Factors affecting orthosis adherence following acute traumatic hand tendon repairs: A prospective cohort study

Abstract Study design Prospective cohort study Background Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. Purpose of the study: This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. Methods Two hundred and twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 hours a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multi-dimensional adherence model (MAM) including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. Modified Hand Injury Severity Scale (MHISS) was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A multivariate logistic regression model was constructed for orthosis adherence. Results One hundred and thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis while 67 (50.4%) was partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [OR=1.2 (95%CI=1.1-1.3), p=0.001] and partial adherence [OR=1.1 (95%CI=1.0-1.2), p=0.01]. Conclusions Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence.