Audit of a Therapist-led Clinic for Carpal Tunnel Syndrome in Primary Care

Abstract

An audit was designed to evaluate the effect on waiting times, did not attend (DNA) rates and quality of clinical management of a hand therapist-led clinic for Carpal Tunnel Syndrome (CTS) in Primary Care, and to investigate whether the clinic acted as an effective threshold mechanism for the Pulvertaft Hand Centre consultant clinics. Following a period of training with a senior consultant at the Pulvertaft Centre, an experienced hand therapist from the Centre worked out in Primary Care seeing patients with a provisional diagnosis of CTS who had been referred directly from General Practitioners (GPs). The referrals were assisted by the use of a local referral protocol. Tinel's and Phalen's tests were performed and areas of sensory loss were documented. A Levine Questionnaire was completed by the patient at an initial appointment and subsequently at review four to eight weeks later. Grip and pinch measurements were taken using a Jamar ® Dynamometer. Mild and moderate CTS can be effectively managed by a community-based Hand Therapy Clinic. Forty five percent of GP-referred CTS patients were successfully managed without referral onto the Hand Centre and did not require further treatment for CTS in the subsequent two years. The consultation length was 30 minutes per patient at the therapist-led clinic, compared with 15 minutes at the Hand Centre. Waiting times were reduced from 90 to 20 days, and the clinic had a low (3%) DNA rate. Wrist splints were expertly chosen and fitted and patients were educated and empowered about their condition. The Hand Therapy Clinic acted as a useful threshold mechanism for Tertiary Care Hand Centre CTS referrals, removing 46% of CTS referrals from the Hand Centre clinics. The proportion of Hand Clinic-referred patients requiring carpal tunnel decompression (CTD) was therefore increased to 62% from 33%. This community-based, hand therapist-led clinic for CTS management is consistent with current Health Service initiatives.

Investigating the Effectiveness of Full-Time Wrist Splinting and Education in the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial

“…Previous research has suggested that conservative management can reduce symptoms of mild CTS in its early phases (Uchiyama et al, 2010), when symptoms are transient (Piazzini et al, 2007;Rose & Probert, 2009;Storey, Dear, Bradley, Couchman, & Burke, 2008), but the results of the current study show that patients who have had symptoms of long duration can also experience relief. Patients with mild symptoms may achieve full recovery and require no surgical intervention following the conservative treatment program, and those with moderate and severe symptoms can learn management strategies to alleviate their symptoms (Rose & Probert, 2009;Storey et al, 2008). This conclusion is pertinent for the sample population in this study, who were experiencing lengthy waits for surgical consultation for CTS.…”

Development and implementation of a hand therapy extended scope practitioner clinic to support the 18-week waiting list initiative

“…Their audit established that mild and moderate CTS could be effectively managed by a community-based ESP clinic in a manner that is superior to that experienced by most CTS patients at a tertiary care clinic in terms of access, splint choice, patient information and empowerment. 8 In summary, the development of ESPs in hand therapy has improved access to a specialist opinion and improved continuity and quality of care. [5][6][7][8] However, there is still a need for further research in the form of randomized controlled trials to evaluate the effectiveness of ESPs in hand therapy.…”

Investigation of the conservative management of mallet injury in Irish acute hospitals

“…Reported benefits include a shortened patient pathway and timely detection of missed diagnoses in the case of wrist injuries; 16 greater patient turnover, increased patient satisfaction and improved continuity of care in the case of hand trauma; 17 and reduced waiting times and costs in the case of carpal tunnel syndrome. 18 The importance of early treatment of mallet injury has been advocated in the past, 6,19 but as there is no clear definition of what constitutes delayed presentation, comparison of outcomes of early versus delayed conservative management is difficult. Brzezienski and Schneider 20 state that 'the period of time after injury that this non-operative treatment can be delayed and still be effective is being extended and the absolute outside time limit is not known' (p. 385).…”