1
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Van Boxtel ME, Jauregui I, Valiquette A, Sullivan C, Graf A, Hanley J. The Effect of Social Deprivation on Hospital Utilization Following Distal Radius Fracture Treatment. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:333-337. [PMID: 38817768 PMCID: PMC11133802 DOI: 10.1016/j.jhsg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Purpose Social determinants of health disparities have been shown to adversely impact outcomes following distal radius fracture (DRF) treatment. Identifying risk factors for increased hospital use following DRF has been historically difficult; however, it is of utmost concern to orthopedic surgeons to improve outcomes and decrease the total cost of care. The effect of social deprivation following DRF has yet to be fully investigated. Methods This is a retrospective cohort analysis of a single institution's experience in treating DRF with either an operative or nonsurgical modality between 2005 and 2020. Patient demographic information and health care utilization (hospital readmission, emergency department [ED] visitation, office visits, and telephone use) were collected from within 90 days of treatment. Area Deprivation Index (ADI) national percentiles were recorded. Patients were stratified into terciles based on their relative level of deprivation, and their outcomes were compared. Secondary analyses included stratifying patients based on treatment modality, race, and legal sex. Results In total, 2,149 patients were included. The least, intermediate, and most deprived groups consisted of 552, 1,067, and 530 patients, respectively. Risk factors for hospital readmission included higher levels of relative deprivation. Identifying as Black or African American and nonsurgical management were risk factors for increased ED visitation. No differences in rate of hospital readmission, ED visitation, office visitation, or telephone use were seen based on deprivation level. Conclusions High levels of social deprivation, treatment modality, race, and legal sex disparities may influence the amount of hospital resource utilization following DRF treatment. Understanding and identifying risk factors for greater resource utilization can help to mitigate inappropriate use and decrease health care costs. We hope to use these findings to guide clinical decision making, educate patient populations, and optimize outcomes following DRF treatment. Type of Study/Level of Evidence Therapeutic III.
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Affiliation(s)
| | - Isaias Jauregui
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew Valiquette
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Connor Sullivan
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Alexander Graf
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jessica Hanley
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
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2
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Fulceri F, Marinelli C, Ghelarducci G, Nucci AM, Poggetti A, Ryskalin L, Gesi M. Early post-surgical rehabilitation and functional outcomes of a traumatic ulnar nerve injury: a pediatric case report. Front Neurol 2024; 15:1351407. [PMID: 38385043 PMCID: PMC10879349 DOI: 10.3389/fneur.2024.1351407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Background Peripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery. Case presentation The patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon's canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living. Conclusion A timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb.
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Affiliation(s)
- Federica Fulceri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Marinelli
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | - Giulia Ghelarducci
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | - Anna Maria Nucci
- Department of Pediatric Orthopedics and Traumatology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy
| | - Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
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3
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Vaksvik T, Støme LN, Føllesdal J, Tvedte KA, Melum L, Wilhelmsen CR, Kværner KJ. Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness. J Hand Ther 2024; 37:3-11. [PMID: 37778875 DOI: 10.1016/j.jht.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Video consultation was implemented as a new service in a hospital hand therapy setting. PURPOSE To describe the first year's practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. STUDY DESIGN Iterative design including economic evaluation. METHODS Using the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients' municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. RESULTS Of 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. CONCLUSIONS The results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.
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Affiliation(s)
- Tone Vaksvik
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | | | - Jorunn Føllesdal
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Linn Melum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kari J Kværner
- Centre for Connected Care (C3), Oslo University Hospital, Oslo, Norway; BI Norwegian Business School, Oslo, Norway
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4
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Toci GR, Green A, Mubin N, Imbergamo C, Sirch F, Varghese B, Aita D, Fletcher D, Katt BM. Patient Adherence With At-Home Hand and Wrist Exercises: A Randomized Controlled Trial of Video Versus Handout Format. Hand (N Y) 2023; 18:680-685. [PMID: 34697956 PMCID: PMC10233647 DOI: 10.1177/15589447211052750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient adherence is important for maximizing patient outcomes. The purpose of this randomized controlled trial was to determine patient adherence and confidence in home therapy exercises of the hand and wrist at multiple time points when distributed by either paper handout or video. METHODS Patients were prospectively enrolled and randomized in orthopedic clinics to either the handout or video exercise group. Exclusion criteria included patients less than 18 years old. Questionnaires were electronically distributed each week for 4 weeks following enrollment. Questionnaires assessed the frequency of exercise performance, percentage of exercises utilized, and confidence in performing the exercises correctly. The handout and video groups were compared via 2-sample t tests for continuous data and χ2 tests for categorical data. RESULTS Of the 89 patients enrolled, 71 patients responded to the initial follow-up survey (80% of randomized patients), and 54 of these patients (76%) completed all surveys at each time point. The handout group (37 patients) and the video group (34 patients) had no differences in response rate or demographics. There were no differences in frequency, exercise utilization rate, or confidence in performing exercises between groups at week 1. However, the video group reported higher exercise utilization and confidence than the handout group at subsequent time points. CONCLUSIONS Video-format distribution of home therapy exercises is superior to that of paper handout distribution for the distal upper extremity rehabilitation. Patients in the video group utilized more exercises and had higher confidence in completing them correctly following initiation of the exercise program.
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Affiliation(s)
- Gregory R. Toci
- Rothman Orthopaedic Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Anna Green
- Rutgers Robert Wood Johnson Medical
School, New Brunswick, NJ, USA
| | - Nailah Mubin
- Nassau University Medical Center, East
Meadow, NY, USA
| | - Casey Imbergamo
- Rutgers Robert Wood Johnson Medical
School, New Brunswick, NJ, USA
| | - Francis Sirch
- Rothman Orthopaedic Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Bobby Varghese
- Rutgers Robert Wood Johnson Medical
School, New Brunswick, NJ, USA
| | - Daren Aita
- Rothman Orthopaedic Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Daniel Fletcher
- Rothman Orthopaedic Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Brian M. Katt
- Rutgers Robert Wood Johnson Medical
School, New Brunswick, NJ, USA
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5
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Cahill G, Wang AA, Lee K, Sakagami M, Welling DB, Stankovic KM. Association of Stapedotomy Volume and Patient Sex With Better Outcome. JAMA Otolaryngol Head Neck Surg 2022; 148:985-986. [PMID: 35925579 PMCID: PMC9353699 DOI: 10.1001/jamaoto.2022.2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gabrielle Cahill
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston.,Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, La Jolla
| | - Annette A Wang
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston
| | - Kyungmi Lee
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge
| | - Masaharu Sakagami
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston
| | - Konstantina M Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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6
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Metz AK, Hart-Johnson T, Blackwood RA, Crawford EA. Sociodemographic Factors Associated With Decreased Compliance to Prescribed Rehabilitation After Surgical Treatment of Knee Injuries in Pediatric Patients. Orthop J Sports Med 2021; 9:23259671211052021. [PMID: 34790832 PMCID: PMC8591652 DOI: 10.1177/23259671211052021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Rehabilitation is an important component of care in postsurgical knee patients, especially as it pertains to return to preinjury activity level. Despite the established significance of rehabilitation in improving outcomes after certain surgical procedures, there is a lack of investigation into compliance rates and factors that affect compliance in pediatric patients. Purpose/Hypothesis: The purpose of this study was to evaluate sociodemographic factors associated with noncompliance in pediatric patients after knee surgery to characterize health disparities in this population. Our hypothesis was that certain sociodemographic factors would be associated with decreased compliance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review of medical records was used to gather data on compliance rate, demographics, and socioeconomic factors for pediatric patients undergoing rehabilitation after knee surgery. Compliance rate was determined by counting the total scheduled appointments, cancellations, and no-shows (defined as visits for which patients did not show up and did not provide notification of cancellation). Various types of knee injuries were included in this study. Data were evaluated using bivariate analyses in addition to hierarchical linear and binary logistic regression to assess for associations between sociodemographic factors and compliance rate. Results: Our total sample size was 186 patients. When compared with patients from non–single-parent households, patients from single-parent households were found to have a lower rate of physical therapy compliance (72.2% vs 80.1%; P < .001), were less likely to reach the 85% compliance threshold (9.1% vs 42.4%; P < .001), and had an increased amount of cancellations and no-shows (16.7 vs 11.7 visits; P = .02). Although a small sample size, Hispanic/Latino patients were shown to have a lower achievement of the 85% compliance threshold compared with non-Hispanic/Latino patients (0% vs 38.2%; P = .04). Increased distance from the rehabilitation clinic was associated with lower achievement of the 85% compliance threshold (P = .033). Conclusion: Overall, there were several significant demographic and socioeconomic variables associated with rehabilitation compliance, specifically single-parent status, distance to rehabilitation clinic, and ethnicity. These results suggest potential predictors of decreased compliance that warrant prospective investigation.
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Affiliation(s)
- Allan K Metz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Office of Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan, USA
| | - Tami Hart-Johnson
- Office of Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan, USA
| | - R Alexander Blackwood
- Office of Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Eileen A Crawford
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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7
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Scott J, Castelli J, Valdes K. The use of a temperament test to increase HEP adherence. J Hand Ther 2021; 34:142-144. [PMID: 31126716 DOI: 10.1016/j.jht.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Jamie Scott
- Occupational Therapy Department, Gannon University, Ruskin, FL, USA.
| | | | - Kristin Valdes
- Occupational Therapy Department, Gannon University, Ruskin, FL, USA
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8
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Comparison of Postoperative Occupational Therapy and Narcotic Use in Two Carpometacarpal Arthroplasty Approaches. Plast Reconstr Surg 2021; 148:223e-233e. [PMID: 34398086 DOI: 10.1097/prs.0000000000008152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors sought to determine whether differences exist in (1) the number of postoperative occupational therapy visits and (2) narcotic use in two carpometacarpal arthroplasty groups. METHODS A retrospective study comparing patients undergoing abductor pollicis longus (APL) suspensionplasty (154 patients) or flexor carpi radialis ligament reconstruction and tendon interposition (FCR LRTI) techniques (40 patients) between January 1, 2012, and August 1, 2018, was performed. Data included demographics, procedure performed, complications, number of postoperative occupational therapy visits, and postoperative morphine equivalent dosage used. Statistical testing used the chi-square test for proportions and the Wilcoxon-Mann-Whitney test for nonnormal data. The significance level was 0.05. RESULTS The APL suspensionplasty and FCR LRTI groups had similar ages (58.1 ± 7.8 years versus 58.1 ± 7.7 years), sex ratios (73 percent female versus 75 percent female), and preoperative narcotic user proportions (1 percent versus 3 percent). Complication rates following the procedures were similar (21 percent and 18 percent, respectively). The number of postoperative occupational therapy visits following APL suspensionplasty (median, 0; interquartile range, 0 to 4) and FCR LRTI (median, 0; interquartile range, 0 to 4) were not significantly different (p = 0.961). There was less use of narcotics following APL suspensionplasty (median, 375 morphine equivalent dosage; interquartile range, 241.9 to 525 morphine equivalent dosage) compared with FCR LRTI (median, 462.5 morphine equivalent dosage; interquartile range, 375 to 768.8 morphine equivalent dosage), and this difference was significant (p = 0.0007). CONCLUSIONS The APL suspensionplasty technique had less narcotic use and similar complication rates and occupational therapy visits compared to FCR LRTI. Prospective studies comparing postoperative pain control and function with these two carpometacarpal arthroplasty techniques may be beneficial. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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9
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Coughlin T, Norrish AR, Scammell BE, Matthews PA, Nightingale J, Ollivere BJ. Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures: a randomized controlled trial of effectiveness. Bone Joint J 2021; 103-B:1033-1039. [PMID: 33926211 DOI: 10.1302/0301-620x.103b.bjj-2020-2026.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. METHODS Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. RESULTS A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). CONCLUSION Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy. Cite this article: Bone Joint J 2021;103-B(6):1033-1039.
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Affiliation(s)
| | - Alan R Norrish
- Queen Elizabeth Hospital, King's Lynn, UK.,Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | | | - Jessica Nightingale
- Nottingham University Hospitals, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Ben J Ollivere
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
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10
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An Evaluation of Risk Factors for Patient "No Shows" at an Urban Joint Arthroplasty Clinic. J Am Acad Orthop Surg 2020; 28:e1006-e1013. [PMID: 33156587 DOI: 10.5435/jaaos-d-19-00550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient physical health and provider financial health are both affected when patients are unable to attend scheduled clinic appointments. The purpose of this study is to identify risk factors for patients missing appointments to better target interventions to improve appointment attendance. METHODS We reviewed scheduled arthroplasty appointments at an urban academic orthopaedic clinic over a 3-year period. We collected information including sex, race, distance to clinic, language, insurance, median income of home zip code, appointment day, time, precipitation, and temperature. Mixed-level multiple logistic regression was used to model the odds of missing appointments in Stata v14. RESULTS Overall, 8,185 visits for 3,081 unique patients were reviewed and 90.7% of appointments were attended. After controlling for time and day of appointment, distance from the clinic, and the primary language spoken, patients with government insurance were two times as likely to miss an appointment compared with privately insured patients. White patients were two times as likely to attend scheduled appointments compared with black/Hispanic patients. Younger patients (<50 years) and older patients (>73 years) were 2.7 times and 1.8 times, respectively, more likely to miss appointments compared with those aged between 65 and 72 years. Appointments on the most temperate days were more likely to be missed, and those on the coldest days (14°F to 36°F) and warmest days (69°F to 89°F) were less likely to be missed. DISCUSSION Appointment no shows are associated with sociodemographic and environmental factors. This information is valuable to help better delineate novel ways to better serve these patient populations.
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11
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Poiset S, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Kwok M, Liss F, Rivlin M, Takei TR, Wang M, Ilyas AM. Predictive Factors for Return to Driving following Volar Plate Fixation of Distal Radius Fracture. J Wrist Surg 2020; 9:298-303. [PMID: 32760608 PMCID: PMC7395838 DOI: 10.1055/s-0040-1709189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/27/2020] [Indexed: 01/05/2023]
Abstract
Background A common query by patients undergoing distal radius fracture (DRF) repair is when (s)he can resume driving postoperatively. A prospective cohort analysis was performed to assess fracture and patient factors on a patient's self-reported ability to return to driving to better inform patients and surgeons. Methods Consecutive patients undergoing DRF repair with locking volar plate were enrolled. Preoperative demographic and radiographic characteristics, and postoperative time to return to driving were collected. Data collected included age, sex, hand dominance, body mass index (BMI), level of education, concomitant ulnar fracture, fracture setting prior to surgery, and AO fracture classification. Results A total of 131 patients were enrolled (108 women, 23 men) with 36 AO type A, 22 AO type B, and 73 AO type C DRFs, with an average age of 59.5 years. Fracture severity by classification did not significantly affect time to return to driving. However, BMI, sex, and age were found to significantly affect time to return to driving. Patients aged 19 to 59 years, 60 to 75 years, and over 75 years returned to driving 13.1, 15.4, and 30.1 days following surgery, respectively ( p < 0.01). Classified by BMI, patients that were normal weight, overweight, and obese returned to driving 11.5, 13.1, and 21.0 days following surgery, respectively ( p < 0.05). Men returned to driving 8.8 days and women 17.3 days postoperatively ( p = 0.001). Conclusion Patients severity of fracture as determined by AO fracture type did not affect time to driving, while increased BMI, female sex, and increased age were found to be significant factors in patients' return to driving time after distal radius fracture repair. Level of Evidence This is a Level II, prospective cohort study.
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Affiliation(s)
- Spencer Poiset
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory Gallant
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher Jones
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William Kirkpatrick
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Moody Kwok
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Frederic Liss
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark Wang
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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12
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Odom EB, Hill E, Moore AM, Buck DW. Lending a Hand to Health Care Disparities: A Cross-sectional Study of Variations in Reimbursement for Common Hand Procedures. Hand (N Y) 2020; 15:556-562. [PMID: 30724594 PMCID: PMC7370389 DOI: 10.1177/1558944718825320] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Despite the role of one's hands in human function and quality of life, financial disincentives to perform common hand procedures in patients with government-sponsored insurance plans may lead to longer wait times and decreased access to care. Here, we identify the variations in reimbursement for 4 common hand procedures as a step toward understanding these financial implications to develop safeguards to minimize effects on access to care. Methods: Billing data were collected over a 10-year period for patients undergoing carpal tunnel release (open, Current Procedural Terminology 64721; endoscopic, 29848), cubital tunnel release (64718), ganglion cyst excision (25111), and interposition arthroplasty (25447). Patients were placed into cohorts according to insurance type-private insurance, Medicare, Medicaid, or worker's compensation-and these were directly compared. Results: A total of 3489 procedures between 2005 and 2015 were identified in this study (carpal tunnel 65.8%, cubital tunnel 28.7%, ganglion cyst excision 4.1%, and interposition arthroplasty 13.8%). In all, 54.7% of patients had private insurance; 26.3%, Medicare; 10.5%, worker's compensation; and 8.5%, Medicaid. Reimbursement, as a percentage of charge, differed significantly by payor type for all cases and by procedure. On average, worker's compensation plans reimbursed 65.5% of submitted charges; private insurance, 50.6%; Medicare, 25.1%; and Medicaid, 24.6%. Conclusions: We found that wide variations in reimbursement for common hand procedures exist and may preclude some surgeons from offering certain procedures to a subset of patients. Understanding these discrepancies is a key first step in minimizing a potential care delivery disparity for this patient population.
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Affiliation(s)
| | - Elspeth Hill
- Washington University School of Medicine, St. Louis, MO USA
| | - Amy M. Moore
- Washington University School of Medicine, St. Louis, MO USA
| | - Donald W. Buck
- Washington University School of Medicine, St. Louis, MO USA,Donald W. Buck II, Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, USA.
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13
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The Relationship between Hand Therapy and Long-Term Outcomes after Distal Radius Fracture in Older Adults: Evidence from the Randomized Wrist and Radius Injury Surgical Trial. Plast Reconstr Surg 2019; 144:230e-237e. [PMID: 31348349 DOI: 10.1097/prs.0000000000005829] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older patients are frequently referred to hand therapy after distal radius fracture. Supervised therapy sessions place a transportation burden on patients and are costly on both the individual and systematic levels. Furthermore, there is little evidence that supervised therapy or home exercises improve long-term outcomes. METHODS Data were collected for the Wrist and Radius Injury Surgical Trial, a multicenter, international, pragmatic, randomized trial of distal radius fracture treatment in patients aged 60 years and older. Referral to therapy and therapy protocol were at the discretion of the treating surgeon and therapist. The authors examined outcomes between participants who underwent therapy and those who did not and assessed the duration of therapy. The authors also analyzed the effect of therapy on subgroups at risk for poor outcomes: older participants and those who had more comorbidities or lower baseline activity. RESULTS Eighty percent of participants underwent therapy; 70 percent participated in both supervised therapy and home exercises. Participants had a mean 9.2 supervised sessions over 14.2 weeks. There were no differences in patient-reported outcomes between participants who underwent therapy and those who did not. Participants who did not have therapy recovered more grip strength. Participants who engaged in therapy for a shorter time reported greater function, ability to work, and satisfaction. There were no relationships revealed in subgroup analyses. CONCLUSIONS Hand therapy after distal radius fracture may not be necessary for older patients. Encouraging participants to resume activities of daily living as soon as possible may be as effective as formal therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Truong JL, Doherty C, Suh N. The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review. Hand (N Y) 2018; 13:509-515. [PMID: 29020814 PMCID: PMC6109905 DOI: 10.1177/1558944717735945] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Socioeconomic factors are known to affect outcomes for both medical and surgical conditions. The purpose of this systematic review was to assess the current evidence regarding the effect of socioeconomic factors such as income, geographic location, educational level, and occupation on clinical outcomes after distal radius fractures. METHODS A systematic search strategy was performed to identify studies commenting on the effect of socioeconomic factors on clinical outcomes following open or closed distal radius fracture repair. Abstract and full-text screening was performed by 2 independent reviewers, and articles were evaluated by Structured Effectiveness Quality Evaluation Scale (SEQES). Treatment outcomes of interest included, but were not limited to, pain, function, range of motion, and grip strength. RESULTS There were 1745 studies that met our inclusion and exclusion criteria for abstract screening. Of these, 48 studies met our inclusion criteria for full-text screening and 20 studies met our criteria for quality analysis with the SEQES score. There were 3 studies of high quality, 16 of moderate quality, and 1 of low quality. Meta-analyses were not possible due to the variability in outcomes of interest across papers. CONCLUSIONS Patient factors indicative of socioeconomic status are relevant predictors of functional outcome after distal radius fractures. There is currently limited evidence in this area of research, and further examination should be considered to improve outcomes from a patient and system standpoint.
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Affiliation(s)
- Jessica L. Truong
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada
| | - Chris Doherty
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada
| | - Nina Suh
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada,Nina Suh, Department of Surgery, University
of Western Ontario, 900 Richmond Street, London, Ontario, Canada N6A 4V2.
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