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1. Variation in Recommendation for Surgical Treatment for Compressive Neuropathy

Author

Gregory Dee Byrd, John Jiuliano, Steve Kronlage, Paul M. Guidera, Steven J. McCabe, C. Taleb, Paul A. Martineau, Asif M. Ilyas, Sander Spruijt, Samir Sodha, Paul C. Bettinger, Robert R.L. Gray, German Ricardo Hernandez, Jose A. Ortiz, Thomas Apard, John A. McAuliffe, Desirae M. McKee, Seth D. Dodds, Thomas F. Varecka, Renato M. Fricker, Karel Chivers, Charles A. Goldfarb, John P. Evans, Charles Metzger, Naquira Escobar Luis Felipe, Julie E. Adams, Marco Rizzo, Prasad Sitaram, Hervey L. Kimball, Robert M. Szabo, Charles Cassidy, Fidel Ernesto Cayon Cayon, John S. Taras, Miguel Pirela-Cruz, H. Brent Bamberger, Steven Beldner, Gladys Cecilia Zambrano Caro, Evan S. Fischer, David Ring, William J. Van Wyk, Daniel B. Polatsch, Carlos Henrique Fernandes, David M. Lamey, Michael J. Quinn, Victoria D. Knoll, David R. Miller, Peter H. DeNoble, Richard S. Gilbert, Jim Calandruccio, Jose Nolla, Kevin J. Malone, Harrison Solomon, Frank L. Walter, Randy M. Hauck, David E. Tate, Daniel A. Osei, Christopher M. Jones, Taizoon Baxamusa, Ines C. Lin, Christopher J. Walsh, Sidney M. Jacoby, Thomas J. Fischer, Ryan P. Calfee, Gary M. Pess, Martin I. Boyer, Lawrence Weiss, Oleg M. Semenkin, Russell Shatford, Brian P.D. Wills, Ralph M. Costanzo, Vipul P. Patel, Andrew L. Terrono, Carrie R. Swigart, Ralf Nyszkiewicz, Nicky L. Leung, Karl Josef Prommersberger, Gary R. Kuzma, D. Kay Kirkpatrick, Christopher S. Wilson, Lawrence S. Halperin, W. Arnnold Batson, George W. Balfour, Marc J. Richard, Lior Paz, Doug Hanel, Rick F. Papandrea, R. Glenn Gaston, Joshua M. Abzug, Ryan Klinefelter, Michael Jones, Jennifer B. Green, Todd E. Siff, Louis W. Catalano, Neil G. Harness, Jay Pomerance, Patrick T. McCulloch, Megan M. Wood, Phani Dantuluri, Saul Kaplan, Christopher J. Wilson, Barry Watkins, Philip Coogan, Leon S. Benson, Jessica A. Frankenhoff, Abhijeet L. Wahegaonkar, Rozental, Jochen Fischer, F. Thomas D. Kaplan, Richard L. Hutchison, Craig A. Bottke, Stephen A. Kennedy, Nicholas J. Horangic, Jennifer Moriatis Wolf, Milan M. Patel, Jorge G. Boretto, Michael W. Kessler, Steven Alter, Timothy G. Havenhill, Frank J. Raia, Catherine Spath, Andrew W. Gurman, Cesar Dario Oliveira Miranda, Lewis B. Lane, Kendrick E. Lee, Hal MccUtchan, Michael W. Grafe, David E. Ruchelsman, Theresa O Wyrick, James M. Boler, Patrick W. Owens, Eric P. Hofmeister, Gregory L. DeSilva, Gary K. Frykman, Ross Nathan, Arjan G.J. Bot, Aida E. GarciaG, Charles J. Eaton, Alan Schefer, Scott A. Mitchell, Michael Nancollas, Richard Barth, José Fernando Di Giovanni, Michael A. Baskies, Georg M. Huemer, Warren C. Hammert, David L. Nelson, L. C. Bainbridge, Maurizio Calcagni, Jamie E. Forigua, John Howlett, H. W. Grunwald, Bernard F. Hearon, Michael J. Behrman, John M. Erickson, Eon K. Shin, Stéphanie J.E. Becker, J. E.B. Stuart, Michiel G.J.S. Hageman, M. Jason Palmer, Bruce I. Wintman, Stephen W. Dailey, Sanjeev Kakar, Jonathan Isaacs, Jack Choueka, Stanley Casimir Marczyk, Alberto Pérez Castillo, Lisa L. Lattanza, Jeff W. Johnson, Ekkehard Bonatz, David M. Kalainov, Peter E. Hoepfner, James G. Reid, Ramon De Bedout, Jeffrey Yao, Ngozi M. Akabudike, Stuart M. Hilliard, Colby Young, David M. Ostrowski, Scott F. M. Duncan, Thierry G. Guitton, Peter J. L. Jebson, Jerome W. Oakey, Plastic, Reconstructive and Hand Surgery, and Orthopedic Surgery and Sports Medicine

Subjects
medicine.medical_specialty, business.industry, Mononeuropathies, MEDLINE, Mindset, Hand surgery, Logistic regression, medicine.disease, Decompression, Surgical, Random Allocation, Adaptation, Psychological, Physical therapy, Medicine, Objective test, Humans, Orthopedics and Sports Medicine, Surgery, Clinical significance, Practice Patterns, Physicians', Radial Neuropathy, business, Null hypothesis, Carpal tunnel syndrome
Abstract

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that—at least in a survey setting—surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery.

Published
2013
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2. Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making

Author

Eric P. Hofmeister, Kevin L. Ju, Sidney M. Jacoby, Thomas J. Fischer, Michael Nancollas, Jennifer Moriatis Wolf, R. Glenn Gaston, Christopher M. Jones, Taizoon Baxamusa, Martin I. Boyer, Ralf Nyszkiewicz, Charles Metzger, Gregory Dee Byrd, Peter J. L. Jebson, Chaitanya S. Mudgal, Chris Wilson, Daniel B. Polatsch, Michael W. Kessler, Carlos Henrique Fernandes, Naquira Escobar Luis Felipe, T. Aspard, Louis W. Catalano, Marc J. Richard, Prosper Benhaim, Seth D. Dodds, Paul A. Martineau, Charles Cassidy, Karel Chivers, Sander Spruijt, Asif M. Ilyas, Leonid I. Katolik, Frank J. Raia, Lior Paz, Steven J. McCabe, Colby Young, Jose A. Ortiz, David E. Ruchelsman, Megan M. Wood, Samir Sodha, Gladys Cecilia Zambrano, Ricardo German Hernandez, John S. Taras, Thierry G. Guitton, Rozental, Jason M. Palmer, Carrie R. Swigart, Abhijeet L. Wahegaonkar, Oleg M. Semenkin, Michael Jones, Ralph M. Costanzo, Sanjeev Kakar, Jonathan Isaacs, Leon S. Benson, Desirae M. McKee, Thomas F. Varecka, Gregory L. DeSilva, David Ring, Gary K. Frykman, Hervey L. Kimball, Aguilar Javier Francisco Sierra, Charles A. Goldfarb, Richard L. Hutchison, Stephen A. Kennedy, H. Brent Bamberger, Lawrence Weiss, David L. Nelson, Jason D. Tavakolian, H. W. Grunwald, Brian P.D. Wills, Thomas D. Kaplan, Catherine Spath, Todd E. Siff, Patrick W. Owens, Michiel G.J.S. Hageman, Frank L. Walter, Joshua M. Abzug, Greg Merrell, Ahmet Kinaci, George W. Balfour, Michael W. Grafe, M. Renato Fricker, Phani Dantuluri, Julie E. Adams, Jochen Fischer, Steven Beldner, José Fernando Di Giovanni, Michael A. Baskies, David M. Kalainov, Gerald A. Kraan, G. Jorge Boretto, W. Arnold Batson, John P. Evans, Marco Rizzo, Thomas F. Stackhouse, Warren C. Hammert, Ryan P. Calfee, Gary M. Pess, Christopher S. Wilson, Gallo Fabio Arbelaez, Ramon De Bedout, Andrew L. Terrono, Saul Kaplan, Romero Jose Camilo Barreto, John A. McAuliffe, Aida Garcia, Robert M. Szabo, Randy M. Hauck, and Christopher J. Walsh

Subjects
Adult, Male, medicine.medical_specialty, Decision support system, Attitude of Health Personnel, Decision Making, Decisional conflict, Surveys and Questionnaires, medicine, Humans, Orthopedics and Sports Medicine, Risks and benefits, Carpal tunnel syndrome, Disadvantage, Aged, Aged, 80 and over, Physician-Patient Relations, business.industry, Patient Preference, Middle Aged, medicine.disease, Patient preference, Carpal Tunnel Syndrome, Preference, Family medicine, Physical therapy, Surgery, Female, business, Null hypothesis
Abstract

Purpose This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). Methods One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. Conclusions There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Clinical relevance Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Published
2013

3. Trigger Finger: Assessment of Surgeon and Patient Preferences and Priorities for Decision Making

Author

Anne-Carolin D. Döring, Michiel G.J.S. Hageman, Frans J. Mulder, Thierry G. Guitton, David Ring, Julie Adams, Joshua M. Abzug, Ngozi M. Akabudike, L.C. Bainbridge, George W. Balfour, H.Brent Bamberger, Camilo Jose Romero Barreto, Michael Baskies, Taizoon Baxamusa, Michael Behrman, Prosper Benhaim, Philip Blazar, James M. Boler, Jorge G. Boretto, Martin Boyer, Ryan P. Calfee, Charles Cassidy, Ralp M. Costanzo, Michael Darowish, Ramon de Bedout, Gregory Desilva, Jose Fernando Di Giovanni, Seth Dodds, John M. Erickson, Naquira Escobar Luis Felipe, C.H. Fernandes, Renato M. Fricker, Gary K. Frykman, Aida E. Garcia, R. Glenn Gaston, Richard S. Gilbert, Michael W. Grafe, Jeffrey A. Greenberg, H.W. Grunwald, Paul Guidera, Warren C. Hammert, Randy Hauck, Steve Helgemo, German Ricardo Hernandez, Eric Hofmeister, Richard L. Hutchison, Asif Ilyas, Sidney M. Jacoby, Peter Jebson, Christopher M. Jones, Sanjeev Kakar, F. Thomas D. Kaplan, Saul Kaplan, Leonid Katolik, Stephen A. Kennedy, Michael W. Kessler, Hervey L. Kimball, D. Kay Kirkpatrick, Ryan Klinefelter, G.A. Kraan, Lewis B. Lane, Lisa Lattanza, Kendrick Lee, Kevin J. Malone, Chad Manke, Paul A. Martineau, Jim Matiko, John McAuliffe, Steven J. McCabe, Desirae M. McKee, Charles Metzger, Scott Mitchell, Jennifer Moriatis Wolf, Michael Nancollas, David L. Nelson, Jose Nolla, Ralf Nyszkiewicz, Jose A. Ortiz, Joachim P. Overbeck, Patrick W. Owens, Rick Papandrea, Lior Paz, Alberto Pérez Castillo, Daniel Polatsch, Gary M. Press, Marc J. Richard, Marco Rizzo, Tamara D. Rozental, David Ruchelsman, Oleg M. Semenkin, Russell Shatford, Fransisco Javier Aguilar Sierra, Todd Siff, Catherine Spath, Sander Spruijt, Ben Sutker, Carrie Swigart, John Taras, Jason D. Tavakolian, Andrew L. Terrono, Eric T. Tolo, Christopher J. Walsh, Frank L. Walter, Barry Watkins, Lawrence Weiss, Brian P.D. Wills, Chris Wilson, Christophe J. Wilson, Jeffrey Wint, and Colby Young

Subjects
Adult, Male, Decision support system, medicine.medical_specialty, Attitude of Health Personnel, Decisional conflict, Patient Education as Topic, Surveys and Questionnaires, medicine, Decision aids, Humans, Orthopedics and Sports Medicine, Aged, Aged, 80 and over, business.industry, Patient Selection, Patient Preference, Middle Aged, medicine.disease, Patient preference, Test (assessment), Surgery, Orthopedics, Trigger Finger Disorder, Family medicine, Female, Trigger finger, Patient Participation, Best evidence, Null hypothesis, business
Abstract

Purpose To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. Methods One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. Conclusions Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TF—differences that might be addressed by a decision aid. Clinical relevance Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Published
2014
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