation kit
is linked to one or more areas of occupation identified
in the OTPF,5 with all areas of occupation, except rest
and sleep, represented by the 10 kits (Table 1). The
supplies for each kit were compiled and placed into
appropriately sized bins (Figure 3), along with the
instruction sheets (Figure 4). Supplies for the kits
were donated by members of the HTSELC or
6 Hand Therapy 0(0)

Figure 4. Instruction sheet for occupation kit of meal preparation.

purchased from local discount stores, resale shops, or
online venues.
The mean O*NET physical abilities ratings for all
kits as rated by student therapists was 2.09 on a 1–7
point scale. Paperwork was the lowest physically
demanding task (1.52) and gross motor leisure was the
highest (2.83). The lowest rating for any physical ability
was explosive strength (1.41) and the highest was arm-
hand steadiness (2.57). The O*NET physical abilities
ratings for each occupation kit were included to alert
therapists to the demands of the activities inside. Refer
to Table 1 for a complete list of mean O*NET ability
ratings for the 10 physical skills rated for each kit.
To quantify patients’ performance when using the
occupation kits, we received approval from the devel-
oper of the Assessment of Work Performance
(AWP),32 Dr Jan Sandqvist, to include an abbreviated
version of the AWP in the occupation kits
(Supplementary Figure 1). The AWP is a standardized
assessment that measures how efficiently the patient
performs real or simulated work activities. This abbre-
viated version includes ratings of five motor skills (pos-
ture, mobility, coordination, strength, and physical
energy) on a 4-point scale, with 1 indicating incompe-
tent performance and 4 indicating competent perfor-
mance. Although some activities in our occupation
Berlet and Kaskutas 7

kits are not work tasks, the AWP provides a standard- Table 2. Therapists’ mean ratings of occupation kits (n ¼ 14).
ized method to quantify performance over time and Likeliness
provides patients with immediate feedback. How well Usefulness of using
kit reflects of occupation occupation
Evaluating the occupation kits Occupation kit the occupationa kitb kitc

Fourteen of the 30 therapists in our program’s clinical Dressing 3.86 2.60 2.64
Feeding 3.43 2.60 3.21
practice completed the survey evaluating the occupa-
Fine Motor Leisure 3.43 3.20 3.43
tion kits, including seven community practice clinicians Gross Motor Leisure 3.53 3.05 3.36
and seven hand therapists, giving a participation rate of Laundry 3.86 1.70 3.12
47%. Of the 14 therapists who completed the survey, Lifting and 3.79 3.15 3.71
45% reported they were likely to use the occupation Carrying Jobs
Light Cleaning 3.79 2.05 3.07
kits—they were most likely to use the paperwork, tech- Meal Preparation 3.57 3.15 2.93
nology, and lifting and carrying jobs kits. The laundry, Paperwork 3.86 3.10 3.50
dressing, and paperwork kits were noted to best reflect Technology Use 3.71 3.00 3.36
the occupation at hand. Table 2 shows the therapists’ a
Not well at all ¼ 1; extremely well ¼ 5.
ratings for the degree the occupation kit represents the b
Low usefulness ¼ 1; high usefulness ¼ 5.
occupation, usefulness of the kit, and likeliness to use c
Strongly disagree ¼ 1; strongly agree ¼ 5.
the kit. Statistically significant lower likeliness ratings
were noted by hand therapists in comparison to com-
munity practice therapists for the laundry and technol- Table 3. Intervention type percentages in HTSELC before and
ogy occupation kits; other ratings between groups were after introduction of occupation kits.
similar.
Pre-occupation Post-occupation
When pilot testing the occupation kits in the
kits (n ¼ 124 kits (n ¼ 20
HTSELC, student therapists used kits in 11 of 20 treat- Type of intervention treatments) (%) treatments) (%)
ment sessions. The kits were rated as being “very
important” in achieving treatment session goal(s) Preparatory methods 61 49
82% of the time and were never rated as “not useful.” and tasks
The light cleaning and lifting and carrying jobs kits Activity and occupation 19 26
Education 19 25
were used most often, but all kits were used at least
Advocacy 1 0.5
once. When comparing intervention type percentages Group 0 0
before and after the introduction of occupation kits
in the HTSELC, we found that use of activity and Note: Student-estimated percentage of time spent delivering intervention
types out of 100% of session.
occupation interventions increased from 19% to 26%
HTSELC: Hand Therapy Student Experiential Learning Clinic.
(Table 3). Additionally, the use of biomechanical inter-
ventions, including preparatory methods and tasks,
decreased from 61% to 49% (Table 3). scale of the standardized AWP32 to quantitatively
assess the competency of performance is a strength of
this research. Previously developed kits were created
Discussion
exclusively as intervention tools and assessment data
This study used data to inform the development of 10 were only observational and narrative.6,9,15 Tiering
occupation kits designed to aid the delivery of the AWP over the occupation kit provides a means to
occupation-based care in our pro-bono hand therapy objectively measure the competency of performance of
student clinic. A scientific approach was used to iden- an occupation over time and identify interventions that
tify occupations this patient population found chal- can improve functional deficits.
lenging, quantify the biomechanical underpinning of Research has shown that OTs practicing hand ther-
each occupation kit, and evaluate the 10 occupation apy should combine occupation-based and biomechan-
kits developed. The occupation kits we developed ical treatment approaches to produce the best
address performance at the occupation and activity outcomes for patients, including increased motion,
levels, while other documented occupation kits address strength, motivation, and satisfaction.9,12,15,17,19,22,33
performance at the skill level.6,9,15 However, tasks An innovation of this research is that we quantified
embedded in these kits are similar to those reported the biomechanical demands of the activities included
in hand therapy literature,6,9,15 including using utensils, in each occupation kit, marrying the biomechanical
opening a jar, tying a shoelace, buttoning, carrying a and occupation-based approaches, which is becoming
bag, and using a spray bottle. Using the motor skills increasingly important in the field of hand therapy.
8 Hand Therapy 0(0)
When evaluating the occupation kits, therapists in
clinical practice agreed that the kits reflected the occu-
pations well; however, their ratings of likeliness to use
the kits and overall usefulness of the kits were lower
than expected. These findings are in line with previous
studies which found that despite therapists affirming
the value of occupation in their practice, they reported
they do not have the tools to deliver care at the occu-
pation level while also balancing the biomechanical
needs of hand therapy patients.19,21 The occupation
kits developed in this research may be the solution.
Pilot testing the occupation kits in our HTSELC dem-
onstrated that practice can shift from primarily utiliz-
ing biomechanical interventions to occupationally
driven treatment without sacrificing the biomechanical
approach. By offering these occupation kits for clinical
use, we hope clinics will increase the use of occupation-
based hand therapy. Targeted education and first-hand
experience observing the impact of the occupation kits
on patients has helped our student therapists under-
stand how these kits improve both biomechanical abil-
ities and occupational performance.
There are some limitations to our study. Firstly, we
only quantified motor demands and provide methods
to assess motor performance with the kits as this is a
common concern in hand therapy. Cognition, psycho-
social, and physiological factors were not explicitly
measured. Secondly, therapists only previewed the
instruction sheets and O*NET ratings for each occu-
pation kit, instead of using the actual occupation kit in
the clinic, which may have impacted likeliness and use-
fulness ratings. Thirdly, this study is based on the
OTPF, specific to the American Occupational
Therapy Association, which may limit generalizability
in understanding of operational definitions. However,
the OTPF aligns well with other models such as
the Person-Environment-Occupation-Performance
Model34 and the Canadian Model of Occupational
Performance.35 Lastly, pilot testing of the kits occurred
with a small, convenience sample of patients seen in an
inner-city student clinic in the Midwest—results should
be interpreted accordingly. However, this study does
provide 10 scientifically based and contextually driven
occupation kits with utility for hand therapy and pos-
sibly other practice areas. Pilot testing in the HTSELC
suggests that occupation kits available in the clinic can
increase occupation-based practice.
Further research on occupation kits is necessary to
determine the impact of these occupation kits on hand
therapy practice. We will continue to use the occupa-
tion kits and develop new kits as the need arises.
Ongoing research in our HTSELC will gather patients’
perceptions of the occupation kits, measure pre–post
intervention changes and six-month outcomes on the
DASH and work DASH, and measure perceptions of
work abilities and work status in patients who have
utilized occupation kits during therapy. Future
research should measure the effect of occupation kits
on therapists’ beliefs and practices and assess the sus-
tainability of these practice changes.
Conclusion
Incorporating occupation and activity into treatment
sessions remains a challenge in hand therapy. The
occupation kits developed in this research can be the
solution to the common barriers hand therapists cite
for not using occupation-based interventions. Bundling
the supplies needed for an occupational area addresses
the barriers of insufficient time and lack of resources,
promoting efficient use in a busy hand clinic. Inclusion
of specific instructions, safety precautions, and physical
activity ratings facilitates safe performance, and use of
the AWP generates measurable performance data.
Lastly, with reimbursement shifting to a health out-
comes model, occupation kits can ensure optimal pay-
ment for services provided. These research findings
suggest that the occupation kits developed in this
study are a first step to helping therapists address occu-
pations within the hand therapy setting. The occupa-
tion kits are currently available through the
Washington University in St. Louis Program in
Occupational Therapy website at https://www.ot.
wustl.edu/about/resources/occupation-kits-1634.
Acknowledgements
The author(s) would like to acknowledge Rose McAndrew,
OTD, OTR/L, CHT and members and patients of the
HTSELC at Washington University in St. Louis Program
in Occupational Therapy.
Declaration of conflicting interest
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Ethical approval
Approval to use patient data for this project was received
from Washington University in St. Louis’ Institutional
Review Board (#201708166). The IRB determined that the
student and therapist participation did not involve human
subject research.
Berlet and Kaskutas
Informed consent
Written consent was obtained from all patients whose data
were analyzed for this project. Since the University’s
Institutional Review Board deemed that therapists’ and stu-
dents’ written consent was not required, completion of activ-
ities they were asked to do provided informed consent.
Guarantor
VK.
Contributorship
VK and LB designed the intervention, conceived the study,
and were involved in gaining ethical approval. LB researched
the literature, completed data analysis, and wrote the first
draft of the manuscript. Both the authors reviewed and
edited the manuscript and approved the final version of the
document.
ORCID iD
Logan Berlet https://orcid.org/0000-0001-5891-2780
Supplemental Material
Supplemental material is available for this article online.
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