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First Letter Regarding “Traditional Versus Digital Media–Based Hand Therapy After Distal Radius Fracture”

Published:November 12, 2021DOI:https://doi.org/10.1016/j.jhsa.2021.09.025
      To the Editor:
      I read with interest the article titled “Traditional versus digital media–based hand therapy after distal radius fracture.”
      • Lara T.R.
      • Kagan R.P.
      • Hiratzka S.L.
      • Thompson A.R.
      • Nazir O.F.
      • Mirarchi A.J.
      Traditional versus digital media based hand therapy after distal radius fracture.
      Novel care delivery models are a timely topic in the context of value-based health care, and I appreciate the opportunity for a pertinent dialogue.
      Although I understand the authors’ motivation to standardize care, given the trial’s design, the benefits of supervised rehabilitation were likely delimited in this study by the degree of protocol standardization. One potential advantage of supervised rehabilitation over a digital application is personalized clinical reasoning based on patients’ healing tissues, psychosocial factors, functional needs, etc. Consistent with precision medicine, future care delivery designs should accommodate the complexities of treatment individualization.
      Beyond this specific study, group-level comparisons of the outcomes of care delivery models, without attention to subgroups, overlook contextual variations in individual patient needs. I echo recommendations for prognostic classification for value-based distal radius fracture rehabilitation and encourage that prognostication includes a biopsychosocial perspective.
      American Academy of Orthopaedic Surgeons
      Management of Distal Radius Fractures: Evidence-Based Clinical Practice Guideline. 2020.
      ,
      • Jayakumar P.
      • Teunis T.
      • Vranceanu A.M.
      • Lamb S.
      • Ring D.
      • Gwilym S.
      Early psychological and social factors explain the recovery trajectory after distal radial fracture.
      Future research should emphasize targeting the right care to the right individual, limiting both the overuse and underuse of supervised rehabilitation.
      Finally, the future of value in health care includes integrated practice, relative to care delivery models, outcome and cost measurements, and payment structures. Hand surgeons and therapists take pride in their synergistic clinical relationships. However, the apparent lack of hand therapist authors in this study and other studies focusing on rehabilitation highlights the gaps in professional integration in the context of research.
      • Shah R.F.
      • Zhang S.
      • Li K.
      • Baker L.
      • Sox-Harris A.
      • Kamal R.N.
      Physical and occupational therapy use and cost after common hand procedures.
      ,
      • Johnson S.P.
      • Kelley B.P.
      • Waljee J.F.
      • Chung K.C.
      Effect of time to hand therapy following zone II flexor tendon repair.
      Hand therapists bring unique expertise and are integral members of upper extremity research teams, from design to dissemination. Particularly when the research focuses on rehabilitation, the involvement of hand therapists should be expected by funders, and peer review of such grants and manuscripts should include the therapists’ perspective. Strengthening professional integration within research is necessary for meaningful innovation to optimize value in hand and upper extremity care.

      References

        • Lara T.R.
        • Kagan R.P.
        • Hiratzka S.L.
        • Thompson A.R.
        • Nazir O.F.
        • Mirarchi A.J.
        Traditional versus digital media based hand therapy after distal radius fracture.
        J Hand Surg Am. 2022; 47: 291.e1-291.e8
        • American Academy of Orthopaedic Surgeons
        Management of Distal Radius Fractures: Evidence-Based Clinical Practice Guideline. 2020.
        (Accessed August 10, 2021)
        • Jayakumar P.
        • Teunis T.
        • Vranceanu A.M.
        • Lamb S.
        • Ring D.
        • Gwilym S.
        Early psychological and social factors explain the recovery trajectory after distal radial fracture.
        J Bone Joint Surg Am. 2020; 102: 788-795
        • Shah R.F.
        • Zhang S.
        • Li K.
        • Baker L.
        • Sox-Harris A.
        • Kamal R.N.
        Physical and occupational therapy use and cost after common hand procedures.
        J Hand Surg Am. 2020; 45: 289-297
        • Johnson S.P.
        • Kelley B.P.
        • Waljee J.F.
        • Chung K.C.
        Effect of time to hand therapy following zone II flexor tendon repair.
        Plast Reconstr Surg Glob Open. 2020; 8: e3278

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