I, too, use the thimble on my middle finger and I use a rubber finger tip (like used to count money/paper from the office supply store) on my index finger. Sometimes I need needle nosed pliers to help pull the needle through the fabric but not too often. Generally I use a hoop but not always...depends on the size of the project.
Many hand quilters speak of the 'rocking' of the needle to get a good rhythm going. I tend to 'rock' the fabric vs the needle. Works better for me.