Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study

Abstract

Introduction There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activities; (iii) what wound care and rehabilitation advice should be provided after CTR. Methods We developed consensus recommendations from an expert panel of hand surgeons, primary care surgeons and hand therapists using an electronic Delphi process. Participants were recruited from clinical organisations using pre-defined criteria. Delphi questionnaires included open text and tick-box responses. Consensus was defined as ≥75% agreement and summary feedback was provided after each round. Results There were 33 panellists (21 surgeons and 12 hand therapists), of which 27 (82%) completed all rounds. Expected return to driving was agreed as 5–14 days. Expected timescales were also agreed for return to seven selected occupational activities. Post-operative advice focused on using and moving the hand, rather than specific rehabilitation. While consensus was reached for most items, there were important areas of disagreement, including divergent views on driving with sutures in situ and the need to inform car insurers. Conclusion Recommendations from this study expand on existing advice by including functional descriptors for occupational activities and guidance timescales generated through a formal consensus process. Areas where consensus was not reached warrant further exploration to assess whether different practices impact clinical and functional outcomes for patients.

Return to driving post upper or lower extremity orthopaedic surgical procedures: a scoping review of current published literature

“…( 62 ), Badger et al ( 63 ), McClelland et al . ( 64 ), Newington et al ( 65 ), Hammert et al ( 66 ), Acharya et al . ( 67 ), Murphy et al ( 68 ), Frazier et al ( 69 ) Immobilisation devices, ROM studies, guidelines Giddins et al ( 1 ), Rawal et al .…”

“…In total, 68 studies were identified meeting our study aims and inclusion criteria for both upper and lower extremity procedures ( Fig. 1 , Table 1 , Supplementary Tables 1 and 2) ( 1 , 14 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ). There was a wide variation in procedures performed and sample size, the study methodology, and measurements obtained.…”

“…There were 37 studies included for upper extremity procedures and guidelines ( 1 , 4 , 14 , 42 , 43 , 49 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ). Some studies reported dominant versus non-dominant limb, while others reported handedness.…”

“…Five studies assessed driving return post carpal tunnel release; all studies employed a questionnaire ( 65 , 66 , 67 , 68 , 69 ). Three assessed patients’ responses and two assessed physician’s advice.…”

“…In total, 68 studies were identified meeting our study aims and inclusion criteria for both upper and lower extremity procedures (Fig. 1, Table 1, Supplementary Tables 1 and 2) (1,14,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,<...…”