Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design

Conlon, Craig; Asch, Steven M.; Hanson, Mark; Avins, Andrew L.; Levitan, Barbara; Roth, Carol P.; Robbins, Michael W.; Dworsky, Michael; Seabury, Seth A.; Nuckols, Teryl K.

doi:10.7812/tpp/15-220

Cited by 7 publications

(21 citation statements)

References 37 publications

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“…This comparison may be helpful clinically in identifying a subgroup of patients with significant motor weakness, as well as quantifying the amount of motor loss. 26 The main limitations of this study stem from its retrospective nature. We had 36% males since the study was performed in a "blue collar" area with a relatively high percentage of laborers.…”

Section: Discussionmentioning

confidence: 96%

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Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

et al. 2017

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The relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.

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Section: Discussionmentioning

confidence: 96%

“…[23][24][25] Other studies have evaluated the effect of accurate diagnosis. 26 The best method to diagnose CTS has long been debated in the literature. 27,28 Sometimes considered an occupational condition, the need for a standardized, objective, and reliable diagnostic tool has not consistently been met.…”

Section: Discussionmentioning

confidence: 99%

Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

et al. 2017

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“…To evaluate quality of care, we reviewed electronic medical records. To assess outcomes, survey researchers interviewed subjects by telephone at baseline (August 2011–March 2013) and at follow‐up (May 2013–October 2014) …”

Section: Methodsmentioning

confidence: 99%

“…10 (August 2011-March 2013) and at follow-up (May 2013-October 2014). 11,12 Participants. Specialists in 30 KPNC Occupational Health Centers treat 45,000 individuals with workers' compensation claims annually.…”

Section: Methodsmentioning

confidence: 99%

Quality of care and patient‐reported outcomes in carpal tunnel syndrome: A prospective observational study

et al. 2018

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“…We found that, during the first year of treatment, 80% of care for CTS adhered to the quality measures' basic standards. Notably, receiving better care was associated with larger improvements in patient‐reported symptoms of CTS, CTS‐related functional status, and overall health‐related quality of life over an 18‐month follow‐up period …”

Section: Introductionmentioning

confidence: 98%

Quality of electrodiagnostic testing for carpal tunnel syndrome: adherence to quality measures

et al. 2020

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Introduction Research has shown that quality of health‐care services is often suboptimal. Little is known about the quality of electrodiagnostic testing. Methods We prospectively recruited 477 adults with workers' compensation claims for carpal tunnel syndrome (CTS) from 30 occupational health clinics and evaluated whether electrodiagnostic testing adhered to five process‐oriented quality measures. Results Among patients who had surgery for CTS, nearly all underwent recommended preoperative electrodiagnostic testing (measure #1, 170 of 174, 97.7%). Most electrodiagnostic tests included essential components (measure #2, 295 of 379, 77.8%). However, few reports documented skin temperature (measure #3, 93 of 379, 24.5%) and criteria were seldom met for interpreting test findings as consistent with CTS (measure #4, 41 of 284, 14.4%) or “severe” CTS (measure #5, 8 of 46, 17.4%). Discussion Most patients underwent testing before surgery, but test quality was often suboptimal. This work lays the groundwork for future efforts to monitor and improve the quality of electrodiagnostic testing for CTS.

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Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design

Cited by 7 publications

References 37 publications

Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

Quality of care and patient‐reported outcomes in carpal tunnel syndrome: A prospective observational study

Quality of electrodiagnostic testing for carpal tunnel syndrome: adherence to quality measures

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