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Soydaş D, Makal Orğan E, Yıldız Fındık Ü, Gökce Işıklı A. The relationship between the perception of surgical fear and nursing satisfaction. J Perioper Pract 2023; 33:380-385. [PMID: 36515433 DOI: 10.1177/17504589221137983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Since patient satisfaction is considered a criterion in the evaluation of nursing care, it is important and necessary to know the factors associated with satisfaction. The aim of this study is to determine the relationship between surgical fear and satisfaction with nursing care in surgical patients. This descriptive correlational study was conducted with 110 patients who underwent planned major surgical intervention in a university hospital in Turkey. A patient introduction form, the Surgical Fear Questionnaire and Newcastle Satisfaction with Nursing Care Scale were used to collect data, as well as a face to face interview with patients during the pre and postoperative periods. The results showed that the surgical fear levels of the patients were low, their satisfaction with nursing care was high, and a weak correlation existed between the fear and satisfaction levels. We recommend nursing care interventions aimed at keeping the surgical fear levels of patients low and their satisfaction high.
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Affiliation(s)
- Duygu Soydaş
- Nursing Department, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Esra Makal Orğan
- Nursing Department, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Ümmü Yıldız Fındık
- Nursing Department, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Ayşe Gökce Işıklı
- Health Research and Practice Centre, Thoracic Surgery Department, Trakya University, Edirne, Turkey
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Sajak PMJ, Kaveeshwar S, Aneizi A, Hahn A, Burt CI, Ventimiglia DJ, Stevens KN, Akabudike NM, Pensy RA, Henn III RF. Preoperative Expectations in Hand Surgery Patients. J Hand Microsurg 2023; 15:299-307. [PMID: 37701314 PMCID: PMC10495209 DOI: 10.1055/s-0042-1748782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introduction Studies have shown a link between patients' preoperative expectations and their postoperative satisfaction. However, limited studies exist concerning patient factors associated with higher preoperative expectations in the hand surgery population. This study analyzed preoperative expectation scores of patients undergoing hand surgery and aimed to determine associated patient characteristics. Materials and Methods A total of 418 elective hand surgery patients aged 15 years and older enrolled in a prospectively collected orthopaedic registry from June 2015 to December 2018 were analyzed. Patients were administered preoperative questionnaires including six Patient-Reported Outcome Measurement Information System domains and other activity and pain scales. Expectation scores were measured using the six domains of the Musculoskeletal Outcomes Data Evaluation and Management System expectations questionnaire. Bivariate and multivariable analyses were conducted to identify independent predictors of higher expectations. Results Overall, patients had high expectations (≥ 80.0) of their hand surgery. Higher mean expectation scores were seen with females, college graduates, better baseline health status, and fewer prior hand surgeries ( p < 0.05 for all). No significant associations were found among the Common Procedural Terminology codes and expectations. Multivariable analysis confirmed that college degree ( p = 0.023) and less pain ( p = 0.008) were predictive of higher baseline expectations. Conclusion In sum, more educated patients with less pain at baseline and better baseline health status have higher expectations of their hand surgery. Hand surgeons can use these results to help focus their preoperative counseling and expectation management.
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Affiliation(s)
- Patrick M. J. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Alexander Hahn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Dominic J. Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Kali N. Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, United States
| | - Ngozi M. Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Raymond A. Pensy
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - R. Frank Henn III
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
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Twardowska M, Czarnecki P, Jokiel M, Bręborowicz E, Huber J, Romanowski L. Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1404. [PMID: 37629694 PMCID: PMC10456912 DOI: 10.3390/medicina59081404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.
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Affiliation(s)
- Marta Twardowska
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Marta Jokiel
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Ewa Bręborowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland;
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
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Stock LA, Brennan JC, Johnson AH, Gelfand J, Turcotte JJ, Jones C. Disparities in Hand Surgery Exist in Unexpected Populations. Cureus 2023; 15:e39736. [PMID: 37398773 PMCID: PMC10310399 DOI: 10.7759/cureus.39736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Background The purpose of our study is to investigate disparities in the patient populations and outcomes of carpal tunnel release (CTR) and trigger finger release (TFR). Methods A retrospective review of 777 CTR and 395 TFR patients from May 2021 to August 2022 was completed. The shortened form of the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (QuickDASH) was recorded to evaluate physical function preoperatively and at one and three months postoperatively. This study was deemed institutional review board-exempt by the institutional clinical research committee. Results Compared to CTR, TFR patients resided in zip codes with higher levels of social vulnerability across dimensions of 'household composition and disability' (p=0.018) and 'minority status and language' (p=0.043). When analyzing QuickDASH scores by demographics and procedure, preoperative scores were statistically significantly higher for non-married (p=0.002), White (p=0.003), and female sex (p=0.001) CTR patients. Further, one-month postoperative scores were statistically higher for White and non-married CTR patients (0.016 and 0.015, respectively). At three months postoperatively, female and non-married patients had statistically significant higher scores (0.010 and 0.037, respectively). In TFR patients, one-month postoperative QuickDASH scores for White and female patients were statistically significantly higher (0.018 and 0.007, respectively). There were no significant differences in QuickDASH scores between rural and non-rural patients, household income (HHI) above or below the median, or the Social Vulnerability Index (SVI) dimensions. Conclusion Our study found marital status, sex, and race were associated with disparities in pre-and postoperative physical function in patients undergoing carpal tunnel or trigger finger release. However, future studies are warranted to confirm and develop solutions to disparities within this population.
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Affiliation(s)
- Laura A Stock
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Jane C Brennan
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Andrea H Johnson
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Jeffrey Gelfand
- Orthopedic Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Justin J Turcotte
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Christopher Jones
- Orthopedic Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, USA
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Crijns TJ, Segina P, Kortlever JTP, Thomas JE, Ring D, Reichel L, Vagner G, Ramtin S. Moderators and Mediators of the Relationship of Shared Decision-Making and Satisfaction. J Patient Exp 2023; 10:23743735231171563. [PMID: 37138951 PMCID: PMC10150427 DOI: 10.1177/23743735231171563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Background:Evidence suggests that health literacy, perceived availability of information and guidance to adapt to challenges (informational support), and symptoms of depression all have the potential to mediate or moderate the relationship between patient-rated involvement in decisions and satisfaction with care. If so these could be useful targets for improving patient experience. Methods: We prospectively enrolled 130 new adult patients visiting an orthopedic surgeon over a 4-month period. All patients were asked to complete measures of satisfaction with care (21-item Medical Interview Satisfaction Scale), perceived involvement in decisions (9-item Shared Decision-Making Questionnaire), symptoms of depression (the Patient-Reported Outcomes Measurement Information Scale [PROMIS] Depression Computerized Adaptive Test [CAT]), perceived availability of information and guidance to adapt to challenges (PROMIS Informational Support CAT), and the Newest Vital Sign test of health literacy. Results: The strong correlation between satisfaction with care (ρ = 0.60, P < .001) and perceived involvement in decisions was neither mediated nor moderated by health literacy, perceived availability of information and guidance, and symptoms of depression. Conclusions: The observation that patient-rated shared decision-making is strongly related to satisfaction with an office visit, independent of health literacy, perceived support, and symptoms of depression, is consistent with evidence that various measures of patient experience tend to correlate and emphasizes the importance of the patient-clinician relationship. Level of Evidence: Level II, prospective study.
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Affiliation(s)
- Tom J Crijns
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Paxton Segina
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Joost T P Kortlever
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Jacob E Thomas
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - David Ring
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
- David Ring, Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Health Discovery Building 6.706; 1701 Trinity St., Austin, TX 78712, USA.
| | - Lee Reichel
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Gregg Vagner
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
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Sarwar F, Teunis T, Ring D, Reichel LM, Crijns T, Fatehi A. Surgeon Ratings of the Severity of Idiopathic Median Neuropathy at the Carpal Tunnel Are Not Influenced by Magnitude of Incapability. Clin Orthop Relat Res 2022; 480:1143-1149. [PMID: 34817441 PMCID: PMC9263495 DOI: 10.1097/corr.0000000000002062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/01/2021] [Indexed: 01/31/2023]
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 ± 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. RESULTS After controlling for potentially confounding variables such as magnitude of incapability, factors associated with severity rating on the 11-point ordinal scale included palmar abduction weakness (odds ratio 11 [95% confidence interval 7.7 to 15]), longer duration of symptom episodes (OR 4.5 [95% CI 3.3 to 6.2]), nocturnal numbness in spite of splint immobilization (OR 3.2 [95% CI 2.3 to 4.3]), constant numbness (OR 2.5 [95% CI 1.9 to 3.4]), positive Tinel and positive Phalen test results (OR 2.2 [95% CI 1.6 to 2.9]), and older age (OR 1.6 [95% CI 1.2 to 2.1]). CONCLUSION Our results suggest that surgeons rate the severity of idiopathic median neuropathy at the carpal tunnel based on evidence of worse pathophysiology and are not distracted by greater incapability. CLINICAL RELEVANCE Surgeons who consider greater incapability as an indication of more severe pathology seem to be practicing outside the norm and may be underappreciating and undertreating the unhelpful thoughts and feelings of worry or despair that consistently account for a notable amount of the variation in symptom intensity and magnitude of incapability.
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Affiliation(s)
- Faiza Sarwar
- Department of Orthopedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, Texas
| | - Teun Teunis
- Plastic Surgery Department, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Orthopedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, Texas
| | - Lee M. Reichel
- Department of Orthopedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, Texas
| | - Tom Crijns
- Department of Orthopedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, Texas
| | - Amirreza Fatehi
- Department of Orthopedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, Texas
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Crijns TJ, Brinkman N, Ramtin S, Ring D, Doornberg J, Jutte P, Koenig K. Are There Distinct Statistical Groupings of Mental Health Factors and Pathophysiology Severity Among People with Hip and Knee Osteoarthritis Presenting for Specialty Care? Clin Orthop Relat Res 2022; 480:298-309. [PMID: 34817453 PMCID: PMC8747586 DOI: 10.1097/corr.0000000000002052] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is mounting evidence that objective measures of pathophysiology do not correlate well with symptom intensity. A growing line of inquiry identifies statistical combinations (so-called "phenotypes") of various levels of distress and unhelpful thoughts that are associated with distinct levels of symptom intensity and magnitude of incapability. As a next step, it would be helpful to understand how distress and unhelpful thoughts interact with objective measures of pathologic conditions such as the radiologic severity of osteoarthritis. The ability to identify phenotypes of these factors that are associated with distinct levels of illness could contribute to improved personalized musculoskeletal care in a comprehensive, patient-centered model. QUESTIONS/PURPOSES (1) When measures of mental health are paired with radiologic osteoarthritis severity, are there distinct phenotypes among adult patients with hip and knee osteoarthritis? (2) Is there a difference in the degree of capability and pain self-efficacy among the identified mental health and radiologic phenotypes? (3) When capability (Patient-reported Outcomes Measurement Information System Physical Function [PROMIS PF]) is paired with radiographic osteoarthritis severity, are there distinct phenotypes among patients with hip and knee osteoarthritis? (4) Is there a difference in mental health among patients with the identified capability and radiologic phenotypes? METHODS We performed a secondary analysis of data from a study of 119 patients who presented for musculoskeletal specialty care for hip or knee osteoarthritis. Sixty-seven percent (80 of 119) of patients were women, with a mean age of 62 ± 10 years. Seventy-six percent (91 of 119) of patients had knee osteoarthritis, and 59% (70 of 119) had an advanced radiographic grade of osteoarthritis (Kellgren-Lawrence grade 3 or higher). This dataset is well-suited for our current experiment because the initial study had broad enrollment criteria, making these data applicable to a diverse population and because patients had sufficient variability in radiographic severity of osteoarthritis. All new and returning patients were screened for eligibility. We do not record the percentage of eligible patients who do not participate in cross-sectional surveys, but the rate is typically high (more than 80%). One hundred forty-eight eligible patients started the questionnaires, and 20% (29 of 148) of patients did not complete at least 60% of the questionnaires and were excluded, leaving 119 patients available for analysis. We measured psychologic distress (Patient Health Questionnaire-2 [PHQ-2] and Generalized Anxiety Disorder-2 questionnaire [GAD-2]), unhelpful thoughts about pain (Pain Catastrophizing Scale-4 [PCS-4]), self-efficacy when in pain (Pain Self-Efficacy Questionnaire-2), and capability (PROMIS PF). One of two arthroplasty fellowship-trained surgeons assigned the Kellgren-Lawrence grade of osteoarthritis based on radiographs in the original study. We used a cluster analysis to generate two sets of phenotypes: (1) measures of mental health (PHQ-2, GAD-2, PCS-4) paired with the Kellgren-Lawrence grade and (2) capability (PROMIS PF) paired with the Kellgren-Lawrence grade. We used one-way ANOVA and Kruskal-Wallis H tests to assess differences in capability and self-efficacy and mental health, respectively. RESULTS When pairing measures of psychologic distress (PHQ-2 and GAD-2) and unhelpful thoughts (catastrophic thinking) with the grade of radiographic osteoarthritis, six distinct phenotypes arose. These groups differed in terms of capability and pain self-efficacy (for example, mild pathology/low distress versus average pathology/high distress [PROMIS PF, mean ± standard deviation]: 43 ± 6.3 versus 33 ± 4.8; p = 0.003). When pairing the degree of capability (PROMIS PF) with the Kellgren-Lawrence grade, four distinct phenotypes arose. Patients in three of these did not differ in terms of disease severity but had notable variation in the degree of limitations. Patients with these radiologic and capability phenotypes differed in terms of distress and unhelpful thoughts (for example, moderate pathology/low capability versus mild pathology/high capability [PHQ-2, median and interquartile range]: 3 [1 to 5] versus 0 [0 to 0]; p < 0.001). CONCLUSION Statistical groupings ("phenotypes") that include both measures of pathology and mental health are associated with differences in symptom intensity and magnitude of incapability and have the potential to help musculoskeletal specialists discern mental and social health priorities. Future investigations may test whether illness phenotype-specific comprehensive biopsychosocial treatment strategies are more effective than treatment of pathology alone. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Tom J. Crijns
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Job Doornberg
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Paul Jutte
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Núñez-Cortés R, Cruz-Montecinos C, Torres-Castro R, Tapia C, Püschel TA, Pérez-Alenda S. Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:1615-1627. [PMID: 34861234 DOI: 10.1016/j.apmr.2021.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR). DATA SOURCES Embase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021. STUDY SELECTION Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR. DATA EXTRACTION Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis. DATA SYNTHESIS A total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low. CONCLUSIONS This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom; Primate Models for Behavioural Evolution Lab, Institute of Cognitive and Evolutionary Anthropology, School of Anthropology, University of Oxford, Oxford, United Kingdom
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.
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Shen YP, Li TY, Chou YC, Chen LC, Wu YT. Outcome predictors of platelet-rich plasma injection for moderate carpal tunnel syndrome. Int J Clin Pract 2021; 75:e14482. [PMID: 34107143 DOI: 10.1111/ijcp.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Platelet-rich plasma (PRP) injection is effective for mild-to-moderate carpal tunnel syndrome (CTS), and physicians have been using PRP injections to treat CTS. However, the predictive factors of PRP injections have not been evaluated. This retrospective study sought to identify the predictive factors of PRP injections in patients with moderate CTS. METHODS Seventy-one patients with moderate CTS receiving single PRP injections were enrolled. The outcomes at the third- and sixth-month postinjection visits were categorised into good and poor groups according to the following: (1) good outcome, with visual analogue scale (VAS) score decrease ≧50% and (2) poor outcome, with VAS score decrease <50% of preinjection scores. Significant variables between groups were entered into a binary logistic regression to determine the predictive factors. RESULTS The baseline body weight (BW), distal motor latency (DML), sensory nerve conduction velocity (SNCV), and cross-sectional area (CSA) of the median nerve were significantly different between the groups in the third month. The odds ratios (ORs) of all features were significant, except for SNCV (BW, OR: 0.911; P = .016; DML, OR: 0.383; P = .028; CSA, OR: 0.694; P = .003), and they remained significant in the sixth month (BW, OR: 0.909; P = .004; DML, OR: 0.530; P = .011; CSA, OR: 0.828; P = .032). CONCLUSION Lower BW, DML, and CSA values of the median nerve predict better outcomes after perineural injection of PRP for moderate CTS at the 3- and 6-month follow-ups.
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Affiliation(s)
- Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Hama S, Okada M, Yokoi T, Uemura T, Nakamura H. Pain and numbness one month after carpal tunnel release predict patient-reported outcome measures at sixth months. J Plast Surg Hand Surg 2021; 56:167-171. [PMID: 34324405 DOI: 10.1080/2000656x.2021.1953041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A number of outcome predictors for carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) have been reported. However, some predictors are controversial, and few studies have referred to the early postoperative outcome prognostic factors after CTR. The aim of this study was to investigate whether pain and numbness at 1 month post-CTR were early postoperative predictors of clinical outcomes 6 months after surgery. Pain and numbness were evaluated using the visual analog scale (VAS) preoperatively and at 1 month post-surgery. Patient-reported outcome measures (PROMs), including the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) measure, the Hand20 questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), were recorded for each patient 6 months after surgery. The BCTQ consisted of the Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Multivariable linear regression analysis was performed to investigate the association between the VAS scores and PROMs. We retrospectively identified 93 patients who underwent open carpal tunnel release (OCTR) or endoscopic carpal tunnel release. The mean age of the patients was 67.5 years, and 67 patients (72.0%) were female. Sixty patients were treated by OCTR (65.0%). With multivariable linear regression analysis, we found that pain and numbness, evaluated with VAS 1 month post-surgery had significant correlations with QDASH, Hand20, SSS and FSS 6 months after surgery. In conclusion, pain and numbness 1 month after CTR predict PROMs at 6 months.
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Affiliation(s)
- Shunpei Hama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mitsuhiro Okada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuya Yokoi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuya Uemura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Wessel LE, Ekstein CM, Marshall DC, Chen AZ, Osei DA, Fufa DT. Pre-operative Two-Point Discrimination Predicts Response to Carpal Tunnel Release. HSS J 2020; 16:206-211. [PMID: 33088234 PMCID: PMC7534881 DOI: 10.1007/s11420-019-09694-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited evidence informs whether pre-operative values of two-point discrimination (2PD) in patients with carpal tunnel syndrome predict response to surgery. QUESTIONS/PURPOSES The primary aim of this study was to determine the predictive value of pre-operative 2PD scores on outcomes following carpal tunnel release (CTR). In particular, we sought to evaluate whether a clinically relevant 2PD threshold exists that can predict symptomatic response after surgery. METHODS Patients who underwent CTR between 2014 and 2018 were retrospectively reviewed. Static 2PD scores in each digit, as well as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Levine-Katz scores, were collected from pre- and post-operative records. Pearson correlation coefficients assessed the relationship between pre-operative 2PD, early post-operative 2PD, and patient-reported outcome scores. Poor 2PD was defined as 2PD greater than 10 mm. RESULTS Eighty-nine hands in 73 patients with a mean follow-up of 1.8 years were analyzed. Mean pre- and post-operative 2PD was 7.2 mm and 6.4 mm, respectively, in the most affected digit when measurable. Twenty patients had poor 2PD scores pre-operatively and 14 post-operatively. There was a positive correlation between pre- and early post-operative 2PD scores but no correlation between pre-operative 2PD score and final post-operative functional scores. Only 30% of patients with poor pre-operative 2PD scores demonstrated improvement, compared with 69% of patients with measurable 2PD. CONCLUSION We found that greater pre-operative 2PD scores predicted greater early post-operative 2PD scores but did not lead to worse functional outcome scores post-operatively. Patients with poor pre-operative 2PD scores were likely to demonstrate improvement in functional outcomes scores, while having less reliable improvement in 2PD after CTR. Patients with poor 2PD should be counseled that improvement of tactile perception is less predictable.
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Affiliation(s)
- Lauren E. Wessel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Charles M. Ekstein
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Danielle C. Marshall
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Aaron Z. Chen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Daniel A. Osei
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Duretti T. Fufa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Howard B, Aneizi A, Nadarajah V, Sajak PM, Ventimiglia DJ, Burt CI, Zhan M, Akabudike NM, Henn RF. Early patient satisfaction following orthopaedic surgery. J Clin Orthop Trauma 2020; 11:S823-S828. [PMID: 32999563 PMCID: PMC7503134 DOI: 10.1016/j.jcot.2020.06.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/05/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The healthcare industry is shifting its focus from traditional clinical outcome measures to patient satisfaction metrics. This change has caused orthopaedic surgeons to become increasingly interested in factors influencing patient satisfaction, which would allow them to potentially modify these factors in an effort to increase postoperative satisfaction. The objective of this study was to identify factors associated with patient satisfaction two weeks following extremity orthopaedic surgery. METHODS Patients completed questionnaires preoperatively to assess demographics, activity, pain, expectations, and Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing for Physical Function, Pain Interference, Social Satisfaction, Depression, Anxiety, and Fatigue. Two weeks after their operation, patients completed the same questionnaires in addition to an Improvement Survey and Met Expectations. Satisfaction was assessed with the Surgical Satisfaction Questionnaire. RESULTS Greater surgical satisfaction two weeks following orthopaedic surgery was associated with higher education, alcohol use, better scores on all PROMIS domains at baseline and two weeks, greater activity levels at baseline and two weeks, less bodily pain at baseline and two weeks, less pain in the surgical site at two weeks, greater met expectations, and greater improvement (p < 0.05). CONCLUSION This study provides important information about patient satisfaction two weeks after orthopaedic surgery.
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Affiliation(s)
- Bailey Howard
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick M.J. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J. Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ngozi M. Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Corresponding author. University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive Baltimore, MD, 21207, USA.
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A Review of Carpal Tunnel Syndrome and Its Association with Age, Body Mass Index, Cardiovascular Risk Factors, Hand Dominance, and Sex. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10103488] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carpal tunnel syndrome (CTS) is one of the most common compressive, canalicular neuropathies of the upper extremities, causing hand pain and impaired function. CTS results from compression or injury of the median nerve at the wrist within the confines of the carpal tunnel. Parameters such as age, sex, and body mass index (BMI) could be risk factors for CTS. This research work aimed to review the existing literature regarding the relationship between CTS and possible risk factors, such as age, sex, BMI, dominant hand, abdominal circumference, respiratory rate, blood pressure, and cardiac rate to determine which ones are the most influential, and therefore, take them into account in subsequent applied research in the manufacturing industry. We performed a literature search in the PubMed, EBSCO, and ScienceDirect databases using the following keywords: carpal tunnel syndrome AND (age OR sex OR BMI OR handedness OR abdominal circumference OR respiratory rate OR blood pressure OR cardiac rate). We chose 72 articles by analyzing the literature found based on selection criteria. We concluded that CTS is associated with age, female sex, and high BMI. Trends and future challenges have been proposed to delve into the relationship between risk factors and CTS, such as correlation studies on pain reduction, analysis of weight changes to predict the severity of this pathology, and its influence on clinical treatments.
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14
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Alimohammadi E, Bagheri SR, Hadidi H, Rizevandi P, Abdi A. Carpal tunnel surgery: predictors of clinical outcomes and patients' satisfaction. BMC Musculoskelet Disord 2020; 21:51. [PMID: 31992298 PMCID: PMC6988299 DOI: 10.1186/s12891-020-3082-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. Moreover, carpal tunnel release (CTR) surgery generally has excellent results. The present study aimed to investigate the predictors of clinical outcomes and satisfaction in patients with CTR. Methods In this observational prospective cohort study, 152 patients with open carpal tunnel release surgery were investigated. Complete clinical examinations were performed and recorded before the surgery, two weeks after the surgery and 6 months after the surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) were assessed on admission and at last follow-up visits to evaluate clinical outcomes. Patients’ satisfaction was determined by a 10-point verbal descriptor nominal scale (1 = very poor, 5 = fair and 10 = excellent) and recorded during the last follow -up visits. Results Among 152 patients who were investigated, there were 118 (77.6%) females and 34 (22.36%) males. Overall, surgery improved the outcomes based on Symptom Severity Scale (SSS) and Functional Status Scale (FSS) (P < 0.05). Most of the considered variables did not show significant effects on clinical outcomes and patients’ satisfaction. However, duration of symptoms and electrophysiological severity were the predictors of the change score in SSS(P < 0.05). As well as, age was the only predictor of the change score in FSS (P < 0.05). Finally, according to the linear regression model, the pre-operative grip strength and age were the independent predictors of post-operative satisfaction (P < 0.05). Conclusions Results of the present study revealed that there was a significant improvement in clinical outcomes after CTS surgery. Stronger pre-operative grip strength and younger age were independent predictors of higher post-operative satisfaction. These results can be used in pre-operative counseling and management of post-operative expectations.
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Affiliation(s)
- Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran.
| | - Seyed Reza Bagheri
- Department of Neurosurgery, University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Homa Hadidi
- Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Rizevandi
- operating room department, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Alireza Abdi
- nursing and midwifery school, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
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Núñez-Cortés R, Cruz-Montecinos C, Antúnez-Riveros MA, Pérez-Alenda S. Does the educational level of women influence hand grip and pinch strength in carpal tunnel syndrome? Med Hypotheses 2019; 135:109474. [PMID: 31756589 DOI: 10.1016/j.mehy.2019.109474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Grip and pinch strength are relevant functional variables for various activities of daily life and are related to the quality of life of patients with carpal tunnel syndrome (CTS). OBJECTIVE The main aim was to analyze the relationship between grip and pinch strength and the educational level in women with CTS. STUDY DESIGN Cross-sectional study. METHODS Thirty-one female patients with CTS awaiting surgery were assigned to the low education group if they only had primary education level (completed or not) and the high education group for those having higher education level. The assessments included: grip strength, pinch strength, Visual Analogue Scale, Quick DASH Questionnaire, Pain Catastrophizing Scale and the Tampa scale of kinesiophobia. RESULTS A statistically significant difference was obtained for grip strength (p = 0.027), pinch strength (p = 0.002) and catastrophizing (p = 0.038) between the two groups. No significant differences were observed for the other variables studied (p < 0.05). Grip strength was not related to individual factors: type of work, age, body mass index. CONCLUSION CTS patients with a low educational level exhibited reduced grip and pinch strength and more catastrophic thinking. Future studies should investigate the mechanisms involved in the loss of strength in patients with lower educational levels.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Service of Physical Therapy, Hospital Clínico La Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Biomechanics and Kinesiology Laboratory, Service of Physical Therapy, San José Hospital, Santiago, Chile; Department of Physiotherapy, University of Valencia, Valencia, Spain.
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Fernández‐de‐las‐Peñas C, de‐la‐Llave‐Rincón AI, Cescon C, Barbero M, Arias‐Buría JL, Falla D. Influence of Clinical, Psychological, and Psychophysical Variables on Long‐term Treatment Outcomes in Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial. Pain Pract 2019; 19:644-655. [DOI: 10.1111/papr.12788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/14/2022]
Affiliation(s)
- César Fernández‐de‐las‐Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos AlcorcónSpain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca Universidad Rey Juan Carlos Alcorcón Madrid Spain
| | - Ana I. de‐la‐Llave‐Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos AlcorcónSpain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca Universidad Rey Juan Carlos Alcorcón Madrid Spain
| | - Corrado Cescon
- Rehabilitation Research Laboratory 2rLab Department of Business Economics, Health and Social Care University of Applied Sciences and Arts of Southern Switzerland Manno Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab Department of Business Economics, Health and Social Care University of Applied Sciences and Arts of Southern Switzerland Manno Switzerland
| | - José L. Arias‐Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos AlcorcónSpain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca Universidad Rey Juan Carlos Alcorcón Madrid Spain
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences College of Life and Environmental Sciences Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) University of Birmingham Birmingham UK
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