Hand therapy utilization following digital flexor tendon repair: Trends, timing, predictive factors, and association with reoperation

Background: Physical rehabilitation is considered an important component of recovery following digital flexor tendon repair (FTR), but no studies have thoroughly characterized nationwide therapy utilization in the United States.

Purpose: The current study characterized national trends in the timing and amount of hand therapy utilization following FTR and assessed factors associated with the lack of postoperative hand therapy.

Study design: Retrospective cohort study.

Methods: Zone II FTRs between 2010 and 2020 were identified in PearlDiver. Exclusion criteria included age <18 years, concomitant procedures besides nerve repair, and follow-up in the database of <6 months. The occurrence, timing, and frequency of hand therapy within 6 months of surgery were identified. Odds of not receiving hand therapy were assessed based on clinical and nonclinical characteristics using logistic regression.

Results: Of 6700 FTRs identified, hand therapy was identified for 3319 (50%). The proportion of patients utilizing therapy increased from 2010 to 2020 (44%-56%, p < 0.001). Weekly therapy utilization peaked in postoperative week 4 (41% of all patients attended hand therapy). Lack of hand therapy utilization was associated with several clinical factors (male sex, lower Elixhauser Comorbidity Index score, decreasing number of repairs) and nonclinical factors (geographic region, Medicare insurance).

Conclusions: Despite the reported importance of hand therapy following digital FTR, it may be underutilized in the United States. Patient factors associated with not using hand therapy suggest that more uniform clinical practice should be sought.