Insurance Status Predicts Hand Therapy Adherence following Flexor Tendon Repair: A Retrospective Cohort Study.

Abstract

Many patients are not adherent to hand therapy rehabilitation following surgical repair of traumatic flexor tendon injuries, which can negatively affect surgical outcomes and long-term hand function. The authors aimed to identify the factors that predict patient nonadherence to hand therapy following flexor tendon repair surgery. This retrospective cohort study included 154 patients who underwent surgical repair of flexor tendon injuries at a level I trauma center between January of 2015 and January of 2020. A manual chart review was performed to collect demographic data, insurance status, injury characteristics, and details of the postoperative course, including health care use. Factors significantly associated with occupational therapy no-shows included Medicaid insurance (OR, 8.35; 95% CI, 2.91 to 24.0; P < 0.001), self-identified Black race (OR, 7.28; 95% CI, 1.78 to 29.7; P = 0.006), and current cigarette smoker status (OR, 2.69; 95% CI, 1.18 to 6.15; P = 0.019). Patients without insurance attended 73.8% of their occupational therapy visits, and patients with Medicaid attended 72.0% of their visits, rates significantly lower than the rate of those with private insurance (90.7%; P = 0.026 and P = 0.001, respectively). Patients with Medicaid were eight times more likely to seek emergency department care postoperatively than patients with private insurance ( P = 0.002). Significant disparities in hand therapy adherence following flexor tendon repair surgery exist between patients with different insurance statuses, races, and tobacco use. Understanding these disparities can help providers identify at-risk patients to improve hand therapy use and postoperative outcomes. Risk, II.