Purpose
The use of routine physical therapy (PT) and occupational therapy (OT) after certain
hand procedures, such as carpal tunnel release, remains controversial. The objective
of this study was to evaluate baseline use, the change in use, variation in prescribing
patterns by region, and costs for PT/OT after common hand procedures.
Methods
Outpatient administrative claims data from patients who underwent procedures for carpal
tunnel syndrome, trigger finger, carpometacarpal arthritis, de Quervain tenosynovitis,
wrist ganglion cyst, and distal radius fracture were abstracted from the Truven Health
MarketScan database from 2007 to 2015. The incidence of therapy and total reimbursement
of therapy per patient were collected for each procedure over a 90-day postoperative
observational period. Trends in use of therapy over time were described with average
compound annual growth rates (CAGRs), a way of quantifying average growth over a specified
observation period. Variations in the incidence of PT/OT use across 4 census regions
were assessed.
Results
The incidence of 90-day utilization of PT and OT after hand procedures was 14.0% and
increased for all procedures during the observation period with an average CAGR of
8.3%. Cost per therapy visit was relatively stable when adjusted for inflation, with
an average CAGR of 0.63%. Patients in the northeast had a significantly higher incidence
of PT/OT use than those in the south and west for all procedures except carpometacarpal
arthritis.
Conclusions
Use of PT and OT has increased over time after common hand procedures. Geographical
variation in the utilization rate of these services is substantial. Limiting unwarranted
variation of care is a health policy strategy for increasing value of care.
Type of study/level of evidence
Outcomes Research II.
Key words
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Article info
Publication history
Published online: November 19, 2019
Accepted:
September 30,
2019
Received:
August 28,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
