Exploration of Outcomes and Interventions Used Following Digit Amputation

Research Objectives: To examine changes in pain and function following therapy for a partial thumb or digit amputation. A secondary objective was to explore types of interventions used by therapists, including range-of-motion, desensitization, strengthening, wound care, orthoses use, compression, and modalities.

Design: Retrospective chart review of hospital medical records.

Setting: Academic medical center campus.

Participants: Patient data from 134 charts spanning a three-year period between 2018 and 2021 were reviewed. The charts were identified using diagnostic information included on hand surgery and occupational therapy provider schedules; as well as a search of the EMR using ICD9 and ICD10 data.

Interventions: N/A

Main Outcome Measures: Demographic information was extracted on age, gender, dominance, mechanism of injury along with pre and post therapy scores on visual/numerical analogue pain scales and the Quick DASH. Data was also collected on types of therapy interventions: range-of-motion, desensitization, strengthening, wound care, orthoses use, compression, and modalities.

Results: Data extracted from 67 patients (52 men and 15 women) were included. Mean age was 45.6 years old. Sixty were right dominant, 6 left dominant, and 1 reported being ambidextrous. Mechanisms of injuries in descending order of relative frequency included crush, saw (skill/table), blade/laceration, bite, propelling blade, wood splitter, burn, gunshot wound, infection, motor vehicle accident, and vascular disease.
Interventions used by therapists included range of motion (92.5%), strengthening (73.1%), wound care (73.1%), orthosis use (68.6%), desensitization (76.1%), compression (44.7%) and modalities (19.4%).

A Wilcoxon signed-rank test showed a statistically significant change in pain (Z = -5.5742, p <.00001) and improved function/Quick-DASH (Z = -6.7087, p < .00001) following therapy interventions post digital amputations.

Conclusions: This retrospective chart review suggests that patients referred to therapy following digit amputation have decreased pain and improved function. Further studies are needed to compare outcomes in patients who received therapy to those who did not and to do a prospective study to determine which interventions are most effective.

Author(s) Disclosures: Authors have no disclosures.