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Patient Impact of Denied Rehabilitation Following Total Wrist Arthroplasty: A Retrospective Review
Sofia Restrepo, BA
1, Tantien Nguyen, BS
2, Victor T. Hung, M.D.
3, Tien Nguyen, BS
2, Daniel Bailey, M.D.
4, Joseph Cutrone, MD
5; Alfred Vincent Hess, MD
6(1)Morsani College of Medicine, University of South Florida, Tampa, FL, (2)Foundation For Orthopaedic Research and Education, Tampa, FL, (3)Foundation for Orthopaedic Research and Education, Tampa, FL, (4)University of South Florida Health Morsani College of Medicine, Tampa, FL, (5)University of South Florida, Tampa, FL, (6)Orthopedic Surgery/ Hand and Wrist, Florida Orthopaedic Institute, Tampa, FL
Purpose: Little is known about the impact of postoperative occupational rehabilitation after total wrist arthroplasty. Specialized therapy may provide benefits to TWA patients as it is commonly prescribed after other kinds of arthroplasties. The purpose of this study is to investigate the impact of therapy on TWA patients' ROM, complications, and costs associated with the resulting need for additional surgeries.
Methods: We conducted a retrospective review of 37 patients that underwent total wrist arthroplasty. We analyzed demographics, ROM, QuickDASH scores, complications, and treatment costs.
Results: Patients that received specialized occupational therapy had significantly better pronation and supination than patients without therapy. Wrist flexion, radial deviation, ulnar deviation, and grip strength were not significantly different between groups. Those that did not receive occupational therapy had a significantly higher cost of additional surgeries. The two cohorts had no difference in number of complications.
Conclusion: Specialized therapy provides TWA patients with better range of motion and function. Patients without therapy even showed worse ROM outcomes compared to baseline, highlighting the importance of therapy in the postoperative course. Insurance denials represent the biggest obstacle to receiving adequate therapy and care. Our results suggest that patients without therapy experience greater costs, worse outcomes, and thus face greater burdens.
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