The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

Abstract

Introduction The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health‐care expenditures. Methods We evaluated test quality among 338 adults with workers’ compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12‐item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. Results In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (−0.50 point; 95% confidence interval [CI], −0.89 to −0.12) and functional impairment (−0.42 point; 95% CI, −0.78 to −0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. Discussion Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.

Quality of electrodiagnostic testing for carpal tunnel syndrome: adherence to quality measures

“…Ideally, quality measures should be validated before widespread use. Work described in the accompanying study tested the validity of these quality measures by examining whether adherence was associated with differences in symptoms and functional limitations …”

“…The objective of the present research was to describe adherence to the electrodiagnosis quality measures in this study population . An accompanying study examined whether adherence to these measures was associated with differences in patient‐reported outcomes and health‐care expenditures …”

“…Few of the Ideally, quality measures should be validated before widespread use. Work described in the accompanying study tested the validity of these quality measures by examining whether adherence was associated with differences in symptoms and functional limitations 19. One barrier to future widespread use of these quality measures is the fact that abstracting data from individual test reports is time-consuming.…”

How can we get physicians to change their clinical behavior and embrace best practices?

“…Many clinicians believe that the diagnosis of CTS is based solely on clinical examination and that the electromyography (EMG) is simply confirmatory, with EDx results not influencing clinical management. However, the current studies demonstrate that adherence to guidelines does matter 2 . Now that there are studies demonstrating high‐quality EDx studies meaningfully impact their patients’ functional outcomes, we hope that clinicians will have the motivation to change.…”

“…Now that there are studies demonstrating high‐quality EDx studies meaningfully impact their patients’ functional outcomes, we hope that clinicians will have the motivation to change. However, even if EDx medicine specialists perform high‐quality EDx studies, it is not necessarily true that surgeons will use the information appropriately, such as put forth in the decision tree of Shetty et al 2 One of the authors of this editorial (R.A.W.) has participated as a member of national practice parameter committees with hand surgeons who are of the opinion that CTS is a surgical disorder.…”