Back to 2026 Abstracts
Travel Burden to Certified Hand Therapists: A Geospatial Analysis and Composite CHT Demand Index Incorporating Social Vulnerability
Pooja Dhupati, MPH
1, Shaw Yang Hu, BS
2, Olachi Oleru, MD
3, Sunny H Vansdadia, BS
1, Krishna Unadkat, MS
4; Shelley S. Noland, MD
3(1)University of Arizona College of Medicine Phoenix, Phoenix, AZ, (2)George Washington University, Washington DC, DC, (3)Mayo Clinic, Phoenix, AZ, (4)Mayo Clinic Alix School of Medicine, Scottsdale, AZ
Background
Access to Certified Hand Therapists (CHTs) is critical to recovery following hand surgery. The intersection of social vulnerability and spatial proximity to CHT services has not been systematically evaluated. This study aimed to characterize national travel burden to CHTs by developing a county-level composite demand index incorporating population size, social vulnerability, and CHT availability.
Methods
This national, county-level geospatial study evaluated access to CHTs across the contiguous United States. CHT locations were geocoded from the American Society of Hand Therapists directory and linked to county centroid coordinates to calculate distance to the nearest CHT provider. County-level population estimates and Social Vulnerability Index (SVI) data were obtained from the CDC/ATSDR 2022 SVI database. Broadband internet access data were sourced from the U.S. Census Bureau's American Community Survey.
A Composite CHT Demand Index (CCDI) was developed to estimate adjusted need. For each county, the population size, SVI score, and distance to the nearest CHT were normalized using quantile binning (scaled 1-10). These values were summed and divided by (1 + number of CHTs within 25 miles) to account for local provider availability. Final scores were rescaled from 0 to 100 to improve interpretability. Counties were ranked and visualized using choropleth mapping. Associations between distance and social determinants were assessed using Spearman's rank correlation.
Results
Counties in the West and South demonstrated the greatest geographic isolation, with a median distance of 45.7 miles to the nearest CHT compared to 14.6 miles in the Northeast. Longer distance to care was significantly associated with higher poverty (? = 0.27), lower broadband access (? = 0.41), and greater social vulnerability (? = 0.33; all p < 0.001). CCDI rankings identified high-need counties including Webb and Ector (TX), San Bernardino (CA), and Richmond (GA), characterized by large populations, high SVI scores, and limited therapist availability. The top decile of demand scores included counties in Texas, Georgia, Arizona, and rural California. Even in counties >60 miles from the nearest CHT, an average of 75.6% of households had broadband access, underscoring the potential for telehealth expansion.
Conclusions
This study demonstrates that spatial disparities in CHT access are compounded by underlying social vulnerabilities. A composite CHT demand index incorporating geographic, sociodemographic, and provider availability data identifies high-burden regions underserved by current CHT distribution. These findings may inform interventions aimed at expanding equitable access to rehabilitative care, and highlight opportunities for telehealth to bridge geographic barriers in high-need regions.
Back to 2026 Abstracts
