Measuring Outcomes in Hand Surgery

Background We prospectively studied patients clinically diagnosed with carpal tunnel syndrome (CTS) and treated with the injection of corticosteroid into their carpal tunnel in order to compare changes in the six-item CTS symptoms scale and portable nerve conduction study (NCS) parameters as outcome tools. Our pilot study was the first to assess the utility of the six-item CTS symptom scale (CTS-6) with steroid injections as a patient-directed outcome measure for the treatment of CTS. Methods We enrolled patients who presented to our county hospital orthopedic surgery clinic from August 2012 through August 2013. The patients were clinically diagnosed with CTS. After completing the six-item CTS symptoms scale questionnaire, portable NCS was obtained. Each patient then received an injection of 1 ml of triamcinolone acetonide 40 mg/ml mixed with 1 ml of 1 % lidocaine into the carpal tunnel. Six weeks postinjection, each patient repeated a CTS-6 questionnaire and underwent a repeat portable NCS. The CTS-6 and NCS results were analyzed using the paired samples t test. A Pearson correlation was used to assess the correlation between the changes in the CTS-6 and the NCS measurements. Statistical significance was set at P<0.05. Results Thirty-two wrists in 20 patients were evaluated. There was a statistically significant difference between the CTS-6 scores before and after injection. There were also statistically significant changes in the five of the NCS parameters. None of the correlations between the CTS-6 and the NCS parameters were statistically significant. Conclusions The six-item CTS symptoms scale and portable NCS are both useful measures for evaluating the results of steroid injections. The CTS-6 is an effective tool because of its ease of use, low cost, correspondence with changes in NCS, and ability to monitor the outcome of steroid treatment for carpal tunnel syndrome.

Section: Introductionmentioning

confidence: 99%

Prospective Comparison of the Six-Item Carpal Tunnel Symptoms Scale and Portable Nerve Conduction Testing in Measuring the Outcomes of Treatment of Carpal Tunnel Syndrome with Steroid Injection

Craw

Church

Hutchison

2014

Section: Introductionmentioning

confidence: 99%

“…2,10,11,14 Mounting evidence suggests that patient-to-patient variation in the PROMIS Upper Extremity and DASH scores is more strongly related to mood, coping strategies, and circumstances than to pathophysiology and objective impairment. 1,3,5,[10][11][12]18,22,23 The role of psychological factors in variation in MHQ scores is less well studied. 6,10,13,21,24 London et al noted that the mean MHQ scores were lower in patients categorized as having a high score on the Pain Catastrophizing Scale (PCS), but did not evaluate the correlation of ineffective coping strategies with hand-specific symptoms and limitations on the continuum on which they occur.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,5,[10][11][12]18,22,23 The role of psychological factors in variation in MHQ scores is less well studied. 6,10,13,21,24 London et al noted that the mean MHQ scores were lower in patients categorized as having a high score on the Pain Catastrophizing Scale (PCS), but did not evaluate the correlation of ineffective coping strategies with hand-specific symptoms and limitations on the continuum on which they occur. 16 We undertook this study to examine the relationship between commonly used psychological measures and the MHQ in patients with upper extremity illness.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Influence of Psychological Factors on the Michigan Hand Questionnaire

Drijkoningen

Menendez

et al. 2016

Background: Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. Methods: A cohort of 135 new or follow-up patients presenting to an urban academic hospital-based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression. Bivariate and multivariable analyses measured the correlation of these psychological measures with MHQ. Results: Accounting for potential confounding factors in multivariable regression, upper extremity disability as rated by the MHQ was independently associated with PROMIS Depression, PROMIS Pain Interference, visit type, and working status. The model accounted for 37% of the variability in MHQ scores, with PROMIS Pain Interference having the most influence. Conclusion: Among the non-pathophysiological factors that contribute to patient-to-patient variation in MHQ scores, the measure of less effective coping strategies and symptoms of depression were most influential. Our data add to the evidence of the pivotal role of emotional health in upper extremity symptoms and limitations and the importance of psychosocial considerations in the care of hand illness.

“…Patient-reported outcome measures allow surgeons to critically and objectively self-assess surgical outcomes and subsequently make decisions rooted in evidence as opposed to anecdote. On the national level, health care quality improvement has become a focus as health care delivery and reimbursement undergo rapid changes [1], including a shift toward value-based insurance models, which will require evidence-based patient-reported outcomes to help distinguish between high and low value services [2]. Despite the benefits of obtaining patientreported outcome measures, practical barriers with regard to traditional pen and paper data collection are significant, including the time, labor, and resourceintensive nature of this process, all of which may not be conducive to a high-volume practice setting [3].…”

Section: Introductionmentioning

confidence: 99%

The use of an iPad to Collect Patient-Reported Functional Outcome Measures in Hand Surgery

Yaffe

Goyal

Kokmeyer

et al. 2015

Background The purpose of this study was to evaluate (1) patient preferences regarding iPad and paper-based questionnaires, (2) the efficacy of iPad and paper questionnaires in a hand surgery practice, (3) the influence of questionnaire length on patient preferences and data collection, and (4) patient characteristics associated with a preference for iPad-based questionnaires. Methods Two hundred total patients in a single hand surgery practice were randomly assigned to one of four groups. Each group completed either the Michigan Hand Questionnaire (MHQ) or QuickDASH (QD) using either an iPad or pen and paper. Patient preferences, questionnaire completion and timing, and demographic data were analyzed. Results The use of an iPad was associated with a statistically stronger preference for the same delivery format in the future compared to paper for the MHQ (93.9 vs 52.1 %, p<0.001) and QD (90.0 vs 41.7 %, p<0.001). The MHQ iPad group found the survey "physically easy" more often compared to the MHQ paper group, while no difference was found among QD groups. Questionnaire timing between iPad and paper groups was similar for the MHQ but statistically longer with the iPad for QD. A significantly higher proportion of patients who preferred the iPad were under the age of 50 compared to those who preferred paper. Conclusions The addition of an iPad is an efficient and preferable questionnaire format for functional outcome assessment in a hand and upper extremity surgery practice setting. The iPad is particularly preferable for longer outcome questionnaires and for patients under the age of 50.