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Formal Hand Therapy for Patients Following Basal Joint Arthroplasty: Potential Benefits Versus Added Costs
John R Baumann1, Bryce F Rizvanovic, Julia A V Nuelle
1From the Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
Background:
There is no consensus on whether the benefits of participating in formal hand therapy outweigh the investment required for patients following basal joint arthroplasty. The purpose of this study was to compare patient-reported and functional outcome measures between patients who did and did not participate in formal hand therapy following basal joint arthroplasty. Furthermore, we evaluated the distance patients traveled and the financial burden associated with participating in formal hand therapy.
Methods:
Using a retrospective cohort study design, patients who underwent primary basal joint arthroplasty by the fellowship-trained orthopaedic hand surgeons at our institution between 2021 and 2023 were included in this study. Patients who did not have complete data or had revision surgery were excluded. Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) scores, Kapandji scores, therapy data, and therapy costs were collected. Mann-Whitney U -tests, chi square tests, and Z-tests were used for statistical analysis. The cutoff for statistical significance was set at P < 0.05.
Results:
A total of 73 surgeries in 70 patients were included in this study; 33 out of 73 surgical encounters participated in formal therapy after surgery. The median max Kapandji score and mean increase in PROMIS UE score were higher in the therapy users compared with nontherapy users. Although these differences in PROMIS UE scores were not statistically significant, they were greater than the proposed minimal clinically important difference. Formal hand therapy users did attend more postoperative clinic appointments than nontherapy users. Both the patient-reported and standardized estimated cost of therapy and postoperative clinic appointment cost were higher for therapy groups compared with nontherapy groups.
Conclusion:
The results of this study suggest that although there is no statistically significant difference in PROMIS UE improvement between groups, formal hand therapy may provide a clinically meaningful benefit.
