title: Barriers to Reconstructive Hand Surgery for Rheumatoid Arthritis in China: A Multicenter Survey of Patients and Physicians.
abstract: BACKGROUND
  China has a similar rheumatoid arthritis (RA) disease burden compared with other countries, yet RA patients rarely receive surgical treatment for hand deformities that limit function and impact appearance. We investigated potential barriers to rheumatoid hand surgery in China.
  
  
  METHODS
  Patients with RA, rheumatologists, and hand surgeons at 3 large tertiary hospitals in Beijing completed questionnaires that assess knowledge and attitudes surrounding RA hand surgery. We calculated descriptive statistics and compared responses among groups using chi-square and Fisher exact tests as appropriate.
  
  
  RESULTS
  One hundred RA patients with hand deformities and 94 physicians completed the surveys. No patients had received hand surgery, and just 13% were aware of this treatment option. Patients and physicians most frequently cited uncertain effectiveness of surgery, high cost, and risk of surgical complications as potential barriers to hand reconstruction. Rheumatologists reported low rates of referral to hand surgeons (39% referred <5% of the time and 31% never referred). Most hand surgeons (69%) had not performed metacarpophalangeal arthroplasty, a common procedure for RA hand deformities, within the past year. Some had never performed this operation.
  
  
  CONCLUSIONS
  This survey revealed multiple barriers that support previous observations of infrequent reconstruction of RA hand deformities in China. These obstacles can be addressed through patient education, coordination between specialists, and more robust hand surgeon training in common RA procedures through the application of international plastic surgery collaborations.
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Franzblau
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Xuebing
authors.initials: X
authors.lastname: Liang
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Keming
authors.initials: K
authors.lastname: Wang
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Zhanguo
authors.initials: Z
authors.lastname: Li
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Yingni
authors.initials: Y
authors.lastname: Li
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Melissa
authors.initials: M
authors.lastname: Shauver
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich. (L.E.F.); Plastic Surgery Hospital and 17th Department of Plastic Surgery, Plastic Surgery Hospital (K.W.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (X.L.); Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China (Z.L., Y.L.); and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. (M.S., K.C.C.).
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung