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

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Clinical Question/level Of Evidence: Risk, II.