SPECIAL INTEREST REPORT POSTER DISPLAY

A PRELIMINARY STUDY OF THE INCIDENCE OF ALCOHOL RELATED UPPER LIMB INJURIES AND THE CHALLENGES FOR PHYSIOTHERAPY. McNeill S¹, Taylor A², Kiernan R³, Rooney M¹, Armstrong M¹; ¹Physiotherapy Department, Sligo General Hospital, The Mall, Sligo, Ireland. ²Department of Physiotherapy, School of Health Sciences, University of Limerick, Ireland. ³Department of Public Health Medicine, Rockwood Parade, Sligo, Ireland

PURPOSE: The main purpose of this survey was to investigate the incidence of alcohol related upper limb conditions seen in an outpatient physiotherapy department. Additional aims were to select a validated alcohol-screening tool for use in physiotherapy and to see whether there were any variations in attendance pattern with this group of patients. RELEVANCE: Health problems related to the misuse of alcohol are now recognised as frequent, serious and costly. As the results show, many are injuries requiring the intervention of physiotherapists. An extensive literature review showed that evidence on the the incidence of alcohol related upper limb injuries requiring physiotherapy is limited. PARTICIPANTS: 440 patients referred from 1.12.2004 to 31.7 2006 to the presenter for management of upper limb injuries took part. METHODS: A Senior Physiotherapist (the presenter) working in the Orthopaedic Department of Sligo General Hospital undertook this study. Data were collected on patients referred with an orthopaedic related upper limb condition. A systematic history was taken and an examination was carried out on each patient. Particular cognisance was taken of the time of injury and where it was suspected that alcohol was involved a medical record review was carried out. During subsequent attendance, treatments and interventions were recorded. At discharge,post treatment outcome details were recorded by the therapist for each patient. The number of treatments and any non- attendance were also recorded. ANALYSIS: Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS, version 14.0) Descriptive statistics were applied. RESULTS: A total of 440 patients were referred for physiotherapy management of upper limb conditions during this period of which 25% (n=109) were alcohol related. Hand injuries accounted for 50%(n=55), wrist injuries for 28%(n=30) and shoulder injuries accounted for 9%(n=10). Other upper limb injuries which were alcohol related, accounted for 13% (n=14). Only 30% (n=33) of the alcohol related group attended all appointments compared to 70% (n=232) of those without an alcohol related problem. This means that there is a highly significant association in attendance rates between those with alcohol related upper limb injuries and those without an alcohol related problem (χ² test, p < 0.01). CONCLUSIONS: This study identified that 1:4 of the upper limb injuries referred to the presenter for physiotherapy, were alcohol related. Interestingly, hand injuries were the most common upper limb injury. To the knowledge of the presenter there are no studies or recorded evidence for the incidence of alcohol related upper limb injuries requiring physiotherapeutic management. Evidence with regard to interventions for such injuries is also scant. Given the frequency of the problem, further research is needed. The next stage of this study plans to use conventional physiotherapy, together with the Alcohol Use Disorders Identification Test (AUDIT) for screening. Brief Intervention (BI), which is a recognised intervention, will also be used with those patients who agree to take part. This (BI) is aimed to modify their use of alcohol. Outcomes for providing such intervention will be measured and used to inform clinical practice. IMPLICATIONS: This study has many implications for physiotherapy. Firstly, it is a challenge which should be seen as an opportunity to adapt physiotherapy practice. Many physiotherapists work in areas of health promotion and prevention so it would not be too difficult to make such an adaptation. KEYWORDS: Alcohol, Misuse, Prevention,. FUNDING ACKNOWLEDGEMENTS: Ethical approval and a Research Seed Grant of €5000 have been obtained from Research and Education Foundation, Sligo General Hospital to proceed to the next stage of this study. CONTACT: Sheemac@eircom.net

ETHICS COMMITTEE: Ethics Committee Sligo General Hospital, The Mall, Sligo, Ireland.