Comparative Evaluation of Surgical Procedures with Clinical Equipoise: the Unique Perspective of Our Hand Therapy Colleagues

Abstract

Background

There are several accepted surgical treatment options available for carpal tunnel syndrome, thumb carpometacarpal joint (CMC), osteoarthritis (OA), and wrist degenerative joint disease.

Questions/Purposes

We sought to obtain the views and preferences from a cohort of certified hand therapists (CHT) and hypothesized that this source may identify differences in procedures that are otherwise widely believed to have clinical equipoise.

Methods

Five hundred twelve CHTs were surveyed regarding their experience, volume, and referral base along with their subjective assessments and preferences regarding open versus endoscopic carpal tunnel release (CTR), various surgical procedures for CMC OA, and proximal row carpectomy (PRC) versus 4-corner fusion (4-CF).

Results

The average CHT surveyed had 15.2 years experience and had a referral base of 7.7 different hand surgeons. Twenty-seven percent of respondents perceived superior pain control and incisional tenderness following open CTR compared to that of endoscopic CTR. However, 68% of CHTs would elect to undergo an open CTR themselves. There was no clear consensus for the optimal reconstructive technique for thumb CMC OA. As compared to that of 4-CF, PRC was thought to result in superior pain control (34 versus 22%), motion (43 versus 18%), and earlier discharge from therapy (32 versus 19%); however, 53% of respondents would prefer a 4-CF for themselves.

Conclusions

Hand therapists are intimately involved in the care of surgical patients and provide an educated and unique source for evaluating postoperative outcomes.

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Correspondence to Joseph J. Schreiber MD.

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Conflict of Interest

Joseph J. Schreiber, MD and Susan Clark, BS have declared that they have no conflict of interest. Jeffrey Yao, MD reports personal fees from Arthrex, Smith and Nephew Endoscopy, BME, Trimed, McGinley Orthopedics, and grants from Medartis, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Disclosure forms provided by the authors are available with the online version of this article

Additional information

Investigation performed at Stanford University Medical Center, Redwood City, CA.

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Schreiber, J.J., Clark, S. & Yao, J. Comparative Evaluation of Surgical Procedures with Clinical Equipoise: the Unique Perspective of Our Hand Therapy Colleagues. HSS Jrnl 14, 29–33 (2018). https://doi.org/10.1007/s11420-017-9569-1

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Keywords

  • hand therapy
  • CHT
  • carpal tunnel syndrome
  • arthritis