Purpose
To examine the influence of social deprivation and hand therapy attendance on active
range of motion (AROM) outcomes following flexor tendon repair.
Methods
We performed a retrospective analysis of patients who underwent primary zone I–III
flexor tendon repair between November 2016 and November 2020. Area deprivation index
(ADI) was used to quantify social deprivation. Medical record review determined each
patient’s demographic characteristics, injury details, total hand therapy visits,
and final AROM outcome. Active range of motion was converted to Strickland’s percentage
for analysis. Spearman correlation and simple and multivariable linear regression
models were used to assess relationships between explanatory variables and outcomes.
Results
There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance
of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was
associated with significantly decreased Strickland’s percentage. In the multivariable
model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations
with Strickland’s percentage.
Conclusions
Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after
flexor tendon repair. Social deprivation is likely to contribute to poor outcomes
both by its association with decreased therapy attendance and by other potential pathways
that make it difficult for deprived patients to achieve good surgical outcomes.
Type of study/level of evidence
Prognostic IV.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Improving results of flexor tendon repair and rehabilitation.Plast Reconstr Surg. 2014; 134: 913e-925e
- Flexor tendon repair postoperative rehabilitation: the Saint John protocol.Plast Reconstr Surg Glob Open. 2016; 4: e1134
- The Manchester short splint: a change to splinting practice in the rehabilitation of zone II flexor tendon repairs.Hand Ther. 2014; 19: 47-53
- Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3.J Hand Surg Eur Vol. 2016; 41: 793-801
- Functional outcome of the hand following flexor tendon repair at the ‘no man’s land’.J Orthop Surg (Hong Kong). 2006; 14: 178-183
- A study to examine patient adherence to wearing 24-hour forearm thermoplastic splints after tendon repairs.J Hand Ther. 2008; 21 (quiz 53): 44-52
- Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands.J Hand Ther. 2019; 32: 328-333
- Outcomes of flexor tendon repairs in zone 2 subzones with early active mobilization.J Hand Surg Eur Vol. 2017; 42: 896-902
- Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years.J Hand Surg Eur Vol. 2020; 45: 56-63
- Early active mobilisation following flexor tendon repair in zone 2.J Hand Surg Br. 1989; 14: 383-391
- Improving outcomes in tendon repair: a critical look at the evidence for flexor tendon repair and rehabilitation.Plast Reconstr Surg. 2016; 138: 1045e-1058e
- Tendon rehabilitation: factors affecting outcomes and current concepts.Curr Orthop Pract. 2018; 29: 100-104
- The influence of insurance status on access to and utilization of a tertiary hand surgery referral center.J Bone Joint Surg Am. 2012; 94: 2177-2184
- Social deprivation and hand injury.J Hand Surg Eur Vol. 2007; 32: 256-261
- Socioeconomic impact of gunshot wounds in an urban pediatric population.J Pediatr Surg. 1994; 29: 39-43
- Adherence to therapy after flexor tendon surgery at a level 1 trauma center.Hand (NY). 2014; 9: 175-178
- Racial and socioeconomic disparities in hip fracture care.J Bone Joint Surg Am. 2016; 98: 858-865
- Mental and physical health disparities in patients with carpal tunnel syndrome living with high levels of social deprivation.J Hand Surg Am. 2019; 44: 335.e1-335.e9
- Area deprivation and widening inequalities in US mortality, 1969-1998.Am J Public Health. 2003; 93: 1137-1143
- Patient characteristics, treatment, and presenting PROMIS scores associated with number of office visits for traumatic hand and wrist conditions.Clin Orthop Relat Res. 2019; 477: 2345-2355
- CORR Insights®: what is the impact of social deprivation on physical and mental health in orthopaedic patients?.Clin Orthop Relat Res. 2019; 477: 1836-1838
- The impact of social deprivation on pediatric PROMIS health scores after upper extremity fracture.J Hand Surg Am. 2018; 43: 897-902
- What is the impact of social deprivation on physical and mental health in orthopaedic patients?.Clin Orthop Relat Res. 2019; 477: 1825-1835
- Predictors of time lost from work following a distal radius fracture.J Occup Rehabil. 2007; 17: 47-62
- Predictors of functional outcomes after surgical treatment of distal radius fractures.J Hand Surg Am. 2007; 32: 76-83
- The association of education level on outcome after distal radius fracture.Hand (N Y). 2014; 9: 75-79
- Epidemiology of distal radius fractures and factors predicting risk and prognosis.J Hand Ther. 2016; 29: 136-145
- Socio-economic status and the risk of developing hand, hip or knee osteoarthritis: a region-wide ecological study.Osteoarthritis Cartilage. 2015; 23: 1323-1329
- Association between socioeconomic status and comorbidities among patients with rheumatoid arthritis: results of a nationwide cross-sectional survey.Rheumatology (Oxford). 2019; 58: 1617-1622
- Socioeconomic deprivation and the epidemiology of carpal tunnel syndrome.J Hand Surg Eur. 2012; 37: 123-129
- Does digital nerve injury affect range of motion recovery after zone 2 flexor tendon repair?.Hand (N Y). 2021; 15589447211003187
- University of Wisconsin School of Medicine and Public Health, 2015. Area Deprivation Index V2.0.http://www.neighborhoodatlas.medicine.wisc.edu/Date accessed: March 2, 2020
- Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques.J Hand Surg Am. 1980; 5: 537-543
- Utility of early active motion for flexor tendon repair with concomitant injuries: a multivariate analysis.Injury. 2018; 49: 2248-2251
- Assessment of joint range of motion.in: Early M.B. Physical Dysfunction Practice Skills for the Occupational Therapy Assistant. Mosby, Inc, 2013: 113-130
- A-priori sample size calculator for multiple regression.https://www.danielsoper.com/statcalc/calculator.aspx?id=1Date accessed: January 3, 2021
- Statistical Power Analysis for the Behavioral Science.2nd ed. Lawrence Erlbaum Associates, 1988
- Social deprivation influences the epidemiology and outcome of proximal humeral fractures in adults for a defined urban population of Scotland.Eur J Orthop Surg Traumatol. 2014; 24: 1039-1046
- Predictors of moderate or severe pain 6 months after orthopaedic injury: a prospective cohort study.J Orthop Trauma. 2009; 23: 139-144
- Socioeconomic deprivation predicts outcome following radial head and neck fractures.Injury. 2012; 43: 1102-1106
- Flexor tendon injuries.Hand Clin. 2005; 21: xi-xii
- Flexor tendon rehabilitation in the 21st century: a systematic review.J Hand Ther. 2019; 32: 165-174
- The impact of flexor tendon rehabilitation restrictions on individuals’ independence with daily activities: implications for hand therapists.J Hand Ther. 2013; 26: 22-28
- Rehabilitation after flexor tendon repair, reconstruction, and tenolysis.Hand Clin. 2005; 21: 257-265
- Health literacy in hand surgery patients: a cross-sectional survey.J Hand Surg Am. 2015; 40: 798-804.e2
- Readability of patient education materials in hand surgery and health literacy best practices for improvement.J Hand Surg Am. 2016; 41: 825-832
- The role of socioeconomic status and control beliefs on frequency of exercise during and after cardiac rehabilitation.Appl Psychol Health Well Being. 2012; 4: 49-66
Article info
Publication history
Published online: May 24, 2022
Accepted:
March 23,
2022
Received:
November 16,
2020
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
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
