Geographic Disparities in Access to Certified Hand Therapists in the United States

Abstract

Purpose: Access to a certified hand therapist (CHT) enhances postoperative functional outcomes and reduces morbidity in complex hand surgery and in traumatic injuries that necessitate targeted rehabilitation. However, CHTs are unequally distributed across regions, resulting in access disparities. This study investigated the accessibility of CHT services in the United States by analyzing physical proximity to CHTs and estimated associated personal ground transportation costs.

Methods: County-level distances to the nearest CHT were mapped and evaluated. Transportation costs were calculated using 2024 US Internal Revenue Service standard mileage rates ($0.67 per mile [$0.42/km]). Counties, selected as the geographic unit because of national data availability, were classified as Urban (1-3) or Rural (4-9) based on 2023 Rural-Urban Continuum Codes (RUCCs). Independent t tests compared travel distance in rural and urban counties. Multivariable analyses were performed to evaluate the association of RUCC with distance to nearest CHT.

Results: Distance traveled to nearest CHT provider and travel costs differed significantly between urban and rural counties. On average, individuals in rural counties must travel 38.75 miles (cost of $26.00) to reach a CHT, compared with 13.55 miles (cost of $9.10) for those in urban areas. Rural-Urban Continuum Code is a predictor of travel distance, with each increase in RUCC corresponding to a 4.77-mile increase in travel.

Conclusions: Geographic disparities exist in access to CHTs across the United States, creating potential barriers to optimal rehabilitation outcomes.

Clinical relevance: Limited access to CHTs places a substantial physical and potential economic burden on patients given the frequency and duration of rehabilitation. Further investigation into sociodemographic factors may help identify actionable solutions to improve equitable access nationwide.

Keywords: Access to care; equity; hand surgery; rehabilitation; therapy.