Contribution of patient–advisors during rehabilitation for replantation of digits improves patient-reported functional outcomes: A presentation of concept

Abstract

Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of “patient–advisors”. Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient–reported outcomes in individuals enrolled in a Patient–Advisor Program (PAP). We performed a prospective cohort pilot study of all patients admitted for a finger replantation between July 2015 to January 2016. All patients were offered to partake in the PAP, or else they would constitute the control group. Primary endpoints were functional outcomes as reported by patients at 6–8weeks and 4–6months of follow-up. Secondary endpoints were patient-reported pain and quality of life questionnaires. In total, 62 patients were admitted for finger replantation in the studied period, in which 50 agreed to participate in the study, including 7 in the patient–advisors group and 43 in the control group. Patients from the patient–advisors group fared better on mean scores of the Disabilities of the Arm, Shoulder and Hand than controls (29.6 vs 34.8 respectively at 4–6months). Improvements in the McGill Pain Questionnaire were also greater in the studied group (19.9 vs 33.3 at 4–6months). Replantation patients benefiting from the PAP demonstrated superior functional outcomes on self-reported questionnaires, which could be explained by a better understanding of rehabilitation protocols and compliance when previous patients are active members of the treating team.