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Published on: March 30, 2018
Loss to Follow-up After Tendon Repair: Impact on Functional Recovery
Anam J Furrukh1, Desmond Bennett1, Anna Bogursky1
1From the Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA.
Background:
Hand therapy is essential after flexor and extensor tendon repairs, but adherence varies, raising concerns about outcomes for patients lost to follow-up (LTFU). Previous studies identified predictors of patients being LTFU, but the functional status of these patients remains unclear. This study used the QuickDASH and Patient-Rated Wrist and Hand Evaluation (PRWHE) scores to assess whether patients LTFU achieve comparable outcomes earlier than those who complete therapy.
Methods:
We conducted a retrospective chart review for 268 patients who underwent tendon repair at our institution between January 01, 2014, and December 2, 2024. PRWHE scores, QuickDASH scores, and the number of sessions attended were collected from patients' final hand therapy appointment records. Patients were grouped by adherence: therapy completers versus patients LTFU. Functional scores at discharge or last visit were compared. Statistical analysis was performed using R.
Results:
The LTFU rate was 38%. Median PRWHE change was significantly lower in patients LTFU (27.5) versus completers (50), with significant differences in functional (P = 0.01257) and pain subscores (P = 0.0409). Final PRWHE scores were also significantly higher (worse) among patients LTFU (mean = 42.82) than completers (mean = 24.47), despite similar baseline PRWHE scores (67.41 versus 69.89; P > 0.05). Overall PRWHE improvement was lower for patients LTFU (30.02) versus completers (46.9) (P < 0.05). QuickDASH scores showed no significant difference (P = 0.7473). Kendall rank correlation showed weak, nonsignificant associations between follow-up visits and changes in QuickDASH (P = 0.509) and PRWHE (P = 0.812). Receiver operating characteristic analysis showed modest area under the curve for PRWHE (0.53) and QuickDASH (0.5747), suggesting limited predictive value of visit count.
Conclusions:
Although visit count did not strongly predict functional improvement, worse PRWHE scores in LTFU patients suggest that early dropout may compromise recovery. Efforts should focus on addressing barriers to adherence.
