Predictors of Hand Therapy Non-Compliance Following Flexor Tendon Repair: A Retrospective Cohort Study
Matthew Tomas McLaughlin, BS1; Allison Seitz, BS2; Edalatpour Armin, MD3; Brett F Michelotti, MD2
1University of Wisconsin School of Medicine and Public Health, Madison, WI; 2University of Wisconsin Hospitals and Clinics, Madison, WI; 3University of Wisconsin, Wauwatosa, WI
Introduction: Following surgical repair of injuries to the flexor tendons, hand therapist-directed early mobilization of the affected digits promotes faster tendon healing, improves post-recovery range of motion, and helps prevent secondary tendon ruptures. Despite the demonstrated importance, many patients are non-compliant with postoperative hand therapy protocols, and the patient factors that predict compliance are unknown. This study aims to assess the factors that influence patient adherence to hand therapy following flexor tendon repair surgery.
Materials and Methods: In this retrospective cohort study, we reviewed electronic health records of consecutive patients (N=153) over a 5-year period who underwent acute flexor tendon repair surgery at a tertiary care medical center. Patients were stratified by insurance coverage (no insurance, Medicaid, Medicare, private, or workmen’s compensation) and other demographic variables. Outcomes included no-shows to occupational therapy (OT) appointments, duration of OT follow-up, and postoperative emergency department visits.
Results: Patient factors significantly associated with no-shows to OT appointments were having no insurance (p=0.026) or Medicaid coverage (p=0.001), Black or African American race (p=0.014), and current tobacco use (p=0.047). Uninsured patients attended 73.84% of their OT visits and those with Medicaid attended 71.95% of their OT visits, which were significantly lower rates than 90.73% attendance observed in patients with private insurance (p=0.026 and p=0.001, respectively). Patients with Medicaid were 8 times more likely to no-show to an OT visit or to postoperatively visit the emergency department than patients with private insurance (p=0.001 and p=0.002, respectively). Patients with no insurance or Medicaid averaged 3.67 and 8.86 total OT visits, respectively, which was significantly less than patients with workmen’s compensation coverage who averaged 22.79 visits (p<0.001 and p=0.007, respectively).
Conclusions: We identified statistically significant disparities in attendance to hand therapy appointments following flexor tendon repair surgery. This observed non-compliance to OT may lead to worse surgical outcomes and patient morbidity. These data can assist hospitals, providers, and social workers identify at-risk patients and aid in the development of strategies to increase OT utilization.
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