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Journal of Hand Therapy xxx (xxxx) xxx

Contents lists available at ScienceDirect

Journal of Hand Therapy

journal homepage: www.elsevier.com/locate/jht

Patient satisfaction with telehealth vs in-person hand therapy: A

retrospective review of results of an online satisfaction survey
Alexandra MacKenzie, OTR/L, CHT∗, Eugenia Papadopolous, OTR/L, CHT,
Grace Lisandrelli, BS, Zafir Abutalib, MHS, Erica Fritz Eannucci, PT, DPT OCS
Hospital for Special Surgery New York, NY, USA

a r t i c l e i n f o a b s t r a c t

Article history: Background: The COVID-19 pandemic necessitated a shift from in-person to telehealth visits in many out-
Received 5 October 2021 patient rehabilitation facilities.
Revised 31 October 2022
Purpose: To determine whether patients reported similar levels of satisfaction receiving telehealth hand
Accepted 1 November 2022
therapy as when receiving in-person hand therapy.
Available online xxx
Study Design: Retrospective review of patient satisfaction surveys.
Keywords: Methods: Satisfaction surveys were reviewed retrospectively among patients who participated in in-
Telehealth person hand therapy between April 21 and October 21, 2019, or after participating in telehealth hand
Telemedicine therapy between April 21 and October 21, 2020. Information on gender, age, insurance provider, post-
Patient satisfaction operative status and comments were also collected. Kruskal-Wallis tests were used to compare survey
Surveys and questionnaires scores between groups. Chi -squared tests were used to compare categorical patient characteristics be-
tween groups.
Results: A total of 288 surveys were included: 121 surveys for in-person evaluations, 53 surveys for in-
person follow-up visits, 55 surveys for telehealth evaluations and 59 surveys for telehealth follow-up
visits. No significant differences in satisfaction were observed between in-person and telehealth visits of
either type or when patients were stratified by age (p = 0.78), gender (p = 0.41), insurance payer group
(p = 0.099) or postoperative status (p = 0.19).
Conclusions: Similar rates of satisfaction were observed with both in-person visits and telehealth hand
therapy visits. Questions that related to registration and scheduling tended to score lower across all
groups, while questions related to technology scored lower in the telehealth groups. Future studies are
needed to explore the efficacy and viability of a telehealth platform for hand therapy services.
© 2022 Elsevier Inc. All rights reserved.

Introduction order 202.1 In order to increase the amount of available hospital

The COVID-19 pandemic has led to an unprecedented time for
many industries, including healthcare. Public health and govern-
ment officials instituted several measures, such as calls for social
distancing and stay-at-home mandates, to address the urgent need
to mitigate the disease’s impact on society. A state of emergency
was declared on March 7, 2020 in New York state per executive
Conflict of interest: All named authors hereby declare that they have no con-
flicts of interest to disclose.
This is an institutional review board approved study performed at the Hospital
for Special Surgery.
∗ Additionally, telehealth circumvents the need to schedule trans-
Corresponding author. Hospital for Special Surgery, 535 E. 70th Street, New
York, NY 10021, USA. Tel.: (212) 606-1660.
E-mail address: MackenzieA@hss.edu (A. MacKenzie).
beds, New York state healthcare institutions were required to can-
cel all elective surgeries indefinitely and restrict in-person care to
only the most critical of patients.1 To accommodate these safety
measures, healthcare facilities focused on the rapid expansion of
telehealth services to provide care for new and returning patients,
including in hand therapy settings.2 , 3 Telehealth has also allowed
healthcare professionals to provide care to individuals displaying
symptoms of COVID-19 from a safe distance.4
Telehealth offers several advantages and disadvantages over
traditional in-person healthcare.5 Most notably, telehealth greatly
benefits individuals with limited options for healthcare due to
factors such as physical proximity to facilities and disability.6 , 7 , 8
portation, time away from work, and adjust busy schedules for
many patients attempting to find care.9 Disadvantages to tele-

0894-1130/$ – see front matter © 2022 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jht.2022.11.003

Please cite this article as: A. MacKenzie, E. Papadopolous, G. Lisandrelli et al., Patient satisfaction with telehealth vs in-person hand
therapy: A retrospective review of results of an online satisfaction survey, Journal of Hand Therapy, https://doi.org/10.1016/j.jht.2022.11.
JID: HANTHE
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2 A. MacKenzie, E. Papadopolous, G. Lisandrelli et al. / Journal of Hand Therapy xxx (xxxx) xxx
health include barriers to reimbursement by insurance companies,
concern over the quality of the clinician-patient interaction, and
difficulty with administration of physical examinations, although
the latter has begun to be addressed more extensively.10 , 11 In
light of telehealth’s advantages and disadvantages, an important
question concerns whether patients feel satisfied with telehealth
as a method of receiving care. Information on patient satisfaction
provides insight into the perceived value and user experience of
telehealth in various healthcare settings.
The extant research on patient satisfaction with telehealth has
produced largely positive results from surveying individuals with a
wide variety of conditions and across the full spectrum of care.12
Recent research concerning the sudden deployment of telehealth
services during the COVID-19 pandemic has shown high rates
of satisfaction with telehealth among patients in outpatient or-
thopedic settings.13 , 14 , 15 Studies of patient satisfaction with us-
ing telehealth for ongoing disease management have shown that
patients were highly satisfied with the care they received and
would recommend telehealth to others.16-19 Surgical patients who
received virtual postoperative care reported high levels of satis-
faction with the service,20 , 21 along with a lower rate of read-
mission.21 Individuals who received virtual physical therapy re-
ported similar satisfaction scores to those who received in-person
treatment.22 , 23 , 24 Patients in these studies included general outpa-
tient physical therapy, traumatic brain injury, spinal cord injury,22
post-operative total hip replacement patients,23 and non-operative
proximal humeral fractures.24 There is emerging evidence that pa-
tients receiving hand therapy via telehealth for injuries to and
conditions of the upper extremities are similarly satisfied.11 , 25-28
One study of individuals with hand impairments stemming from
rheumatic diseases, for instance, showed that these individuals had
a positive experience with a telerehabilitation program overall,25
while a pilot study demonstrated equal patient satisfaction be-
tween virtual and in-person groups.26
However, further exploration of patient satisfaction for patients
receiving outpatient hand therapy via telehealth is warranted with
other diagnoses that are common to the hand therapy population.
Diagnoses seen in a typical hand therapy setting can vary widely,
from cumulative trauma to progressive degenerative conditions to
post-operative care. Hand therapy provides unique challenges to a
telehealth delivery model, as many patients require hands-on man-
ual therapy techniques and/or custom orthosis fitting and fabrica-
tion. The COVID-19 pandemic offers a unique opportunity to re-
search a substantive convenience sample of patients receiving hand
therapy via telehealth.
Methods
The present study aims to explore satisfaction of patients re-
ceiving telehealth hand therapy services. Telehealth-based services
using the Zoom platform were launched on March 25, 2020, in
response to the COVID-19 pandemic. We compared satisfaction of
patients who received hand therapy via telehealth in a six-month
period from April 21, 2020, to October 21, 2020, (during the COVID-
19 pandemic) to satisfaction of patients who received in-person
treatment during the same six-month period in 2019, (pre-COVID-
19 pandemic) using the patient satisfaction survey administered
by the authors’ facility. Satisfaction for initial evaluation visits and
follow-up visits were reviewed for both care delivery models. This
time period was chosen because surveys were first distributed for
telehealth visits starting on April 21, 2020. We selected a similar
window from the previous year for in-person visits in order to
have a comparable data set, as we did not have enough surveys
for in-person visits at the start of the pandemic due to shelter in-
place orders mandated by New York State.1
Please cite this article as: A. MacKenzie, E. Papadopolous, G. Lisandrelli et al., Patient satisfaction with telehealth vs in-person hand
therapy: A retrospective review of results of an online satisfaction survey, Journal of Hand Therapy, https://doi.org/10.1016/j.jht.2022.11.
[mNS;April 1, 2023;20:48]
In addition to looking at patient satisfaction scores, we also ex-
amined factors that may influence patient satisfaction, including
age, gender, insurance provider, diagnosis, and whether or not the
patient had surgery. We looked at surveys from initial evaluation
visits (where the patient is being seen for the first time by the
evaluating clinician and a plan of care is determined) and surveys
from follow-up treatment visits (defined as any visit subsequent to
the initial evaluation).
This retrospective study was conducted at our private, urban
hospital and approved by our hospital’s Institutional Review Board
(Approval: ID0 0 017293). The Checklist for Reports Results of Inter-
net E-surveys (CHERRIES) was followed. As per standard of care,
an open, voluntary survey was sent to all patients via short mes-
saging system (SMS) a web link to a patient satisfaction survey
called a Q-review Survey (Quality Reviews, Inc., New York, NY,
USA) with instructions about the survey, to rate the care they re-
ceived. Only rehabilitation management and study staff had access
to the survey responses. Surveys were automatically generated and
sent based on the visit type (initial evaluation or follow-up visit)
and model of care delivery (in-person or telehealth). Therefore, the
following four survey types were delivered at the specified time
points: one hour after initial evaluation (in-person or telehealth),
every 30 days after beginning treatment (telehealth follow up vis-
its) and once every 10 visits (in-person follow up visits). (Table 1)
There is a discrepancy in how often follow up surveys were sent
based on care delivery mode. Originally, follow up surveys were
sent every 10 visits. In April 2020, the rehabilitation department
changed the follow-up time frame to every 30 days in an effort
to collect data at similar time points, as patients tended to reach
10 visits at different times. Items were scored on a 5-star rating,
similar to a Likert scale ranging from 1 to 5. A score of 5 indicates
“most satisfied”, and 1 indicates “least satisfied.” There was one ex-
ception to this 5-star rating system: The question “How likely are
you to refer Hospital for Special Surgery to your friends and fam-
ily?” was used to measure patient satisfaction with therapy ser-
vices and was graded on a 10-point Likert scale with 10 indicat-
ing “most likely to refer” and 1 indicating “least likely to refer.”
Some questions were asked on all survey types, while others were
only asked on specific survey types. For example, the question,
“How would you rate the cleanliness of the center?” was asked
for in-person initial evaluation visits but not telehealth initial eval-
uation visits, as it would not be applicable to a telehealth patient
(Table 1). Patients were also given the opportunity to include open
text comments.
Inclusion criteria included: patients between the ages of 18 and
90 years old who completed hand therapy provided by an occupa-
tional or physical therapist at our facility’s outpatient rehabilitation
locations or remotely through telehealth. Both fully completed and
incomplete surveys were analyzed. Exclusion criteria included: pe-
diatric patients (younger than 18 years of age) and patients seen at
a corporate offsite location.
Data were collected on age, gender, insurance, surgical status,
and diagnosis. Data were analyzed with continuous variables re-
ported as means and standard deviations, while discrete variables
were reported as frequencies and percentages in the descriptive
analysis. A one-way analysis of variance (ANOVA) was employed
for comparisons of patient demographics between survey groups
using continuous data. A chi-squared test was used to compare pa-
tient demographics between survey groups using discrete data. A
patient was defined as satisfied if he or she scored a 9 or 10 on
the satisfaction survey. Comparison of overall satisfaction was as-
sessed using a Mann-Whitney U test for continuous variables and
chi-squared tests for discrete variables. Statistical significance was
defined as α = 0.05. All analyses were performed with Stata, ver-
sion 14.2 (StataCorp., College Station, TX).
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A. MacKenzie, E. Papadopolous, G. Lisandrelli et al. / Journal of Hand Therapy xxx (xxxx) xxx 3

Table 1
Survey questions.

Telehealth In-person Telehealth In-person

Question eval eval follow up follow-up

How would you rate the ability to schedule an appointment? X X

How would you rate the registration process? X X
How would you rate the amount of time your therapist spent with you? X X X X
How well did your therapist explain the findings from your initial evaluation and the treatment plan? X X
How would you rate our concern for your questions and worries? X X
How would you rate the technology (picture and sound quality) and ease of use? X X
How would you rate your confidence that your rehab needs are being or were met through telehealth? X X
Overall, how would you rate your experience during this visit? X X
Would you have been comfortable if this virtual visit had been an in-person visit given ongoing concerns X X
about coronavirus?
What could we have done to improve your experience? X X X X
How likely is it that you would recommend [Blank] Hospital to friends and family? X X X X
How would you rate the courtesy and friendliness of the staff? X X
How would you rate your confidence in the skill of your therapy team? X X
How would you rate the degreeto which our outpatient therapy services have helped you progress toward X X
your rehabilitation goals?
How would you rate the education you received in future injury prevention and overall wellness? X
My treatment goals were achieved, and I would recommend this service to others with similar issues. X X
Upon arrival, how would you rate the waiting time before seeing your therapist? X
How would you rate the cleanliness of the center? X
How well did the team work together to provide care? X
How would you rate information provided about your treatment and progress? X
How would you rate the overall care received during your visits? X

Table 2
Overall patient characteristics by survey group.

Overall patient characteristics and by survey group

Characteristic In-person eval In-person follow Telehealth eval Telehealth follow Total p-value test

N=121 N=53 N=55 N=59 N=288

Age 60.3 (14.2) 60.8 (14.3) 61.4 (13.0) 58.7 (15.3) 60.4 (14.2) .78 ANOVA
Age group < 20 0 (0.0%) 0 (0.0%) 1 (1.8%) 0 (0.0%) 1 (0.4%) .51 Pearson’s chi-squared
20-29 4 (3.4%) 4 (7.7%) 2 (3.6%) 3 (5.4%) 13 (4.6%)
30-39 6 (5.0%) 3 (5.8%) 1 (1.8%) 2 (3.6%) 12 (4.3%)
40-49 15 (12.6%) 5 (9.6%) 5 (9.1%) 2 (3.6%) 27 (9.6%)
50-59 29 (24.4%) 12 (23.1%) 13 (23.6%) 11 (19.6%) 65 (23.0%)
60-69 29 (24.4%) 16 (30.8%) 22 (40.0%) 23 (41.1%) 90 (31.9%)
70+ 36 (30.3%) 12 (23.1%) 11 (20.0%) 15 (26.8%) 74 (26.2%)
Gender Male 34 (28.1%) 10 (18.9%) 17 (30.9%) 13 (22.0%) 74 (25.7%) .41 Pearson’s chi-squared
Female 87 (71.9%) 43 (81.1%) 38 (69.1%) 46 (78.0%) 214 (74.3%)
Insurance provider Commercial 55 (45.5%) 35 (66.0%) 34 (61.8%) 35 (59.3%) 159 (55.2%) .099 Pearson’s chi-squared
Medicaid 8 (6.6%) 5 (9.4%) 3 (5.5%) 0 (0.0%) 16 (5.6%)
Medicare 47 (38.8%) 10 (18.9%) 17 (30.9%) 23 (39.0%) 97 (33.7%)
Workers’ Comp 6 (5.0%) 0 (0.0%) 1 (1.8%) 0 (0.0%) 7 (2.4%)
Financial Assistance 1 (0.8%) 1 (1.9%) 0 (0.0%) 1 (1.7%) 3 (1.0%)
International 1 (0.8%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.3%)
No Fault 3 (2.5%) 2 (3.8%) 0 (0.0%) 0 (0.0%) 5 (1.7%)

Results
Of the 288 surveys received that met the study inclusion cri-
teria, 121 were for in-person hand therapy initial evaluations, 55
were for telehealth hand therapy initial evaluations, 53 were for in
person hand therapy follow-up visits, and 59 were for telehealth
follow-up visits. Patient characteristics among all survey types can
be found in Table 2 and a list of diagnoses in Table 4. The age
range of the study population was between 18 and 90 years, with
a mean age of 60.4 (±15) years. There was no statistically sig-
nificant difference found between ages (p = .78) or within age
groups (p = .51). Across groups, most patients who answered the
survey were in the 60- to 69-year-old age group (n = 90), and
approximately two-thirds of the patients were female (n = 214).
There was no statistically significant difference found between
gender (p = .41). Commercial insurance providers made up the
majority of payers across all categories (55.2%), followed by Medi-
care (33.7%). Medicaid 123 (5.6%), Workman’s Comp (2.4%), No
Fault (1.7%), Financial Assistance (1%) and International (.3%). There
was no statistically significant difference found between insurance
providers (p = .099) (Table 2). The response rate for the study pe-
riod of in-person initial evaluation visits was 17.55% and in person
follow-up visits was 15.22%. The response rate for the study pe-
riod of telehealth initial evaluation visits was 24.47% and for tele-
health follow-up visits was 14.97%. There were several patients in
the follow-up groups who were seen for an extended period of
time and therefore received multiple surveys. Within the in-person
follow-up visit group, out of 53 responses, there were four patients
who responded more than once and in the telehealth follow-up
visit group, out of 59 responses, there were six patients who re-
sponded more than once.
In every group, the majority of patients were post-operative,
with the exception of the in-person initial evaluation group. In the
telehealth initial evaluation group, there were slightly more post-
operative patients (52.7%; 29) than non-operative patients (47.3%;
26). In the in-person initial evaluation group, there were more

Please cite this article as: A. MacKenzie, E. Papadopolous, G. Lisandrelli et al., Patient satisfaction with telehealth vs in-person hand
therapy: A retrospective review of results of an online satisfaction survey, Journal of Hand Therapy, https://doi.org/10.1016/j.jht.2022.11.
JID: HANTHE
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4 A. MacKenzie, E. Papadopolous, G. Lisandrelli et al. / Journal of Hand Therapy xxx (xxxx) xxx

Table 3
Comparing patient characteristics between satisfied vs unsatisfied patients.

Characteristic Unsatisfied Satisfied p-value (per characteristic) test

N = 15 N = 273
Age 61.5 (14.6) 60.4 (14.2) .60 Mann-Whitney U
Age group < 20 0 (0.0%) 1 (0.4%) .43 Pearson’s chi-squared
20-29 0 (0.0%) 13 (4.9%)
30-39 2 (13.3%) 10 (3.7%)
40-49 1 (6.7%) 26 (9.7%)
50-59 2 (13.3%) 63 (23.6%)
60-69 4 (26.7%) 86 (32.2%)
70+ 6 (40.0%) 68 (25.5%)
Gender Male 4 (26.7%) 70 (25.6%) .93 Pearson’s chi-squared
Female 11 (73.3%) 203 (74.4%)
Insurance provider Commercial 7 (46.7%) 152 (55.7%) .71 Pearson’s chi-squared
Medicaid 0 (0.0%) 16 (5.9%)
Medicare 8 (53.3%) 89 (32.6%)
Workers’ Comp 0 (0.0%) 7 (2.6%)
Financial Assistance 0 (0.0%) 3 (1.1%)
International 0 (0.0%) 1 (0.4%)
No Fault 0 (0.0%) 5 (1.8%)
Post-operative? No 9 (60.0%) 117 (42.9%) .19 Pearson’s chi-squared
Yes 6 (40.0%) 156 (57.1%)
Survey group Telehealth eval 2 (13.3%) 53 (19.4%) .23 Pearson’s chi-squared
In-person eval 10 (66.7%) 111 (40.7%)
Telehealth follow 1 (6.7%) 58 (21.2%)
In-person follow 2 (13.3%) 51 (18.7%)
Patient evaluation In-person eval 10 (83.3%) 111 (67.7%) .26 Pearson’s chi-squared
Telehealth eval 2 (16.7%) 53 (32.3%)
Patient follow-up In-person follow-up 2 (66.7%) 51 (46.8%) .50 Pearson’s chi-squared
Telehealth follow-up 1 (33.3%) 58 (53.2%)

Fig. 2. Satisfaction at follow up: mean scores from in-person vs telehealth therapy.

Fig. 1. Satisfaction at evaluation: mean scores from in-person vs telehealth therapy.

non-operative patients: 55% (66) patients were non-operative and

45% (55) were post-operative. (Table 3) In both of the follow-up
groups (in-person and telehealth), the majority of patients were
postoperative. In the in-person follow-up group, only 19% (10)
patients were non-operative, while 81% (43) were postoperative.
In the telehealth follow-up group, 40% (24) patients were non-
operative, while 60% (35) were postoperative. The mean scores for
both in-person and telehealth initial evaluation visits range from
4.7 to 5.0 (Fig. 1). Similar results were observed when looking at
mean scores from in-person vs telehealth follow-up visits, with Fig. 3. Mean scores of overall satisfaction for in-person and telehealth for all visit
scores ranging from 4.8 to 5.0 (Fig. 2). We found that there were types.
no statistically significant differences in satisfaction observed be-
tween in-person and telehealth initial evaluation visits and follow-
up visits (Fig. 3, Table 3). Patient satisfaction also did not differ telehealth cohort, four people commented on the technology. A
by age (p = .60), age grouping (p = .43), gender (p = .93, insur- respondent in the telehealth cohort commented “This is the best
ance provider (p = .71), or operative status (p = .19) (Table 3). method of having PT. Even without COVID, I can do from home or
Each survey contained the question “What could we have done to if on travel [sic]. There are no interruptions that I would get in a PT
improve your experience?” A total of 55% of survey respondents facility” while another respondent in the same cohort commented
took the opportunity add a comment. Of those who commented, “personally, I like to do my PT in person.” In the in-person cohort,
44% replied with a variation of “nothing,” “n/a” or “not a thing” there were eight comments about improving the ease of schedul-
Other comments included feedback about specific therapists. In the ing appointments, compared to the telehealth cohort where there

Please cite this article as: A. MacKenzie, E. Papadopolous, G. Lisandrelli et al., Patient satisfaction with telehealth vs in-person hand
therapy: A retrospective review of results of an online satisfaction survey, Journal of Hand Therapy, https://doi.org/10.1016/j.jht.2022.11.
JID: HANTHE
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A. MacKenzie, E. Papadopolous, G. Lisandrelli et al. / Journal of Hand Therapy xxx (xxxx) xxx
was only one comment about improving the ease of appointment
scheduling.
Discussion
In a survey of hand therapists prior to the start of the COVID-
19 pandemic, telehealth was identified as a technology likely to
revolutionize the practice of hand therapy.29 Telehealth services
rapidly expanded at the start of the pandemic, ensuring that pa-
tients could continue to have access to healthcare services when
in-person treatment options were strictly limited due to shelter-in-
place guidelines. It is important to examine the patient experience
with alternative delivery models particularly in a hand therapy set-
ting, where care is traditionally hands-on in nature. We found that
patients receiving telehealth hand therapy services reported high
levels of satisfaction with scores ranging from 4.7 to 5.0 and that
there was no difference in patient satisfaction scores between pa-
tients who received in-person hand therapy visits compared to pa-
tients receiving telehealth hand therapy with either initial evalua-
tions or follow-up treatments. This is consistent with findings look-
ing at patient satisfaction with telehealth in other settings30 , 31 ;
however, this warrants further examination with patients receiving
hand therapy in a telehealth setting.
Worboys et.al (2018)11 found high levels of patient satisfaction
with telehealth with hand therapy patients in their small sample
of 18 participants. However, in the telehealth delivery model that
they studied, there was an Allied Health Assistant present on the
patient side to assist the treating telehealth therapist with taking
measurements as well as to assist with technology and set-up. In
addition, more than half of the patients in the study were in a sim-
ulated telehealth session, not attending a telehealth session from
home. This model was not feasible in our study.
Table 4
Diagnoses for in-person and telehealth initial evaluations.
Diagnosis:
Traumatic conditions:
Wrist fracture
Hand fracture
Elbow fracture
Extensor tendon injury
Elbow contracture
Flexor tendon injury
BPI
Dislocation, elbow
Dislocation, finger
Ulnar collateral ligament, thumb
Totals:
Non-traumatic Conditions:
Trigger finger
Lateral/medial epicondylitis
Rheumatologic conditions
Dupuytren’s
Osteoarthritis
Shoulder Pain
Wrist Pain
Carpal tunnel syndrome
Dequervain’s Tenosynovitis
Hand pain, stiffness
Triangular fibrocartilage injury
Carcinoma
Complex regional pain syndrome
Ganglion
Radial Nerve Palsy
Rotator Cuff Tear
Cubital tunnel syndrome
Wartenberg’s syndrome
Cerebrovascular accident
Totals:
Please cite this article as: A. MacKenzie, E. Papadopolous, G. Lisandrelli et al., Patient satisfaction with telehealth vs in-person hand
therapy: A retrospective review of results of an online satisfaction survey, Journal of Hand Therapy, https://doi.org/10.1016/j.jht.2022.11.
[mNS;April 1, 2023;20:48]
5
Hirth et al.28 surveyed patients in Australia with a broad range
of hand diagnoses and reported satisfaction with telehealth ther-
apy services, however there was no comparison made to levels of
satisfaction with in-person treatment, nor did they explore factors
that could relate to patient satisfaction. In addition, a broader def-
inition of satisfaction was used, with scores of one, two or three
out of seven indicating satisfaction.28 Because we issue patient sat-
isfaction surveys as standard practice for all outpatients at our fa-
cility, we were able to compare rates of satisfaction with in-person
visits to telehealth visits. We were also able to explore whether
patient factors such as gender or insurance provider had an impact
on satisfaction rates.
In both the in-person groups and the telehealth groups, oper-
ative and non-operative cases of wrist and hand fractures made
up the majority of diagnoses seen. (Table 4) There was more va-
riety in the diagnoses seen in the in-person group, and this may
be because this group had a larger sample size. Interestingly, there
were higher rates of diagnoses such as osteoarthritis, De Quervain’s
tenosynovitis and carpal and cubital tunnel syndromes in the tele-
health initial evaluation group (58% of non-traumatic conditions
in the telehealth group compared to 17% in the in-person initial
evaluation group). This could be due to a variety of factors. In our
clinic, these diagnoses are typically seen as one-time walk-in vis-
its directly from the physician’s office and may not be captured in
the in-person initial evaluation group during the time period we
were studying. In addition, people working from home in poten-
tially less-than-ideal ergonomic situations are more likely to de-
velop repetitive strain syndromes. We did not look at the overall
number of visits utilized between groups, but this could be an area
of further study to determine if patients tend to utilize more or
fewer visits in a telehealth model.
In-person initial evaluation: Telehealth initial evaluation:
23 11
12 6
9 1
5 2
3 0
3 0
2 0
2 0
1 2
0 2
60 24
12 4
9 1
9 2
5 1
5 10
4 1
4 1
3 5
3 4
1 0
2 2
1 0
1 1
1 0
1 1
1 0
0 2
1 0
0 1
63 36
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Patient satisfaction surveys are one metric used to determine
and improve quality of care. However, satisfaction is subjective and
can be difficult to measure.32 As there was no question on the sur-
vey that explicitly asked “How satisfied are you with your care?”,
we based overall patient satisfaction on the question “How likely
are you to recommend [our services] to friends and family?” This
question is a “Net Promoter Score (NPS)” and is considered to be
the gold standard of customer experience metrics.33 It is seen as
a discriminator of healthcare performance and was therefore used
to determine patient satisfaction with rehabilitation services. De-
pending on the patient’s response, they may fall into one of three
categories to establish the NPS score.33 Those scoring a 9 or a 10
are typically loyal and enthusiastic about the services rendered and
the company, which is why we chose those patients scoring a 9 or
10 on this question to be “satisfied.” Those with an 8 or below
were determined to be unsatisfied, as those scoring a 7 or 8 are
typically satisfied with services rendered but not happy enough to
promote the company’s business or services and those scoring 0-6
are unhappy customers, by definition of an NPS score.33 Centers for
Medicare and Medicaid (CMS) requires that hospitals report such
scores in order to receive funding.34 Future studies looking at tele-
health could look at other metrics of quality of care, such as pa-
tient reported outcome measures and objective outcome measures,
or questionnaires more specific to telehealth.
In both the telehealth and in-person groups, the questions that
scored the lowest were questions involving registration and ap-
pointment scheduling, while questions involving direct patient care
scored higher (Figs. 1 and 2). This was true in both groups and in-
dicates that the patient-therapist relationship was established in
the telehealth group, despite the virtual setting. In the telehealth
initial evaluation group, one question that scored lower was “How
would you rate the registration process?” In the in-person initial
evaluation group, the question that scored the lowest was “How
would you rate the ability to schedule an appointment?” The ques-
tion that scored lower in both telehealth groups was “How would
you rate the technology (picture and sound quality) and ease of
use?” In response to survey results, efforts have been made to im-
prove the registration and scheduling process, as well as having
an information technology expert available to assist the patient via
telephone with any technology challenges the patient may be hav-
ing.
Patel et al.35 found in a comparison of outpatient healthcare
visits before and during the pandemic, that use of telehealth for
outpatient physical therapy services dropped by more than 50%.
This is reflected in our satisfaction survey return rate in that the
number of patients was higher in the pre-pandemic in-person
group compared to the pandemic telehealth group. A closer look
at utilization of services would indicate whether we experienced a
similar drop off at our facility. Patel et al.35 also found that out-
patient physical therapy visits made up only a small percentage
of telehealth visits compared to other specialties, such as psychia-
try and endocrinology. This may be due to the fact that there are
fewer therapy visits in a similar time period, as these visits tend
to be longer than physician visits.
There may be several factors that contribute to successful
delivery of care via telehealth. These include focused sessions
without the distractions of a busy clinic, the ability to deliver care
without face masks and face shields, and the ability of patients
to demonstrate their exercises in their own homes.36 High rates
of patient satisfaction can have implications for providing hand
therapy to patients who may live in more remote locales or to
select patient populations by easing the burden of traveling to a
hand therapy clinic. Future studies can look at patient satisfaction
with telehealth hand therapy when there is not a pandemic
occurring and compare outcomes between patients who receive
Please cite this article as: A. MacKenzie, E. Papadopolous, G. Lisandrelli et al., Patient satisfaction with telehealth vs in-person hand
therapy: A retrospective review of results of an online satisfaction survey, Journal of Hand Therapy, https://doi.org/10.1016/j.jht.2022.11.
[mNS;April 1, 2023;20:48]
in-person and telehealth services. Future studies can also more
closely examine provider satisfaction with hand therapy services
delivered via telehealth.
A survey of hand therapists indicated that 78% of therapists felt
that telehealth would likely continue after the pandemic settles.37
In a survey of hand therapists 10 months into the pandemic, it was
found that operative cases were more likely to be seen in person,
whereas non-operative and patients 65 or older were more likely
to receive telehealth hand therapy. Telehealth was more likely to
be utilized in urban settings compared to suburban or rural set-
tings.38 This reinforces the importance of exploring patient satis-
faction with this service delivery method, especially as hand ther-
apists generally employ therapeutic touch in a typical therapy ses-
sion and feel that it is an important factor in patients achieving
successful outcomes.2 High patient satisfaction scores demonstrate
that telehealth in an outpatient hand therapy setting is a reason-
able method of delivery of care.
Limitations
There were several limitations to this study. First, the surveys
differed in certain questions between groups, and the surveys have
not been validated. In addition, survey items were scored on a 5-
star rating, similar to a Likert scale ranging from 1 to 5, however,
it is unclear if a star rating system directly translates to a Likert
scale.39
Furthermore, there was a relatively small sample size, partic-
ularly in the telehealth groups. This could be accounted for by
the fact that fewer people were undergoing elective surgeries in
the spring of 2020, and fewer people were participating in high-
risk activities during that period, leading to fewer injuries overall.
The surveys only capture a small portion of actual patients eval-
uated and treated and can, therefore, only be a sampling of pa-
tient satisfaction. The response rate for the study period of tele-
health initial evaluations was higher than the response rate from
the in-person initial evaluation visits, while the follow-up visit re-
sponse rate was similar between telehealth and in-person groups.
Non-response bias can have an impact on how data are interpreted
and what changes the hospital needs to make in response to sur-
vey results. One recent study found that hospital-based satisfaction
survey response rate has been in decline since 2008 from a high of
33.3% to 26.7% by 2017,40 which was similar to our response rate in
the initial evaluation telehealth group. A lower response rate may
not be reflective of what the patient perception is in the general
population. Survey fatigue could account for the lower rates of re-
turn amongst the follow-up visits in both the in-person and tele-
health groups. The surveys for follow-up visits were sent out after
the 10th visit for the in-person group and the telehealth follow-
up group, which were then switched to every 30 days. As a re-
sult, this study does not capture the satisfaction of patients who
had fewer than 10 visits or who have been on program less than
30 days. The higher rate of survey return in the telehealth initial
visit group could be reflective of enthusiasm for telehealth in the
early days of the pandemic, with the enthusiasm for surveys wan-
ing as the pandemic continued. As this study only captured tele-
health results during a six-month window of time at the start of
the pandemic (when in-person care was not an option), it is un-
known whether patients were eager to continue therapy in any
capacity and thus more understanding of any limitations inherent
in telehealth care. It is unclear what the patient satisfaction rates
would be with telehealth in a post-pandemic setting and worthy
of further exploration.
Furthermore, there were 10 patients in the two follow-up
groups who filled out more than one satisfaction survey. The sur-
veys reflect the patient experience at different time points and
JID: HANTHE
ARTICLE IN PRESS
A. MacKenzie, E. Papadopolous, G. Lisandrelli et al. / Journal of Hand Therapy xxx (xxxx) xxx
afford patients the opportunity to rate their experience through-
out the course of their care. All patients who replied more than
once did not change their satisfaction scores with the exception
of one patient in the telehealth follow-up group who went from a
score of 8 (unsatisfied) to a score of 10 (satisfied) with a change in
provider.
Conclusions
We found that patients receiving outpatient hand therapy ser-
vices report high levels of satisfaction, regardless of whether care
was delivered in-person or via telehealth. This demonstrates that
telehealth hand therapy is a reasonable service delivery method.
Acknowledgments
The authors wish to thank Gwen Weinstock-Zlotnick and Violet
Yuen for their assistance with this project.
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