Remote Collection of Patient-Reported Outcomes Following Outpatient Hand Surgery: A Randomized Trial of Telephone, Mail, and E-Mail

Schwartzenberger, Justin; Presson, Angela P.; Lyle, Adam; O’Farrell, Andrew; Tyser, Andrew R.

doi:10.1016/j.jhsa.2017.05.002

Cited by 31 publications

(27 citation statements)

References 22 publications

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“…It can be assumed that nonrespondents would experience less discomfort and symptoms at the one-year follow-up after surgery whereas morbidity would be higher in respondents, thereby explaining their willingness to participate. Nevertheless, the response rate of 49 % in our study is comparable to the 42 % reported by Schwartzenberger et al (2020) for a mail survey of the BCTQ at 1 year after CTS surgery [26].…”

Section: Discussionsupporting

confidence: 87%

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Multanen

Uimonen

Repo

et al. 2021

BMC Musculoskelet Disord

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Background Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. Methods Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. Results Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p < 0.001) and postoperative (59 vs. 66; p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. Conclusions While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. Level of Evidence Level III.

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Section: Discussionsupporting

confidence: 87%

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Multanen

Uimonen

Repo

et al. 2021

BMC Musculoskelet Disord

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“…For the operating room group, BCTQ responses were previously obtained for patients treated with CTR for a prior study 22 conducted at our institution that had a wider scope. For the current study, we included only the subset of patients who had 1 year or greater follow-up after isolated open unilateral or bilateral CTR (eg, those undergoing additional simultaneous surgeries were excluded) performed by fellowship-trained orthopedic hand surgeons.…”

Section: Methodsmentioning

confidence: 99%

“…Specific details regarding the approach to data collection can be found in the original study, which included telephone, e-mail, and verbal score aquisition. 22 Differences in patient and surgical encounter demographics between the PR and operating room groups were compared using t tests for continuous variables and chi-square or Fisher exact test for categorical variables. To assess whether postoperative BCTQ scores between the PR and operating room groups were equivalent, we employed the 2 one-sided t test (TOST) procedure at , in which we tested whether the 90% confidence intervals (CIs) for the difference between PR and operating room groups fell within a prespecified range.…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Open Carpal Tunnel Release Outcomes Between Procedure Room and Operating Room Settings

Stephens

Tyser

Presson

et al. 2021

Journal of Hand Surgery Global Online

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Purpose: Carpal tunnel release (CTR) surgical costs are minimized when performed in the procedure room (PR) setting, compared with the operating room. However, it remains unclear whether outcomes differ between surgical settings. Our purpose was to compare outcomes at 1 year or greater follow-up after open CTR between patients treated in PR versus operating room settings using the Boston Carpal Tunnel Questionnaire (BCTQ). Methods: A change in clinical care protocols at our institution occurred in 2014. Before this, all CTRs were performed in the operating room; thereafter, these were transitioned to the PR. Adult patients who underwent isolated unilateral or bilateral open CTR in either surgical setting were considered for inclusion, in which procedures were conducted between January 2014 and October 2018 for the PR group and January 2009 and March 2014 for the operating room group. The Functional Status Scale (FSS) and the Symptom Severity Scale (SSS) components of the BCTQ were collected for all eligible patients at a minimum of 1 year after surgery. We used univariate and multivariable linear regression to determine whether postoperative BCTQ scores were equivalent between PR and operating room groups within a threshold of one-fourth of the lowest estimates of the minimal clinically important difference. Results: No differences in demographics, comorbidities, or insurance type were observed between the 104 PR and 112 operating room patients. Survey response rate was 25% and 25% for the PR and operating room patients, respectively. At a mean follow-up of 3 ± 1 years, FSS and SSS scores were equivalent between PR and operating room groups on bivariate analysis. The multivariable equivalence test also demonstrated equivalent FSS and SSS scores between PR and operating room groups within a one-fourth minimal clinically important difference threshold while controlling for age, sex, presence of diabetes or thyroid disease, unilateral versus bilateral CTR, and surgeon. Conclusions: Clinical outcomes did not differ between PR and operating room settings after open CTR. Type of study/level of evidence: Therapeutic III.

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“…In addition to the exponential growth of telehealth encounters, other areas of advancement that show promise or have been emphasised during this crisis are the collection of patient‐reported outcome measures (PROMs), and, in the present study, the collection of a DMH. Regarding PROMs, it is already known via prior research that having patients complete PROMs via email or other web‐based platforms can be an efficient way to routinely collect PROMs with less resource utilisation compared to telephone or traditional mail approaches (Schwartzenberger et al., 2017 ). However, other evidence suggests that PROMs response rates via email is lower than when PROMs are asked to be completed via telephone or traditional mail (Palmen et al., 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Digital medical history implementation to triage orthopaedic patients during COVID‐19: Findings from a rapid cycle, semi‐randomised A/B testing quality improvement project

Bernstein

Graaf

Meijers

et al. 2021

Musculoskeletal Care

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Introduction The COVID‐19 pandemic severely impacted musculoskeletal care. To better triage the notable backlog of patients, we assessed whether a digital medical history (DMH), a summary of health information and concerns completed by the patient prior to a clinic visit, could be routinely collected and utilised. Methods We analysed 640 patients using a rapid cycle, semi‐randomised A/B testing approach. Four rapid cycles of different randomised interventions were conducted across five unique patient groups. Descriptive statistics were used to report DMH completion rates by cycle/patient group and intervention. Multivariable logistic regression was used to determine whether age or anatomic injury location was associated DMH completion. Ethical Approval N/A (Quality Improvement Project) Results Across all patients, the DMH completion rate was 48% (307/640). Phone calls were time consuming and resource intensive without an increased completion rate. The highest rate of DMH completion was among patients who were referred and called the clinic themselves (78% of patients [63 out of 81 patients]). Across all patients, increasing age (odds ratio [OR]: 0.985 (95% CI: 0.976–0.995), p = 0.002), patients with back concerns (OR: 0.395 (95% CI: 0.234–0.666), p = 0.001), and patients with non‐specific/other musculoskeletal concerns (OR: 0.331 (95% CI: 0.176–0.623), p = 0.001) were associated with decreased odds of DMH completion. Discussion and Conclusion DMHs can be valuable in helping triage orthopaedic patients in resource‐strapped settings, times of crisis, or as we transition towards value‐based health care delivery. However, further work is needed to continue to increase the completion rate about 50%.

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Remote Collection of Patient-Reported Outcomes Following Outpatient Hand Surgery: A Randomized Trial of Telephone, Mail, and E-Mail

Cited by 31 publications

References 22 publications

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Use of conservative therapy before and after surgery for carpal tunnel syndrome

A Comparison of Open Carpal Tunnel Release Outcomes Between Procedure Room and Operating Room Settings

Digital medical history implementation to triage orthopaedic patients during COVID‐19: Findings from a rapid cycle, semi‐randomised A/B testing quality improvement project

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