Full Length Article| Volume 35, ISSUE 4, P655-664, October 2022

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Multi-site evaluation of advanced practice hand therapy clinics for the management of patients with trigger digit


      • 67% of patients with TD diverted from the SOPD and treated in APHT improved sufficiently to allow discharge from the SOPD without specialist surgical consultation.
      • Only 1.4% of patients discharged from APHT were re-referred for the same condition in the following 12 months.
      • Superior initial Michigan hand questionnaire scores were associated with discharge from APHT without need for surgical review.
      • 88% of patients returned to SOPD were booked for surgery demonstrating high levels of agreement between surgeons and APHT regarding need for surgery.


      Study Design

      Prospective cohort design.


      Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking.

      Purpose of the Study

      To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals.


      Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed.


      104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service.


      Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.


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      JHT Read for Credit

      Quiz: # 879

      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.
        • d.
          prospective cohort
      • # 2.
        In Australia
        • a.
          essentially all hand problems are initially treated in surgical outpatient clinics
        • b.
          essentially all chronic hand conditions are initially evaluated by hand therapists before being evaluated in surgical outpatient facilities
        • c.
          hand therapy practices often see patients with chronic conditions before being evaluated in surgical outpatient clinics
        • d.
          hand therapists are not permitted by law to evaluate patients prior to being evaluated by a physician
      • # 3.
        The patient sample was
        • a.
          trigger finger patients
        • b.
          all patients seen in hand therapy from SOPD waitlists
        • c.
          Dupuytren's contracture patients
        • d.
          carpal boss patients diverted from SOPD waitlists
      • # 4.
        Following APHD
        • a.
          all patients returned to their SOPD
        • b.
          approximately 2/3 did not return to their SOPD
        • c.
          approximately 50% required surgical release of the A2 pulley
        • d.
          approximately 50% were satisfied with their outcome
      • # 5.
        Diversion from waitlists to hand therapy was shown to be an effective patient management strategy in patients with chronic hand complaints
        • 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.