Hand Therapy After Flexor and Extensor Tendon Repair: A Retrospective Study Assessing Predictors of Loss to Follow-Up
Desmond J Bennett, MD, UMass Medical School, Worcester, MA, Jugert Bango, MD, University of Massachusetts Medical School, Worcester, MA and Douglas M. Rothkopf, MD, Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA
Background: Postoperative hand therapy is important for regaining function and preventing complications in patients undergoing tendon repair of the hand and wrist. However, loss to follow-up (LTFU) can hinder this process. A review on rehabilitation regimens following extensor tendon repairs found that LTFU across five studies occurred 19-33% of the time. In this study, we sought to determine the rate of LTFU for flexor and extensor repairs, as well as factors that predict attrition of plastic surgery hand patients.
Methods: Charts were retrospectively reviewed for patients who underwent extensor or flexor tendon repair of the hand, wrist, or forearm between 2014-2019. Data including age, sex, zip code, employment status, education level, insurance type and past psychiatric history were collected. Income was calculated using a surrogate income based on patient zip code. Hand therapy notes were evaluated, and the rate of loss to follow-up was calculated. Logistic regression was used to analyze factors.
Results: A total of 149 patients were identified and analyzed. The rate of loss to follow-up was 42%. Factors that predicted loss were younger age, male gender, lower educational degree, and a documented psychiatric history. Employment status, income, insurance type, and distance from the hand therapy center did not predict attrition. The number of hand therapy weeks recommended by the occupational therapist did not differ between those who were lost and those who were not. On average, lost patients completed 53% of their suggested hand therapy course. This corresponded to completing 5.1 out of the suggested 9.7 weeks.
Conclusions: The current study identified demographic factors associated with attrition in patients undergoing tendon repairs of the distal upper extremity. Factors included patients that were younger, male, less educated, and had a documented psychiatric history. By identifying factors that predict LTFU, specific strategies can be developed to reduce attrition rates, particularly for at-risk populations. Increased education on the benefits of hand therapy, as well as frequent appointment reminders might be worthwhile approaches. Further, coordinated care between all caregivers could help to reduce attrition rates and ultimately improve patient care following tendon repair.
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