QUALITY ASSURANCE

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Roslyn B. Evans, otr/l, cht

Our Staff

 Research Updates

 

Quality assurance

Cover art from  the Journal of Hand Therapy 18:2, 2005. 

edited by Roslyn B. Evans OTR/L, CHT and Terri Skirven, OTR/L, CHT.

     

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The artwork above is the cover art from  the Journal of Hand Therapy 18:2, 2005. 

edited by Roslyn B. Evans OTR/L, CHT and Terri Skirven, OTR/L, CHT.

The special edition on tendon and nerve has 18 papers defining the newest research on tendon and nerve.

The cover art makes the “visual connection between healing at the most basic biologic level in tendon  (cellular manipulation with growth factors and gene therapy) and function at the highest level ( an elite musician whose skill requires exquisite motion, dexterity, and sensibility), and was designed by Roslyn Evans, V. Mehta University of Chicago, and medical artist, Kip Carter, Medical college of Georgia.  From:   Evans RB.  Connecting Art and Science.  How far have we come?  Journal Hand Therapy.  18:2, 71-9, 2005

Our Mission

            Indian River Hand and Upper Extremity Rehabilitation, Inc., in practice since September 1980, is a private, therapist owned practice, which specializes in the delivery of rehabilitative services for patients with upper extremity injury or pathology. The practice provides support to orthopedic and plastic surgeons, rheumatologists, neurologists, and primary care physicians in Indian River, St. Lucie, Martin, Brevard, and Okeechobee counties as well as assistance to hand, elbow and shoulder surgeons from the University of Florida, University of Miami, Mayo Clinic of Jacksonville, Cleveland Clinic of Ft. Lauderdale, and orthopaedic specialists in the Orlando area. The practice receives direct referral from the Hospital of Special Surgery, NYC; Philadelphia Hand Center, Mayo Clinic Rochester other well know hospitals and specialty clinics around the country. Roslyn Evans, OTR/L, CHT has longstanding professional relationships with many hand surgeons at tertiary centers around the USA. These professional relationships developed through publications, teaching at national meetings, and clinical collaborations. 

The primary mission of this specialty practice in hand and upper quadrant therapy is to provide the highest quality of care to this group of patients, and to assist both the patient and surgeon or physician in obtaining the best possible functional result in the shortest time span possible. Saving time lost from work and minimizing expense associated with poor clinical results is important to employers, carriers, and to the patients. Rehabilitation services include wound care (simple and complex), custom splint fabrication (termed orthotics) or fracture bracing (dynamic and static), management of complex acute injuries and post-surgical cases including all tissues…skin, vessel, nerve, tendon, ligament, muscle, joint, and bone. Manual exercise and joint mobilization techniques are utilized at the appropriate time during healing to regain function for the musculoskeletal system. As the tissues have stabilized and developed tensile strength, work hardening, up-graded resistive exercise, and ergonomic counseling are instituted in preparation for return to work, and other daily functions. Patients receive direct one-on-one manual care from 5 skilled Occupational Therapists (all Certified Hand Therapists) and 1 Physical Therapist who is also a Certified Hand Therapist (CHT).

The secondary mission of this clinic is educational.   Clinical research (flexor tendon rehabilitation, extensor tendon rehabilitation, inflammatory disorders, carpal tunnel, Dupuytren’s disease, work related cumulative trauma disorders, and wound healing to date) is ongoing. Research is disseminated through publication in peer-reviewed professional journals, and through post-graduate level teaching at the state, national, and international level. Indian River Hand Rehabilitation serves as a resource for professionals and insurance adjustors who have questions regarding updated rehabilitation techniques and referral sources for local, state, national and international levels. Educational information is distributed upon request free of charge. PUBLICATIONS BY ROSLYN B. EVANS, OTR/L, CHT ARE LISTED IN THE ATTACHED CIRRICULUM VITA, and most current listed again below.

Clinical Excellence

Indian River Hand and Upper Extremity Rehabilitation is well known on a national and international level for clinical and research excellence. The clinic, specializing in complex injuries, treats a fairly heavy caseload each day. Local surgeons and nurse case managers are comfortable with the level of expertise afforded their patients, and will refer the patients within 24 hours post-operative in most cases for wound management, custom splinting (orthotics), treatment planning, and controlled exercise. Each case is treated individually with the most advanced scientific standards and not, as with many clinics, according to general protocols. The clinic atmosphere is dynamic, efficient, with focus on return to work as soon as healing tissues are stabilized.

Research performed in this clinic is published in Journal of Hand Surgery, Techniques in Hand and Upper Extremity Surgery, Journal of Hand Therapy, Hand Clinics, The Year Book of Hand Surgery, Journal of Physical Therapy, , and chapters in 8 textbooks on the management of upper extremity disorders. The owner and director, Roslyn B. Evans, OTR/L, CHT has 58 peer-reviewed publications. She has been the invited editor for the Journal of Hand Therapy for the first special edition in 1989 (April-June 2:2 1989) with focus on tendon management, and again for a special edition on tendon and nerve injury ( April-June 2005 18:2) for the Journal of Hand Therapy…soliciting and editing 22 articles on these subjects from national and international experts in the field, along with a scientific article on zone I flexor tendon research and editorial.
Most current publications (others listed in curriculum vitae):

Evans, RB.  Managing the Injured Tendon:  Current Concepts. Journal of Hand Therapy.  2012;25:173-90. Invited paper for  special edition on Basic Science JHT.

Evans, RB.  Therapist’s Management of Carpal Tunnel Syndrome:  A Practical Approach. In Skirven TM, Osterman AL, Fedorczyk, Amadio PC, eds.  Rehabilitation of the Hand and Upper Extremity. ed 6.  Elsevier (Mosby),  2011,  pp 666-677.

Evans, RB.  Therapeutic Management of Dupuytren’s Contracture. In Skirven TM, Osterman AL, Fedorczyk, Amadio PC, eds.  Rehabilitation of the Hand and Upper Extremity. ed 6.  Elsevier (Mosby),  2011,  pp 281-288.

Von Der Heyde RL,  Evans RB.  Wound classification and Management. In Skirven TM, Osterman AL, Fedorczyk, Amadio PC, eds.  Rehabilitation of the Hand and Upper Extremity. ed 6.  Elsevier (Mosby),  2011, pp 219-232.

Evans RB.   Clinical management of extensor tendon injuries:  the therapists perspective.  In Skirven TM, Osterman AL, Fedorczyk, Amadio PC, eds.  Rehabilitation of the Hand and Upper Extremity. ed 6.  Elsevier (Mosby),  2011, pp 521-554.

Elliot D. Barieri CH, Evans RB, Mass D, Tang JB.  IFSSH Flexor Tendon Committee Report 2007.  J Hand Surg Eur Vol, 2007 Jun;32(3):346-56.  Evans, RB.  Flexor Tendon Rehabilitation Update Other Than Zone II.   Invited editorial review by the International Federation for Societies for Surgery of the Hand Committee on Flexor Tendons. 

Evans RB.  Connecting Art and Science:  How Far Have We Come?  (editorial)  J Hand Ther 18:2, 71-79.  2005.

Evans RB.  Zone I flexor tendon rehabilitation with limited excursion and active tension technique.  J Hand Ther 18:2, 128-140.  2005.

Professional Development  

All therapists maintain their Florida state license and national certifications with the American Occupational Therapy Association (AOTA), American Physical Therapy Association (APTA); and the Hand Therapy Certification Commission. We hold memberships in AOTA, APTA, the American Society of Hand Therapists (ASHT), and Mrs. Evans is an associate member of the American Society for Surgery of the Hand (ASSH); also the Florida Occupational Therapy Association, Florida Hand Society. Education includes CPR bi-annual recertification courses.

Patient Focus

The primary focus of the practice is the patient, and proper management of each case. Each patient is initially evaluated with respect to all tissues and systems of the upper extremity regardless of the primary diagnosis listed on the physician referral. Many patients are referred to this clinic for evaluation and for help with establishing the clinical diagnosis. Diagnosis is based on physician evaluation, history, and clinical examination by the senior therapist, Roslyn Evans OTRL/CHT and other certified therapists. Electronic Medical records are completed as the patient is evaluated and treated and faxed to the physician, nurse case manager, and insurance company as required immediately following treatment. Conversations with the physician take place the day of referral if questions exist or to get approval for therapy management techniques. Frequency of visits and treatment planning are determined by the state of healing issues and the patient’s ability to follow a home program effectively. Evaluation is ongoing. Each visit includes an evaluation of improvement and assessment of the treatment plan so that procedures for wound care, splinting, and exercise can be altered as the patient progresses. The therapists are alert to changes, which suggest the development of infection, inflammation, poor compliance with home program, or the existence of undefined problems, which may interfere with progress. The physician is notified of any changes, and treatments are altered accordingly. Social issues which affect progress (lack of transportation, patient inability to follow instruction, patient non-compliance, or problems at home) are addressed as much as possible. Standards for the Physical Plant meet county, state and federal requirements; the clinic is Medicare certified.

Medical Records 

 Medical records are always current and confidential An Electronic Medical Record system, CEDERON/APTA CONNECT, approved by Medicare, the American Society of Hand Therapists, the American Occupational Therapy Association, and the American Physical Therapy Association has been in place since 2010. Data input is recorded by the treating therapist at the time of treatment and faxed or sent electronically to the MD, and/or carrier immediately following evaluation or treatment. Records meet Medicare standards and are current to the day of treatment. Patient records are compliant with the Health Insurance Portability and Accountability Act (HIPPA) and are kept 7 years as required by law.

 

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