Clinical quality measures for electrodiagnosis in suspected carpal tunnel syndrome

Abstract

Extensive research has documented that medical care in the United States is not of optimal quality, meaning that well-established care processes are not consistently provided to the patients who would benefit from them. To assess and improve quality of care, specific measures are needed. The objective of this study was to develop quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome (CTS). We used a variation of the well-established RAND/UCLA Appropriateness Method to develop the measures. A physiatrist and quality measurement experts developed draft measures based on guidelines and literature. Subsequently, in a two-round, modified-Delphi process, a multidisciplinary panel of 11 national experts in CTS reviewed a summary of the evidence and then rated the measures for validity and feasibility. Seven draft measures were developed. The expert panel combined two, modified the others, and then judged all resulting measures to be valid and feasible. The measures cover compelling indications for testing, essential test components when CTS is suspected, skin temperature measurement and normalization, and the appropriate interpretation of test results. These measures define a minimum standard of care for the use of electrodiagnostic tests in suspected CTS and are consistent with recent guidelines developed by the American Association of Neuromuscular and Electrodiagnostic Medicine. Provider organizations, insurance companies, and professional societies can use these measures in efforts to monitor and improve quality of care for this common and disabling condition.

Antidromic vs orthodromic sensory median nerve conduction studies

“…It is also generally accepted that the study of short segments of the nerve across the site of compression increases the sensitivity of the study (Jablecki et al, 2002). In fact, one of the most sensitive tests recommended for the assessment of compression of the median nerve at the wrist is stimulation at the palm and recording over the wrist at a distance of 8 cm (Jablecki et al, 2002, Sandin et al, 2010). …”

“…The neurophysiological study of CTS is not fully standardized but, instead, many methods have been described and are being used without consensus. To begin with, there is no universal agreement on whether to use antidromic or orthodromic techniques and no advice on that matter has been issued in various guidelines published so far (Jablecki et al, 2002, Sandin et al, 2010, Basiri and Katirji, 2015). …”

Clinical Quality Measures for Intraoperative and Perioperative Management in Carpal Tunnel Surgery

“…Here, we report on the first two steps and the results of early pilot testing. This was one aspect of an effort to develop quality measures for carpal tunnel syndrome; other measures have been reported separately [16, 17, 21]. …”

Quality Measures for the Diagnosis and Non-Operative Management of Carpal Tunnel Syndrome in Occupational Settings

“…We also developed measures to assess the quality of electrodiagnostic testing [19], whether carpal tunnel release surgery is performed for appropriate indications [20], and the quality of peri-operative management; these measures are being reported elsewhere.…”