Full-Length Paper| Volume 35, ISSUE 1, P32-40, January 2022

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

  • Serpil Savaş
    Corresponding author. Süleyman Demirel University Medical School, Physical Medicine and Rehabilitation Department, Doğu Kampüsü, Çünür, 32260 Isparta, Turkey. Tel.: +902462119281; fax: +902462112830.
    Süleyman Demirel University Medical School, Physical Medicine and Rehabilitation Department, Isparta, Turkey
    Search for articles by this author
  • Çiğdem Aydoğan
    Süleyman Demirel University Medical School, Physical Medicine and Rehabilitation Department, Isparta, Turkey
    Search for articles by this author
Published:October 16, 2020DOI:


      • Possible factors affecting orthosis adherence were evaluated by using the multidimensional adherence model.
      • Only one-third of the patients with acute traumatic tendon repair were fully adherent with the orthosis wear program.
      • Depression in the very acute period of injury impaired orthosis adherence.



      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.

      Study Design

      This is a prospective cohort study.


      Two hundred 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 h 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 multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system–related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence.


      One hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01].


      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.


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      JHT Read for Credit

      Quiz: # 808

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
        • b.
          case series
        • c.
          prospective cohort
        • d.
      • # 2.
        How many patients were fully compliant to their orthosis wearing regiment?
        • a.
        • b.
        • c.
        • d.
      • # 3.
        The authors felt that __________ in the patients was a significant factor in non-compliance to the orthosis wearing regiment
        • a.
          lack of understanding
        • b.
          inadequate funding
        • c.
        • d.
      • # 4.
        The WHO’s MAM was designed to help understand reasons affecting
        • a.
          patient education
        • b.
          staff coordination
        • c.
          adherence to medical regiments (e.g. orthosis wearing schedules)
        • d.
          orthosis designs in hand injury populations
      • # 5.
        Due to the low level of patient compliance to orthosis wearing, the authors recommend plaster immobilization in a protected position for 4-6 weeks immediately following tendon repair.
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.