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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. Interobserver variability in the treatment of little finger metacarpal neck fractures

Author

Lewis B. Lane, Rick F. Papandrea, Minoo Patel, P. Hahn, Andrew H. Schmidt, Gerald A. Kraan, William Dias Belangero, David E. Ruchelsman, Henry Broekhuyse, J. H. Scheer, Vassilios S. Nikolaou, Travis M. Hughes, C.J.H. Veillette, N. Bijlani, Aida Garcia, Charles Cassidy, S. Moghtaderi, M. A J Van De Sande, Timothy Omara, B. Watkins, E. Forigua Jaime, C. Young, Philipp N. Streubel, A. Berner, R. de Bedout, M. P. J. van den Bekerom, Maurizio Calcagni, Grant Bayne, T. Higgins, Mahmoud I. Abdel-Ghany, Rick Tosti, L. C. Bainbridge, Matthew Rg Menon, Lior Paz, M. Soong, Warren C. Hammert, Yoram A. Weil, Randy M. Hauck, Grant E. Garrigues, S. G. Kaar, D.M. Silva, Thomas G. Stackhouse, Richard L. Hutchison, Augustus D. Mazzocca, Lars C. Borris, M. Quell, Fabio Suarez, Daniel Haverkamp, Chris Wilson, R. Omid, Gladys Cecilia Zambrano Caro, Daniel B. Polatsch, Theodoros I. Tosounidis, Marco Rizzo, Jose Nolla, F. García, Richard S. Page, Charalampos G. Zalavras, Asif M. Ilyas, E.T. Tolo, Megan M. Wood, H. Durchholz, G. Kohut, Michael J. Behrman, Peter Kloen, Christos Garnavos, David L. Nelson, Charles A. Goldfarb, R. Gaston, Michael W. Kessler, Koroush Kabir, Chad Manke, John M. Erickson, Thomas Mittlmeier, Prosper Benhaim, Seth D. Dodds, V. Philippe, K. Dickson, Richard Buckley, Karel Chivers, Bernard F. Hearon, Jonathan Isaacs, M. Ladislav, H. Goost, Peter R. Brink, Edward J. Harvey, Richard S. Gilbert, D.K. Kirkpatrick, Ronald Liem, H. W. Grunwald, R. Wallensten, Sergio Rowinski, Jim Calandruccio, Minos Tyllianakis, G.J. Della Rocca, H. B. Bamberger, Thomas J. Fischer, Kevin J. Malone, Marc J. Richard, Saurabh P. Mehta, Niels W. L. Schep, E.M. Hammerberg, Peter Schandelmaier, Jeffrey Wint, German Ricardo Hernandez, J. Moreta-Suarez, Christopher M. Jones, Taizoon Baxamusa, Martin I. Boyer, W.T. Benjamin, Jennifer Moriatis Wolf, M. Bonczar, Jos J. Mellema, J. Munyak, Julie E. Adams, Matej Kastelec, Milind Merchant, Erik T. Walbeehm, Robert Haverlag, Thomas Apard, C. Klostermann, Sanjeev Kakar, Peter J. L. Jebson, N.L. Leung, A. L. Van Der Zwan, W. A. Batson, Lob Guenter, Denise Eygendaal, S.A. Meylaerts, Renato M. Fricker, Anže Kristan, Michael W. Grafe, T. Begue, Kevin Eng, D. F. P. van Deurzen, Steven Beldner, Martin Richardson, C. J. Barreto, J.F. Di Giovanni, Lars Adolfsson, M. Darowish, Gregory L. DeSilva, Gary K. Frykman, K. Erol, Theresa O Wyrick, Evan D. Schumer, Christopher B. Wall, Antonio Barquet, L.M.S.J. Poelhekke, Scott A. Mitchell, Paul M. Guidera, Constanza L. Moreno-Serrano, E. Stojkovska Pemovska, Frank L. Walter, Michael J. Prayson, John A. McAuliffe, N. Elias, Robert D. Zura, Christopher J. Wilson, Marc F. Swiontkowski, Oleg M. Semenkin, Russell Shatford, Jack Choueka, Ryan P. Calfee, Gary M. Pess, Stanley Casimir Marczyk, C. Taleb, Andrew P. Gutow, Nikolaos K. Kanakaris, Neil Wilson, John T. Capo, Vincenzo Giordano, C. D. Oliveira Miranda, J. Itamura, Joseph M. Conflitti, A. B. Shafritz, George S.M. Dyer, Ralph M. Costanzo, B. E. Kreis, Carl Ekholm, R. Cardoso, Scott F. M. Duncan, David Ring, Nicholas L. Shortt, A.J.H. Vochteloo, Lawrence Weiss, A. Platz, Valentin Neuhaus, T. Havlicek, Charles Metzger, Andrew L. Terrono, Thierry G. Guitton, Kendrick E. Lee, Marinis Pirpiris, Thomas W. Wright, Gertraud Gradl, Georg M. Huemer, B. M. Nolan, David M. Kalainov, D.O. Oloruntoba, Paul A. Martineau, Sander Spruijt, Kyle J. Jeray, Carlos Henrique Fernandes, Frank J. Raia, G. C. Babis, J. Biert, P. Lygdas, Axel Jubel, Brian P.D. Wills, Michael A. Baskies, Peter L. Althausen, Kevin M. Rumball, Rodrigo Pesantez, Mohamed Shafi, Harold Alonso Villamizar, Carrie R. Swigart, Francisco Lopez-Gonzalez, Frede Frihagen, Thomas Dienstknecht, Saul Kaplan, Matt Mormino, M. J. Palmer, Thomas A. DeCoster, A. B. Spoor, Job N Doornberg, W. Satora, Todd E. Siff, Eric P. Hofmeister, Joshua M. Abzug, George W. Balfour, J. C. Goslings, P. Inna, Stephen A. Kennedy, Parag Melvanki, Jochen Fischer, Raymond Malcolm Smith, P. V. van Eerten, George S. Athwal, Diederik O. Verbeek, D. Brilej, L.A.B. Campinhos, Daniel A. Osei, K.J. Ponsen, Iain McGraw, Michael Nancollas, R. van Riet, Philip E. Blazar, C. Cornell, Craig A. Bottke, Taco Gosens, F. T. D. Kaplan, George M. Kontakis, Graduate School, Orthopedic Surgery and Sports Medicine, Other departments, Surgery, Other Research, and AMS - Amsterdam Movement Sciences

Subjects
Adult, Male, medicine.medical_specialty, Radiography, Fractures, Bone, Random Allocation, Finger Injuries, medicine, Humans, Lateral view, Orthopedics and Sports Medicine, Practice Patterns, Physicians', Nonoperative management, Aged, Observer Variation, Orthodontics, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Neck fracture, Little finger, Middle Aged, Surgery, medicine.anatomical_structure, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Orthopedic surgery, Female, Metacarpus, business, Angular deformity
Abstract

Purpose To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved

Published
2014

3. How surgeons make decisions when the evidence is inconclusive

Author

Prashanth Ina, Robert R.L. Gray, Gustavo Mantovani Ruggiero, David J. Rowland, Yoram Weil, M. R. de Vries, Renato M. Fricker, Georges Kohut, Antonio Barquet, Karl Josef Prommersberger, Takashi Sasaki, Eckart Schwab, Taco Gosens, Joseph M. Conflitti, David Ring, M. A. Aita, Ladislav Mica, Joseph A. Abboud, Michael Jones, Daniel Hernandez, Gregory L. DeSilva, Hal MccUtchan, Thomas W. Wright, Kendrick E. Lee, Marinis Pirpiris, Ian A. Harris, Marc F. Swiontkowski, Neil Wilson, Norah M. Harvey, Eric P. Hofmeister, Howard D. Routman, Lawrence Weiss, Nicholas L. Shortt, Jorge Rubio, Axel Jubel, John S. Taras, Gustavo Regazzi, Sergio L. Checchia, Jack Choueka, Jorge L. Orbay, Michael A. Baskies, Rolf Norlin, Vispi Jokhi, Todd E. Siff, Ashish S. Ranade, Lisa L. Lattanza, Jeff W. Johnson, Hans J. Kreder, Rozental, Cayón Cayón, Rajat Varma, Paul T. Appleton, Leonid I. Katolik, Asheesh Bedi, Filip Celestyn Dolatowski, Steve Kronlage, Paul M. Guidera, Elisabeth Prelog-Igler, David M. Kalainov, Charles L. Getz, Chunyan Jiang, Porcellini, A. Iossifidis, J Andrew I Trenholm, Frede Frihagen, K. Sprengel, Minos Tyllianakis, Steven J. McCabe, David Weiss, C. Taleb, Andrew P. Gutow, Sebastian Kluge, Jin Young Park, Michael R. Hausman, Paul A. Martineau, Michel P J Van Den Bekerom, W. A H Van Der Stappen, Thomas G. Stackhouse, Thomas Dienstknecht, Babst H. Reto, Jonathan L. Hobby, Iain McGraw, Tony Wanich, Augustus D. Mazzocca, Samir Sodha, J. Biert, Matthias Turina, Ines C. Lin, Daniel Rikli, Fischmeister Martin, Chad Manke, Roman Pfeifer, Lars C. Borris, M. Quell, Fabio Suarez, Daniel B. Whelan, John P. Evans, Michael Nancollas, Marco Rizzo, Lawrence S. Halperin, Carl Ekholm, David E. Tate, Steven J. Morgan, Betsy M. Nolan, F. J. Seibert, W. Arnnold Batson, Richard Barth, Brent Bamberger, A. B. Spoor, Seth D. Dodds, Jeffrey A. Greenberg, Victoria D. Knoll, Wade R. Smith, Michael D. McKee, Rolf W. Peters, Christopher J. Walsh, Jochen Fischer, Martin I. Boyer, Raymond Malcolm Smith, P. V. van Eerten, Philipp N. Streubel, Thomas B. Hughes, Milind Merchant, Peter J. L. Jebson, Bret C. Peterson, Theodoros H. Tosounidis, Luke S. Austin, David L. Nelson, M. R. Krijnen, K.J. Ponsen, Chris Wilson, Gladys Cecilia Zambrano Caro, Daniel B. Polatsch, Matthew D. Budge, Reza Omid, Louis W. Catalano, Emil H. Schemitsch, Roy G. LiemKulick, Richard S. Page, Michael W. Kessler, Donald Endrizzi, Anna N. Miller, Jorge G. Boretto, Peter Kloen, J. Michael Wiater, Fidel Ernesto, German Ricardo Hernandez, Leon S. Benson, Peter J. Evans, John Howlett, Verhofstad, Michael J. Behrman, A. L. Van Der Zwan, Ryan P. Calfee, Robert D. Zura, Leon Elmans, Anica Eschler, D. Kaplan, Richard S. Gilbert, F. Thomas, Johannes M. Rueger, Eon K. Shin, Sam Moghtaderi, Julie E. Adams, Jaimo Ahn, D. F. P. van Deurzen, Ralf Nyszkiewicz, W. Jaap Willems, Huub Van Der Heide, Aida Garcia, L.M.S.J. Poelhekke, Philip E. Blazar, Daniel C. Wascher, Luis Antonio Buendia, S. Prashanth, Peter Krause, Maarten W.G.A. Bronkhorst, Noah D. Weiss, Kyle J. Jeray, Ronald Liem, Andrew L. Terrono, Niels W. L. Schep, Sander Sprujt, Ryan Klinefelter, Robert Haverlag, Steven Beldner, Nikolaos G. Lasanianos, Ramon De Bedout, Rudolf W. Poolman, I. J.V. Kleinlugtenbelt, Alexander Marcus, Greg Merrell, Naquira Escobar Luis Felipe, Kimberlly S. Chhor, Jeffrey Yao, Lob Guenter, Parag Melvanki, Arie B. van Vugt, Francisco Lopez-Gonzalez, Craig Lomita, Saul Kaplan, Matt Mormino, Theresa O Wyrick, Gregory J. Della Rocca, C. Noel Henley, Edgardo Ramos Maza, Christopher B. Wall, Fred Baumgaertel, Roger P. van Riet, Sebastian Rodriguez-Elizalde, Stuart M. Hilliard, George S. Athwal, Peter V. Giannoudis, Angela A. Wang, Tamir Pritsch, John A. McAuliffe, Robert J. Feibel, Timothy Omara, Paul Levin, Jonathan Rosenfeld, Michael J. Prayson, Mark E. Baratz, R. Bryan Benafield, Christian Perrotto, George L. Thomas, Punita V. Solanki, George M. Kontakis, Robert Wagenmakers, Charles A. Goldfarb, Andrew H. Schmidt, Abhay Shrivastava, Mark D. Lazarus, Frederico C M Vallim, L. Marsh, Keith A. Segalman, H. Goost, Peter R. Brink, Michael W. Grafe, Jonathan P. Braman, April D. Armstrong, Charles Cornell, Thomas A. DeCoster, Daphne M. Beingessner, Neal C. Chen, Charalampos Zalavras, M. A J Van De Sande, Jennifer L. Giuffre, Thuan V. Ly, Georg M. Huemer, Vani J. Sabesan, Rodrigo Pesantez, Kevin Eng, A. Lee Osterman, Darren S. Drosdowech, Michael Moskal, B. Van Den, Nigel Rossiter, Michael Baumgaertner, Christian Heiss, James F. Kellam, P. C. Fuchs, Matej Kastelec, David J. Hak, Karel Chivers, Amy L. Ladd, Reid A. Abrams, Bob Arciero, Russell Shatford, Toni M. McLaurin, George S.M. Dyer, Ralph M. Costanzo, Frank L. Walter, Craig M. Torosian, Koroush Kabir, Timothy G. Havenhill, Brian L. Badman, Joachim P. Overbeck, Charles Metzger, Vishwanath M. Iyer, Annette K B Wikerøy, Carlos Henrique Fernandes, Jay Pomerance, Patrick T. McCulloch, Megan M. Wood, Richard Jenkinson, Brian J. Cross, Christos Garnavos, Marcus Lehnhardt, Ashok K. Shyam, Michael LeCroy, Abhijeet L. Wahegaonkar, Carrie R. Swigart, Lisa Taitsman, Vasileios S. Nikolaou, Gerald R. Williams, J. H. Peters, Sergio Rowinski, William Dias Belangero, Ibrahim Ibrahim, Jeremy A. Hall, Charles Cassidy, Mahmoud I. Abdel-Ghany, Michiel G.J.S. Hageman, M. Jason Palmer, Joseph P A M Vroemen, Frank J. P. Beeres, Alberto Pérez Castillo, Gustavo Borges Laurindo De Azevedo, Martin Richardson, Wolfgang Baer, Shep Hurwit, J. V. Clarke, Robert Tashijan, Scott F. M. Duncan, Thierry G. Guitton, Steven J. Rhemrev, J. Wolkenfelt, Richard Wallensten, Neil Saran, Brett D. Crist, J. Carel Goslings, Qiugen Wang, Francisco Javier Aguilar Sierra, Leonardo Alves De Mendonca, Paula M. Hasenboehler, Sanjeev Kakar, Grant E. Garrigues, Leonardo Rocha, Joel Murachovsky, Vidyadhar Telang, Edward J. Harvey, Richard Buckley, Jose A. Ortiz, Schandelmaier, Edward K. Rodriguez, Konul Erol, H. J. Helling, Nikolaos K. Kanakaris, Jeffry T. Watson, Desirae M. McKee, Graduate School, Orthopedic Surgery and Sports Medicine, AMS - Amsterdam Movement Sciences, Surgery, Other Research, and Other departments

Subjects
Male, medicine.medical_specialty, Decision Making, Alternative medicine, Likert scale, medicine, Humans, Orthopedics and Sports Medicine, Somewhat Important, Reimbursement, Social influence, Evidence-Based Medicine, business.industry, Mentors, Perspective (graphical), Evidence-based medicine, Hand, Surgery, Orthopedics, Family medicine, Practice Guidelines as Topic, Female, Clinical Competence, business, Null hypothesis
Abstract

Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between "very important" and "very unimportant." Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were "works in my hands," "familiarity with the treatment," and "what my mentor taught me." The most important factors when evidence shows no difference between 2 surgeries were "fewer complications," "quicker recovery," "burns fewer bridges," "works in my hands" and "familiarity with the procedure." Europeans rated "works in my hands" and "cheapest/most resourceful" of significantly greater importance and "what others are doing," "highest reimbursement," and "shorter procedure" of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated "what my mentor taught me," "what others are doing" and "highest reimbursement" of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

Published
2013

4. 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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