Surgeon Ratings of the Severity of Idiopathic Median Neuropathy at the Carpal Tunnel Are Not Influenced by Magnitude of Incapability

Abstract

Background Accurately distinguishing the severity of pathophysiology from the level of symptom intensity and incapability is a foundation of effective treatment strategies under the biopsychosocial paradigm of illness. With respect to idiopathic median neuropathy at the carpal tunnel (the symptoms and signs of which are referred to as carpal tunnel syndrome), surgeons who are more likely to recommend surgery based on the magnitude of symptoms and incapability rather than the severity of neuropathy may be underappreciating and undertreating mental health opportunities and overtreating mild, and on occasion unmeasurable, disease. A survey-based experiment that randomizes elements of the patient presentation can help determine the relative influence of magnitude of incapability on ratings of pathology severity. Question/purpose What factors are associated with severity rating of idiopathic median neuropathy at the carpal tunnel on an 11-point ordinal scale? Methods One hundred eight hand and wrist members of the Science of Variation Group (among approximately 200 participants who complete at least one survey-experiment a year related to the upper extremity on average) reviewed seven scenarios of fictional median neuropathy with seven randomized variables: age, gender, limitations of daily activity (incapability), Tinel and Phalen test results, duration of numbness episodes, prevention of numbness with nocturnal splint immobilization, constant numbness, and weakness of palmar abduction. Participants had a mean age of 51 6 10 years, 90% (97 of 108) were men, and 74% (80 of 108) were subspecialized in hand surgery. Surgeons were asked to rate the severity of idiopathic median neuropathy at the carpal tunnel on a on an 11-point ordinal scale. Factors associated with rated severity were sought in multilevel ordered logistic regression models. Fifteen surgeons did not complete all of their assigned randomized scenarios, resulting in a total of 675 ratings.a Members of the SOVG are listed in an Appendix at the end of this article. Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Surgeon Implicit Association of Women With Supportive Roles in Medicine

“…In the SOVG, a core group of approximately 200 surgeons participate in at least one survey experiment per year. 18 The survey roster included 826 e-mail addresses for surgeons, some of which may be retired or nonworking addresses. A total of 102 participants completed the questionnaire and IAT and were thus included in this study.…”

Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound

“…Excluding severe IMNCT, we theorized there would be two probability classes: mild-to-moderate but nonsevere IMNCT, where surgery might have more potential for benefit than for harm because it addresses pathophysiology and provides more than the expected nonspecific effects of treatments such as surgery, and no or very mild IMNCT, where surgery might not have sufficient potential for benefit to balance the inherent and potential harms associated with surgery. We grouped very mild with no IMCNT because the distinction is difficult and based on the rationale that very mild IMNCT is treated nonoperatively because it is not detectable IMNCT [12,16]. More classes are possible, but we are not certain whether they are useful to patients and specialists.…”

CORR Insights®: Surgeon Ratings of the Severity of Idiopathic Median Neuropathy at the Carpal Tunnel Are Not Influenced by Magnitude of Incapability

“…Workers at the plant increased their productivity when they were being observed during the study, but productivity declined when the study finished [6]. In the study by Sarwar et al [5] in this month’s Clinical Orthopaedics and Related Research ® , the Hawthorne effect may particularly be in play because the group of surgeons was surveyed on their assessment of disease severity under the premise of studying the non-objective methods influencing patient evaluation and its effect on the surgeon’s decision-making process.…”

“…The authors [5] should be commended for their efforts to better understand the nuances of tying objective findings to subjective patient complaints to form a clinical assessment. It was reassuring to see that the group of surgeons included in the study considered the factors we have all been taught to focus on as the ones that are the most valuable in assessing severity.…”