The Associations Between Social Determinants of Health and Therapy Attendance With Early Recovery After Operative...

The purpose of this study was to: (1) examine the demographic and socioeconomic factors associations with lack of formal hand therapy after operatively treated distal radius fractures (DRFs); and (2) determine whether formal postoperative therapy was associated with differences in patient-reported function, range of motion (ROM), and incidence of complications after operatively treated DRFs.

This study analyzed adult patients (>18 years) with operatively treated DRFs at a tertiary center between September 2020 and December 2023. It examined the associations between demographic factors and socioeconomic status (measured by the Area Deprivation Index and Social Vulnerability Index [SVI]) with attendance at postoperative therapy. Patient-Reported Outcomes Measurement Information System (PROMIS) scores and wrist motion were compared between the therapy and no therapy cohorts at 4 to 6 weeks postoperatively and at final follow-up (median 86 days).

Among 344 patients analyzed, 279 patients (81%) attended hand therapy, whereas 65 patients (19%) did not. Lack of insurance or Medicaid insurance and higher Transportation/Housing SVI percentile (more disadvantaged) independently predicted not attending formal postoperative therapy. At both 4 to 6 weeks and final follow-up, formal postoperative therapy attendance was not associated with statistical differences in PROMIS scores, wrist motion, or incidence of complications.

Disadvantaged patients are less likely to have access to postoperative therapy but the routine alternative of providing in-office instructions for home stretching does not compromise early recovery. While this study suggests that formal postoperative therapy is not needed universally, in practice we have seen individual patients that greatly benefited from attending rehabilitation.