Fostering holistic hand therapy: Emergent themes of client experiences of mind-body interventions

Abstract

Background

Mind-body interventions are a viable holistic approach to rehabilitation; however, evidence for mind-body approaches in hand therapy is lacking.

Objectives

This study explored the experiences of clients with musculoskeletal disorders undergoing two mind-body interventions within hand therapy.

Methodology

Qualitative data were obtained from clients who received mindfulness meditation and sonographic biofeedback as part of hand therapy. Semi-structured interviews conducted after four therapy sessions elicited participants’ experiences and acceptability. Emergent themes were identified through an iterative, qualitative descriptive process.

Results

Three themes emerged: insight on the body; relaxation and relief; and I am in control. A fourth theme was identified in the acceptability data, that is, mindfulness as a meaningful activity. At least one of the interventions was acceptable to each participant.

Implications

Positive participant experiences support further consideration of mind-body interventions as a useful holistic approach in hand therapy to support wellness, quality of care, and participation in recovery.

Introduction

Mind-body interventions are an effective strategy for providing holistic treatment to improve quality of care and healthcare outcomes while promoting overall health and wellness (Goyal et al., 2014). Hand therapists have publicly advocated for holism in practice, as combining the medical model with mind-body approaches maximizes treatment outcomes (Breger Stanton, 2008), and complementary approaches can also support increased self-efficacy, quality of life, and acceptance of pain symptoms (Cricchio et al., 2011; Giese, 2005). Two such interventions that aim to enhance the mind-body connection are mindfulness meditation and visual biofeedback.

Mindfulness meditation is a low-cost, often self-guided exercise that is complementary and supportive to other interventions; yet, mindfulness-based research within physical rehabilitation is nascent (Hardison & Roll, 2016). Emerging literature suggests mindfulness may help people change perceptions of pain and improve quality of life by mediating effects on anxiety, stress, and depression related to medical conditions (Course-Choi, Saville, & Derakshan, 2017; Forster, Nunez Elizalde, Castle, & Bishop, 2015). One form of mindfulness that may be particularly useful in physical rehabilitation is a body scan. During a mindful body scan, participants are encouraged to become non-judgmentally aware of the physical sensations (e.g., tension, pain) present in the body. This type of meditation has been shown to increase interoceptive awareness and focus (Kok & Singer, 2017). Increasing bodily awareness in a non-judgmental manner can aid progress, especially for individuals whose symptoms may initially limit engagement or participation in the therapy session.

Biofeedback is a more widely used mind-body intervention in physical rehabilitation. Biofeedback interventions provide a representation of internal bodily processes to assist in attenuating or augmenting those processes. In rehabilitation, feedback is often provided in visual forms. For example, when shown a visualization of the sheer force of index finger and thumb movement, individuals recovering from a stroke can demonstrate increased pinch strength (Seo, Fischer, Bogey, Rymer, & Kamper, 2011). Similarly, visual biofeedback with sonography is gaining use in musculoskeletal rehabilitation to encourage specific muscle activity and facilitate body awareness (Potter, Cairns, & Stokes, 2012), most frequently with individuals who have lower back pain and women with pelvic floor dysfunction (Giggins, Persson, & Caulfield, 2013; Roll, Asai, & Tsai, 2016).

Mind-body interventions warrant further investigation as these holistic interventions have been shown have clinically significant immediate and long-term effectiveness, improving not only client experiences of hand therapy, but overall occupational engagement and quality of life (Elliot, 2011; Hardison & Roll, 2016; Reid, 2011). This study aimed to capture client’s experiences and acceptability for the use of these two mind-body interventions integrated into their hand therapy sessions. Although both mindful body scans and sonographic biofeedback have been shown to have positive effects for individuals with various medical conditions, there is limited evidence regarding the application or utility of these interventions in the context of hand therapy. Identifying essential ways in which mind-body interventions impact the therapeutic experience from the client’s perspective is a vital first step toward developing best practices that foster holism within hand therapy.

Methods

Study Design and Methodological Rigor

A randomized, cross-over trial was conducted to investigate two mind-body interventions as a component of hand therapy. This manuscript focuses on findings that have emerged from the synthesis of qualitative data obtained through the parent study. Specifically, semi-structured interviews were conducted at the conclusion of study participation to: (1) explore experiences of mind-body interventions and 2) discern the acceptability of mind-body interventions in a hand therapy context. Our analysis sought to develop a comprehensive and complex illustration of the participants’ experiences of the interventions by examining a variety of perspectives across participant demographics (Creswell & Poth, 2017). The study protocol received Institutional Review Board approval, and all participants provided informed consent.

All of the researchers were occupational therapists who had previous experience with the mind-body interventions and had a shared interest in enhancing hand therapy through holistic care. To minimize bias in the patient experience, the researchers were not involved in recruitment and were not present during the interventions. Instead, each clients’ treating therapist conducted recruitment and intervention using standardized language that did not divulge specific details of the research process or the outcomes being evaluated. A research assistant who had no knowledge of how the participants had engaged with the mind-body interventions during the therapy session selected the participants to be interviewed. The interviewer had no previous interactions with the participants and was not one of the treating therapists. The interview guide was written in neutral language with positive and negative probes to ensure participants fully considered their experiences, and the interviewer avoided adding personal thoughts or reflections. One author was involved only in data analysis, serving to increase trustworthiness by balancing the coding and interpretations of the other two authors who had been engaged throughout the study. All three researchers continuously acknowledged their own opinions regarding the interventions and reflected on their analysis of the data to ensure that their own perspectives were not influencing data interpretation.

Participants

We recruited participants from an outpatient hand therapy clinic at an academic medical center at the completion of their initial evaluation. Inclusion in the parent study required: a unilateral musculoskeletal injury of the upper extremity, pain higher than 2/10 with activity, attending at least two therapy visits per week, and English-speaking. Clients under the age of 18 or those with any profound cognitive deficits were excluded. As we could not interview all participants in the parent study due to researcher and patient availability and data analysis support, we determined that one-third of the study participants would provide foundational information on general perceptions of clients receiving mind-body interventions. We purposefully sampled clients across gender, work status, and age, as well as across diagnoses from among categories related to acute traumas, elective surgeries, and repetitive strain injuries.

Interventions

Participation in the parent study began with the client’s second therapy visit and continued across four 60-minute treatment sessions (Figure 1). Participants were randomly assigned to one of two groups, which designated the order that two mind-body augmented sessions were provided. Standard hand therapy was also provided as a baseline session, as well as between the two mind-body augmented sessions to serve as a washout period. Standard hand therapy was not controlled; instead, the treating therapist selected interventions at their discretion from among any treatments deemed appropriate for each client.

Figure 1.

Timing of individual interventions within each therapy visit. Note: This order of interventions across the four visits was used for half of the participants, whereas the mind–body components in Visits 2 and 4 were switched for the other half of the participants.

During mind-body augmented sessions, the mind-body interventions lasted for 20-minutes followed by 40-minutes of standard hand therapy. The mindful body scan was an audio-guided meditation lead by a trained mindfulness instructor, which had been pre-recorded for research purposes and was not specifically tailored to hand therapy. Participants were instructed to become aware of sensations (e.g., touch, tingling, pain, temperature, muscle activation) across body regions, beginning with the feet and proceeding upward. Participants used noise-cancelling headphones in a private area of the clinic and were given the option to sit or lie down. Sonographic biofeedback was provided by the client’s treating therapist using a GE Venue 40, point-of-care sonography machine. The therapist provided instruction to help the client identify various bones, muscles, tendons, and internal fixation plates/screws, and demonstrated how these structures moved during finger or hand motion. Participants engaged in a comparison between their affected and unaffected sides using both static and dynamic imaging. Although no printed or digital images or videos were provided to the clients, the therapists encouraged participants to recall the visualizations during exercises and activities, both in therapy sessions and at home.

Data Collection and Analysis

Participant demographics were obtained at baseline, and participant experiences with the mind-body interventions were examined through follow-up interviews conducted within two weeks after completing the four study sessions. Only the participant and interviewer were present during the interviews, which were conducted in a private room, lasted about 30 minutes, were audio recorded, and were transcribed verbatim. With input from the therapists, we developed a semi-structured interview guide to explore participant experiences with each intervention, acceptability of the interventions as part of hand therapy, and potential benefits or challenges. A sample question, “What are your general thoughts about the body scan?” had follow-up probes such as, “Did you find the intervention helpful or not helpful?” and “What did you like and not like about the intervention?” The interviewer summarized the participants’ experiences at various stages during the interview, allowing the participant to verify the interpretation, correct errors, or provide additional thoughts.

We completed a qualitative content analysis using a deductive approach (Graneheim & Lundman 2004; Krippendorff, 2013). Two researchers who did not conduct the interviews, read the transcripts several times to obtain a sense of the data as a holistic, contextualized unit of analysis. We then implemented a systematic interpretation of the text, condensing the interviews into meaning units close to the description of the manifest content, followed by collective interpretation of meanings abstracted into sub-themes focused on experiences and acceptability. Sub-themes were identified specific to each treatment, as well as overarching sub-themes across both interventions. Through a process of reflection along with a review of related literature, the sub-themes were unified into themes and discussed among all three researchers. The authors engaged in ongoing and numerous conversations to reach a consensus on the final emerging themes, synthesis of findings, and overall implications of the data. An additional review of the meaning units that potentially rejected the interpretations of the manifest content were analyzed and nothing that contradicted the themes were discovered.

Results

We interviewed eight participants, including four females and four males ranging in age from 37–67 years with a range of diagnoses (Table 1). Four participants were working either full-time or part-time, two were working on modified duty due to being injured, and two were retired. The average interview length was 28 minutes (minimum: 15 minutes; maximum: 36 minutes), with a total of 221 minutes of transcribed audio. Three themes emerged relative to participant experiences with the mind-body interventions. One theme explicitly related to sonographic biofeedback, insight on the body, and one theme was attributed to the mindful body-scan, relaxation and relief. The third theme, I am in control, was as an overarching concept discussed in response to both interventions. Acceptability and preference was varied; however, a fourth emergent theme was identified, mindfulness as a meaningful activity in daily life.

Table 1.

Demographics of the eight clients who participated in the semi-structured interviews.

Participant Number	Age (Years)	Gender	Work Status	Diagnosis
2	37	Male	Full-Time	Right Middle Finger Mid-Phalanx Fracture
4	62	Female	Part-Time	Right Index Finger Trigger Finger
5	67	Female	Full-Time	Left Brachial Plexus Injury
6	43	Male	Full-Time	Left Thumb Laceration, Left Lateral Epicondylitis
15	63	Female	Retired	Left Carpal Tunnel Release, Left Trapeziectomy, Osteoarthritis of first carpometacarpal joint
17	56	Female	Modified/Off due to injury	Right Trapeziectomy
18	54	Male	Modified/Off due to injury	Right Hand Pain, Possible Carpal Tunnel Syndrome, Right Upper Extremity Pain
21	61	Male	Retired	Tendon Transfer of Right Extensor Indices Proprius to Extensor Pollicis Longus

Insight on the body

I was able to look at [the sonographic image] and concentrate on how [the therapist] had me move my hand and do certain things. I saw the muscles, saw the nerves, saw the bones, and the way [the image] reacts. And then could come here and do the exercises. I’m still able to visualize all the movements. It was very helpful. (P18)

This excerpt illustrates how better understanding of injury led to an increased ability to concentrate on specific body structures. This process of insight on the body involved two components. First, the sonography helped participants understand how specific body structures related to their injury and the impact medical procedures had on the affected area(s).

I always enjoyed when the doctor would go through x-rays, and I would be able to inspect what was wrong with my hands. So, with the sonogram, and trying to understand it and the anatomy and what the doctor did and where, that was really helpful. (P21)

Second, several participants identified a physical cause of the symptoms they experienced. One participant described: “I was able to see how healthy my left-hand looks, and what I need to work on with my right, and why it’s acting this way. It just really, really turned on the insight to what’s going on” (P18). In many cases, sonography was a helpful tool that aided in identifying a physical explanation of perceived pain: “I liked seeing the reasons why I was feeling the pain. It made a lot more sense, and I knew what I had to work on” (P02).

When participants successfully identified internal body structures that elicited symptoms, they often felt a sense of validation: “I thought [the sonographic biofeedback] was great information. What I am feeling is true; the pain is true” (P17). This sense of validation made it easier for participants to cope with their injury. As one participant described, sonography helped him become aware of the inner workings of his injury, which improved acceptance of the injury:

I loved [the sonographic biofeedback]. It was just fascinating to actually look at [my hand], see what’s happening in my hand, and see how my tendons are moving. It made it very real…anytime somebody can show me something that actually helps me understand [my injury], it’s easier for me to deal with it. (P04)

Overcoming the lack of knowledge for their specific condition was identified as a key barrier to full participation in the recovery process. One participant posited, “I think the more information the individual has on their care, the more they are going to be concerned about it” (P18). Sonography helped another participant understand the complex nature of his surgeries:

[The biofeedback] was really helpful in knowing what the doctor transferred. I’ve had other hand surgeries where the doctor said, ‘Well I’m taking this tendon here, and I’m going to transfer it over to here.’ When it came to this last surgery, the doctor transferred a tendon I thought another doctor had already used...I was in the blind. Even though I tried to listen to doctors, I tried to understand what they were saying. If there’s a picture of it, it’s always better. (P21)

Relaxation and relief

“I was very stressed... therapy was always on the edge of my seat kind of thing because didn’t know what was going to happen. When I had [the body scan], it calmed me” (P05). Even though one participant was unfamiliar with meditation and found it “unusual,” this participant similarly reported, “[the body scan] was interesting in it helped me to relax” (P06). A recurring theme related to the mindful body scan was an increased ability to control their symptoms through relaxation. “Personally, I thought [the body scan] was perfect. Because it started giving me relaxation. I could feel the relaxation starting from my toes, going up my body” (P18). This relaxation increased pain management in several cases. One participant described an escape from feeling pain after the mindful body scan: “For somebody who’s never done something like that, [the body scan] was very relaxing. It took me out of my pain state for a minute” (P17).

As a result of relaxation and successful symptom management, participants noted being able to focus more during therapy and demonstrated a sense of increased self-efficacy, which improved their performance in therapy. One participant described this exact phenomenon: “[The body scan] definitely helped me relax. It helped me concentrate more on certain areas of my hand that I needed to be working on” (P18). Similarly, another participant noted, “[The body scan] just helped me to relax more while I was doing the therapy, not to let myself get all tensed up. So, I felt the pain – tried to let it go” (P15).

I am in control

I can live in the abstract world, but when I’m trying to get my head around coping with something or getting control of a situation if something remains abstract, it’s much, much more frustrating. (P04)

Both the biofeedback and mindful body scan seemed to provide increased awareness, focused understanding, and sense of self-efficacy that led to a sense of being more in control of their recovery. A story emerged throughout the comments of one participant who at first discussed the impact of the biofeedback stating, “My sensitivity. I was more aware of what was going on with my hand and just the different areas of the hand.” Later the participant noted, “I’m usually a tense person, and listening to the audio not only helped me relax; but it, what the exercises were doing, I was able to receive that.” Finally, making a third remark, “I think [the mind-body interventions] helped my therapy because it made me feel less out of control…like ‘okay, I’m okay. I’m in control. I can do this. I can make myself feel better.” (P05)

Being more in-tune with their bodies, understanding the focus of the therapy, and feeling more in control, participants were better positioned to be active participants and partners with the therapists during their care. Due to this partnership, participants experienced increased motivation, capacity, and empowerment to act on their own behalf. “I was really participating, I was really involved, and I was really being informed. It made me want to work harder. It lifted me from the participant that was being done to. I was now a partner in my care.” (P05)

For some participants, gaining insight and control supported an increased sense of choicefulness that was reflected through self-initiated and future-oriented actions, such as creating targeted goals. One participant described this benefit: “I think if people have [the sonographic biofeedback], they can understand more about their healing process and what needs to be done” (P18). This participant further described how the experience with sonography provided a sense of reassurance to the overall recovery process:

It was helpful when I did the movements and [the therapists] explained what it meant. If there was a lot of movement in one area, then that was normal…So that was helpful. It was more like reassurance. I find if I see something changing I think it reassures me that what I’m doing is what I should be doing to help remedy the problem. (P18)

Moreover, participants described how they saw sonography as a potential tool to demonstrate recovery over time and promote continued participation in recovery. One participant noted, “[Sonography] is telling us that we are healed. [Therapy] is working. It is beneficial” (P17). A sentiment closely echoed by another participant, “[We should use sonography to] compare and see if the nerves look better; if they’re less compressed because of exercises. I think that’ll be a great thing ... Just seeing that you’re progressing? That’s one of the best things” (P05).

Acceptability and preference

Participants were generally positive about both interventions and frequently noted how the interventions provided a holistic benefit to recovery. “I think [mind-body interventions] are really good for looking at the whole person, not just this or that” (P17). The majority of participants (i.e., five) gave positive feedback for both interventions; three participants expressed a preference. This clear preference is best exemplified by a participant who did not like the mindful body scan, but was excited about the sonographic biofeedback:

For me, the really heavy hitting thing was the sonography. I was like, “This is cool.” I could see what’s going on and that really made me visualize it. Seeing it move around, I was like, “This is what my hand does.” (P02)

In contrast, a participant with a strong affinity for the body scan disliked the biofeedback due to difficulty in identifying body structures, “I wasn’t really sure what I was looking at. It’s all just looks kinda fuzzy there. So, I’m just not sure what I got out of that” (P15). Alternatively, two participants who did not find the body scan useful posited the potential benefits for other participants. “[The body scan] was interesting in that it helped me relax, but it was unusual. Sometimes I felt like it stopped because there were long moments of silence. I even remember one time picking up the iPod like, “Is this thing still on?” (P06). The other indicated:

The tape put me to sleep… I think body awareness in any sort of physical activity is important. So really focusing in on the very thing that you’re doing, if it’s something that you struggle with, [the body-scan] would be very helpful. I’m involved with a lot of athletics, so I do that anyway. When I exercise, I’m thinking about those parts of my body. So [the body-scan] was nice as it was very relaxing and really calming … I don’t know if I took its information far past that session. (P02)

Mindfulness as a meaningful activity

Beyond acceptability in hand therapy, two participants noted improved overall health and wellness through the incorporation of mindfulness as an activity within their daily lives. In one case, a participant shared how she applied mindful occupations to her daily routine and improved her overall health:

Basically, in the morning, before I try any of my exercises, I start listening to the meditation. It’s helping me relax. It’s helping me think. My mood has changed. I’m more positive instead of being more negative. At first, I felt I was very depressed because I don’t feel normal. So, the meditation has helped me improve my way of thinking. It has also improved the exercises. If it wasn’t for the meditation that I had in therapy, I would have never known about it, and I wouldn’t have felt better (P18).

A second participant described sharing the benefits of mindfulness with her family: “I got audio since then for my son who has trouble sleeping...to relax him...to bring him down a bit. I think it’s very good therapy” (P17). These occupations have helped improve not only physical abilities but these participants’ overall quality of life and wellbeing.

Discussion

We explored client experiences of mind-body interventions as a component of hand therapy to determine client-centered value in investigating and implementing holistic care within hand therapy. All participants noted that at least one of the two of mind-body interventions would be useful in their recovery, and four themes relating to these participants’ experiences emerged: insight on the body, relaxation and relief, I am in control, and mindfulness as a meaningful activity. These findings provide impetus for continued investigation by highlighting potential implications for the use of mind-body interventions in hand therapy. Specifically, mind-body interventions may be useful for addressing psychosocial needs, enhancing education, developing embodiment, and improving engagement and self-efficacy within hand therapy.

Psychological factors such as stress and anxiety can contribute to poor recovery (Keijsers, Feleus, Miedema, Koes, & Bierma-Zeinstra, 2010). Furthermore, pain intensity, catastrophic thinking, and magnitude of disability can be largely explained by psychological factors (Teunis, Bot, Thornton, & Ring, 2015). Unfortunately, psychological factors are often overlooked both in research and in clinical practice within hand therapy (Chown et al., 2017; Hannah, 2011; Takata, Wade, & Roll, 2017). Participants in our study experiencing stress or anxiousness upon arriving at therapy conveyed how these factors were somewhat reduced by the mind-body interventions, providing impetus for continued investigation of how mind-body interventions can mitigating psychological symptoms.

In tandem client psychological symptoms, various psychosocial constructs are worth considering. Mind-body interventions may provide a venue for the empathizing mode of therapeutic uses of self, which is correlated with increased client participation (Fan & Taylor, 2018). Similarly, the process of enhancing awareness of and interest in the body state through mindful meditation can improve autonomy by increasing self-knowledge, improving acceptance of body states, and enhancing self-efficacy for managing negative psychological experiences (Brown, Creswell, & Ryan, 2015). Additionally, the mind-body interventions implemented in this study helped many participants gain a sense of control. These findings parallel emerging discussions in occupational science that link mindfulness states to increased engagement in occupations (Reid, 2011). As such, mind-body interventions may enhance the actual occupation of hand therapy participation and injury recovery, both of which are exemplified by reports in our data of increased participation as active partners in the therapy/recovery process.

An additional practical implication for mind-body interventions is the enhancement of client education, which hand therapists recently rated as the most critically important aspect of intervention (Keller et al., 2016). However, clients can forget up to 80% of information (Bekkers et al., 2014) and recall worsens when anxiety and distress are present (Kessels, 2003). In addition, hand therapy clients exhibiting non-adaptive pain thoughts demonstrate biased perceptions of therapist advice (Bekkers et al., 2014). In our findings, the mindful body scan served to reduce anxiety and stress allowing clients to be more receptive to education, and sonography provided clients with a deeper understanding of anatomy and their injury to reinforce learning. In total, participants felt more confident in understanding their injury and properly performing exercises, consistent with existing evidence (Giggins et al., 2013).

As participants gained greater insight through the understanding of the anatomical structures involved and the root of their symptoms, they better embodied their injury. Embodiment supports conscious awareness of an injury and provides an opportunity to reconstruct, re-evaluate, and gain control of symptoms (Bullington, 2009; Tarr & Thomas, 2011). In our findings, participants noted that this embodiment led to an improved ability to participate in therapy, which is consistent with other literature suggesting that the embodiment of symptoms can improve engagement in occupations and participation in meaningful activities (Stroh-Gingrich, 2012). In addition, by learning to manage symptoms, especially pain, participants demonstrated increased self-efficacy in the recovery process. Promoting client self-efficacy should be a priority to therapists, as higher self-efficacy can not only improve symptom management (Fridberg & Gustavsson, 2017), but also improve home exercise adherence (Picha & Howell, 2018) and overall functional outcomes (Fortinsky et al., 2002).

In total, all findings in this work led to an increased client-centered focus in the hand therapy setting, where clients reported being more in control and directly engaged, which is key to improving the therapy experience (Dixon, Thornton, & Young, 2007). Facilitating engagement is identified as an essential goal within occupational therapy rehabilitation (AOTA, 2014). Participants generally related a deepened interest and fascination with the mind-body interventions in a way that demonstrated excitement that carried into the standard hand therapy intervention portion of the visit. Furthermore, the individuals who responded exceptionally positively to mind-body interventions found ways to participate in these occupations outside of therapy. While improved engagement in therapy was not an expected outcome for this study, the interwoven relationship of this outcome to the primary themes in this study should be a key construct in further investigations of the use of mind-body interventions in hand therapy.

Limitations

Our findings should be cautiously interpreted due to the preliminary nature of this study, which was meant as a first step in exploring mind-body interventions within hand therapy where no previous evidence exists. The results of our small sample qualitative study with a single exposure to each of the two interventions may not be representative of all hand therapy clients’ experiences, and we may not have reached data saturation within the themes that emerged. Similarly, the finding that every person in this study was interested in at least one of the two interventions may not be true of all hand therapy clients. Selection bias may have skewed our findings in a positive direction, as people who had no interest in mind-body interventions may have opted out of the study. Moreover, results could be skewed due to the context from which the sample was recruited, that is, a clinic in an urban, academic medical center on the west coast. In addition, our study was not designed to investigate and cannot address the relationship of the mind-body interventions on specific, long-term therapy outcomes (e.g., functional recovery).

Implications for research and practice

Despite the limited scope of this study, the overwhelmingly positive feedback following a one-time exposure to two mind-body interventions provides confidence for continued inquiry and development of holistic approaches within hand therapy. The identified themes require further validation using rigorous approaches, potentially through narrative or phenomenological examination from both the client and therapist perspectives. In addition, both qualitative and quantitative evaluations of the use of mindfulness-based meditations and sonographic biofeedback across a full episode of care are indicated. Such studies should examine characteristics that dispose individuals to being receptive to mind-body interventions, to identify best practices for implementation within the demanding clinical context, and to determine how these interventions aid engagement in therapy to improve recovery, health and wellbeing.

Given the current needs of individuals receiving rehabilitation and apparent gaps in evidence combined with healthcare trends toward client-centered care, investigating holistic care within hand therapy is timely. Holistic hand therapy should promote psychosocial adaptation by emphasizing pain or anxiety management, facilitating client-centered goals and interventions, and promoting a supportive collaboration between therapist and client. Using mind-body interventions to provide holistic, client-centered therapy may improve psychosocial outcomes and empower clients to manage their recovery. Through a holistic approach, clinicians can assist clients in reflecting on their hand injury or trauma as a manageable experience, rather than an extraordinary event outside of their control. This reframing provides individuals with health conditions or who have been injured with an opportunity to understand the self, manage coping and support resources, and achieve a higher level of self-awareness and integration with the environment to promote participation and recovery (McColl, 1994).