Appropriateness of Carpal Tunnel Syndrome Management Compared With the AAOS Appropriate Use Criteria

Study Overview
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Brief Summary
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Purpose: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder among adults that causes upper-extremity disability. The American Academy of Orthopedic Surgeons (AAOS) developed an evidence-based appropriate use criteria (AUC) for the management of CTS. This study aims to assess the appropriateness of our practice and the usability of the AUC by comparing the actual management provided at our institution with that recommended by the AUC. Methods: A retrospective review of the electronic medical records at our hospital will be performed between 1 Jan 2016 and 31 Dec 2019. Data will be collected by two authors independently. The collected data will be input into the AUC application to determine the rate of the appropriateness of the treatments. Afterwards, the agreement between the actual treatment provided and the AUC recommendation will be assessed. The primary outcome will be the appropriateness rate. Descriptive statistics such as the mean, range and percentage will be used to summarize the patients' demographics and treatment options. Results: The appropriateness rating (appropriate, maybe, or rarely appropriate) for each treatment will be described with percentages. Similarly, the agreement of the treatments implemented at our institution with the AUC recommendations will be expressed as a proportion. A subgroup analysis within the same cohort compared the appropriateness rates of surgical release of patients across different surgical specialties using chi2 test. Conclusion: This study will show if the management provided at our institution were appropriate and in agreement with the AUC recommendations. Additionally, it will test the usability of AUC for carpal tunnel syndrome as a valuable and practical tool that can be applied in clinical settings.

Official Title
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Appropriateness of Carpal Tunnel Syndrome Management Compared With the AAOS Appropriate Use Criteria: A Retrospective Review Across Various Specialties

Conditions
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Carpal Tunnel Syndrome

Intervention / Treatment
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* Other: Comparing the appropriateness of our practice and the usability of the AUC through comparing the actual management provided at our institution with that recommended by the AUC.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients (≥ 18 years) who were diagnosed with CTS. Exclusion Criteria as per the AUC: Acute carpal tunnel syndrome Untreated inflammatory arthritis Untreated diabetes Thyroid disease Pernicious Anemia Patients with a known space-occupying lesion in the carpal tunnel Failed treatment after surgery Pediatric and adolescent patients

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Comparing the appropriateness of our practice and the usability of the AUC through comparing the actual management provided at our institution with that recommended by the AUC.|The AUC application for carpal tunnel syndrome management requires four patients' variables to generate appropriateness ratings for six different treatment options. Each procedure is rated as appropriate, maybe appropriate, or rarely appropriate. The six procedures include splint, steroid injection, carpal tunnel release, oral steroids or Ketoprofen phonophoresis, investigation of alternative diagnoses, and further investigation using an electro-diagnostic study. To judge the usability of the AUC for the management of carpal tunnel syndrome, the required parameters of each patient were collected and entered into the AUC application by two independent authors to generate the appropriateness rating of the provided treatment for each patient. Afterwards, the agreement between the AUC recommendations and the actual treatment that was provided at our institution was assessed.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The rate of appropriateness of CTS management in our practice compared to the AUC recommendation | AUC Appropriateness rate (percentage/Continuous outcome): The AUC application for carpal tunnel syndrome management requires four patients' variables to generate appropriateness ratings for six different treatment options. Each procedure is rated as appropriate, maybe appropriate, or rarely appropriate. The six procedures include splint, steroid injection, carpal tunnel release, oral steroids or Ketoprofen phonophoresis, investigation of alternative diagnoses, and further investigation using an electro-diagnostic study. To judge the appropriateness of the AUC for the management of carpal tunnel syndrome, the required parameters of each patient were collected and entered into the AUC application by two independent authors to generate the appropriateness rating of the provided treatment for each patient. Afterwards, the agreement between the AUC recommendations and the actual treatment that was provided at our institution was assessed. | 4 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Carpal tunnel syndrome, Management, Hand Surgery