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Scalise V, Brindisino F, Pellicciari L, Minnucci S, Bonetti F. Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041995. [PMID: 33670831 PMCID: PMC7922196 DOI: 10.3390/ijerph18041995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/21/2022]
Abstract
The aim of this article was to investigate the knowledge, management, and clinical practice of Italian physiotherapists concerning patients with carpal tunnel syndrome (CTS). A national cross-sectional survey consisted of 24 questions was administered from December 2019 until February 2020. A Chi-squared independence test was run to study any difference between subgroups of the sample and responses to the questionnaire. Five hundred and eight respondents completed the survey. Most respondents (n = 225/508; 44.3%) are under 29 years old, female (n = 256/508; 50.4%) and have been working as physiotherapists for less than 5 years (n = 213/508; 41.9%). Most of respondents correctly knows about the cause (n = 455/508, 89.6%), main signs and symptoms of CTS (n = 415/508, 81.70%) and administer education, manual therapy, myofascial techniques and therapeutic exercises (n = 457/508, 89.88%). Three hundred and sixty-four (71.68%) respondents were aware of the influence of psychosocial factors on the patient’s outcomes. The survey showed greater adherence to evidences by physiotherapists holding a master’s degree. The results are mostly comparable with other surveys structured all over the world on the same topic. Italian physiotherapists management of the CTS was not always in line with current evidence. Interventions such as education, manual therapy, therapeutic exercise, nerve and tendon glide techniques are widely used, while the orthotic is only offered by half of the sample.
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Affiliation(s)
- Valentina Scalise
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
| | - Fabrizio Brindisino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, I-86100 Campobasso, Italy
| | - Leonardo Pellicciari
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Pisana, I-00166 Rome, Italy
- Correspondence: or ; Tel.: +39-32-8568-2656
| | - Silvia Minnucci
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy; (V.S.); (F.B.); (S.M.); (F.B.)
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Syron LN, Case SL, Lee JR, Lucas DL. Linking Datasets to Characterize Injury and Illness in Alaska's Fishing Industry. J Agromedicine 2021; 26:31-44. [PMID: 33146590 DOI: 10.1080/1059924x.2020.1845893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Limited research has characterized nonfatal injury/illness in Alaska's hazardous fishing industry. This study aimed to determine (a) the utility of linking datasets to conduct surveillance, and (b) injury/illness patterns during 2012-2016. Data were obtained from the Alaska Trauma Registry (ATR), Fishermen's Fund (FF), and US Coast Guard (USCG). Datasets were coded to identify patterns in injury/illness characteristics and circumstances. Probabilistic linkage methods were utilized to identify unique incidents that appeared in more than one dataset. After linking datasets, 3,014 unique injury/illness cases were identified. By dataset, 2,365 cases appeared only in FF, 486 only in USCG, 110 only in ATR, 25 in ATR and FF, 15 in ATR and USCG, 10 in USCG and FF, and 3 in all datasets. FF mainly captured claims submitted by small, independently-owned vessels in Southcentral and Southeastern Alaska. In contrast, USCG mainly captured reports from large, company-owned vessels in Western Alaska. By nature, cases were most frequently sprains, strain, and tears (27%), cuts (15%), and fractures (11%). Across fleets, injuries/illnesses most frequently resulted from contact with objects and equipment (41%), overexertion and bodily reaction (27%), and slips, trips, and falls (20%). Work processes associated with traumatic injuries were most frequently hauling gear (18%) and walking, climbing, and descending (18%). Half of all injuries were of moderate severity (53%). Linking datasets, which capture different segments of Alaska's fishing industry, provides the most comprehensive understanding of nonfatal injury/illness to date. These results, stratified by fleet and severity, will inform prevention strategies.
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Affiliation(s)
- Laura N Syron
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, National Institute for Occupational Safety and Health, Washington, D.C., USA
| | - Samantha L Case
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, National Institute for Occupational Safety and Health, Washington, D.C., USA
| | - Jennifer R Lee
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, National Institute for Occupational Safety and Health, Washington, D.C., USA
| | - Devin L Lucas
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, National Institute for Occupational Safety and Health, Washington, D.C., USA
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Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers' Compensation Claims. J Occup Environ Med 2019; 60:710-716. [PMID: 29438153 DOI: 10.1097/jom.0000000000001301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was o examine how work and nonwork health-related factors contribute to workers' compensation (WC) claims by gender. METHODS Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models. RESULTS For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men. CONCLUSION This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.
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Applebaum KM, Asfaw A, O’Leary PK, Busey A, Tripodis Y, Boden LI. Suicide and drug-related mortality following occupational injury. Am J Ind Med 2019; 62:733-741. [PMID: 31298756 PMCID: PMC7485601 DOI: 10.1002/ajim.23021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Drug overdoses and suicides have been rising since 2000 and are major contributors to a 3-year decline in US life expectancy. Studies suggest that injured workers have elevated rates of depression and opioid use, but no studies have measured excess mortality related to these risks. MATERIALS AND METHODS We linked New Mexico workers' compensation data for 100 806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. We then estimated the association between receiving lost-time workers' compensation benefits and mortality hazard ratios (HRs) and 95% confidence intervals (CIs) based on Fine and Gray cause-specific subdistribution hazards for common causes of death and for drug-related, suicide, and alcohol-related mortality. RESULTS There was almost a 3-fold increase in combined drug-related and suicide mortality hazard among women (HR = 2.63, 95% CI = 1.91-3.64) and a substantial increase among men (HR = 1.42, 95% CI = 1.13-1.79). Circulatory disease mortality hazard was elevated for men (HR = 1.25, 95% CI = 1.05-1.50). CONCLUSION Workplace injuries severe enough to require more than a week off work may impair workers' long-term health and well-being. Drug-related deaths and suicides may be important contributors to the long-term excess mortality of injured workers. Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of postinjury depression may substantially reduce mortality consequent to workplace injuries.
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Affiliation(s)
- Katie M. Applebaum
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Abay Asfaw
- Economic Research and Support Office, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, District of Columbia
| | - Paul K. O’Leary
- Office of Retirement and Disability Policy, US Social Security Administration, Washington, District of Columbia
| | - Andrew Busey
- Department of Economics, Boston University, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Leslie I. Boden
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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Franklin GM, Evanoff B. Treatment of Carpal Tunnel Syndrome: Surgery or More Conservative Management? Muscle Nerve 2019; 60:12-13. [PMID: 31049992 DOI: 10.1002/mus.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/28/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Gary M Franklin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA.,Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Bradley Evanoff
- School of Medicine, Washington University in St. Louis, St Louis, MO
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de Wit M, Wind H, Hulshof CTJ, Frings-Dresen MHW. Person-related factors associated with work participation in employees with health problems: a systematic review. Int Arch Occup Environ Health 2018; 91:497-512. [PMID: 29700608 PMCID: PMC6002456 DOI: 10.1007/s00420-018-1308-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems? METHODS A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies. RESULTS In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation. CONCLUSIONS The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.
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Affiliation(s)
- Mariska de Wit
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Haije Wind
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Nuckols TK, Conlon C, Robbins M, Dworsky M, Lai J, Roth CP, Levitan B, Seabury S, Seelam R, Benner D, Asch SM. Quality of care and patient-reported outcomes in carpal tunnel syndrome: A prospective observational study. Muscle Nerve 2018; 57:896-904. [PMID: 29272038 DOI: 10.1002/mus.26041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Higher quality care for carpal tunnel syndrome (CTS) may be associated with better outcomes. METHODS This prospective observational study recruited adults diagnosed with CTS from 30 occupational health centers, evaluated physicians' adherence to recommended care processes, and assessed results of the Boston Carpal Tunnel Questionnaire (BCTQ) and Short Form Health Survey version 2 (SF-12v2) at recruitment and at 18 months. RESULTS Among 343 individuals, receiving better care (80th vs. 20th percentile for adherence) was associated with greater improvements in BCTQ Symptom Severity scores (-0.18, 95% confidence interval [CI] -0.32 to -0.05), BCTQ Functional Status scores (-0.21, 95% CI -0.34 to -0.08), and SF12-v2 Physical Component scores (1.75, 95% CI 0.33-3.16). Symptoms improved more when physicians assessed and managed activity, patients underwent necessary surgery, and employers adjusted job tasks. DISCUSSION Efforts should be made to ensure that patients with CTS receive essential care processes including necessary surgery and activity assessment and management. Muscle Nerve 57: 896-904, 2018.
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Affiliation(s)
- Teryl K Nuckols
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA.,Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Craig Conlon
- Employee Health, The Permanente Medical Group, Oakland, California, USA
| | - Michael Robbins
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Michael Dworsky
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Julie Lai
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Carol P Roth
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Barbara Levitan
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Seth Seabury
- University of Southern California, USC Schaeffer Center, Los Angeles, California, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | | | - Steven M Asch
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA.,VA Palo Alto Health Care System, Menlo Park, California, USA.,Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California, USA
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Peters SE, Coppieters MW, Ross M, Johnston V. Perspectives from Employers, Insurers, Lawyers and Healthcare Providers on Factors that Influence Workers' Return-to-Work Following Surgery for Non-Traumatic Upper Extremity Conditions. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:343-358. [PMID: 27586696 DOI: 10.1007/s10926-016-9662-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders' perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. METHODS A questionnaire was distributed to RTW stakeholders via gatekeeper organizations. Stakeholders rated 50 potential prognostic factors from 'not' to 'extremely' influential. Data were dichotomized to establish stakeholders' level of agreement. Disagreements between stakeholder groups were analyzed using χ 2. The relationship between stakeholder demographic variables and rating of a factor was determined via regression analysis. RESULTS One thousand and eleven stakeholders completed the survey: healthcare providers (77.8 %); employer representatives (12.2 %); insurer representatives (6.8 %); and lawyers (3.2 %). Factors with the highest stakeholder agreement for influencing RTW were: self-efficacy (92.2 %); post-operative psychological status (91.8 %); supportive employer/supervisor (91.4 %); employer's willingness to accommodate job modifications (90.7 %); worker's recovery expectations (88.3 %); mood disorder diagnosis (86.6 %); post-operative pain level (86.4 %); and whether the job can be modified (86.3 %). Disagreements between stakeholder groups were found for 19 (36 %) factors. The strongest disagreements were for: age; gender; obesity; doctor's RTW recommendation; and presence of a RTW coordinator. Respondents' characteristics (e.g., age, workers' compensation jurisdiction, work experience, stakeholder group) were associated with factor rating. CONCLUSION The factors stakeholders rated as having the greatest influence on RTW were predominately psychosocial and modifiable. These variables should be the focus of future research to determine prognostic factors for RTW for workers with upper extremity conditions, and to develop effective RTW interventions.
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Affiliation(s)
- Susan E Peters
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia.
| | - Michel W Coppieters
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Australia
- Orthopaedic Surgery, School of Medicine, The University of Queensland, St Lucia, Australia
| | - Venerina Johnston
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Besen E, Gaines B, Linton SJ, Shaw WS. The role of pain catastrophizing as a mediator in the work disability process following acute low back pain. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jabr.12085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elyssa Besen
- Liberty Mutual Research Institute for Safety; Hopkinton MA USA
| | - Brittany Gaines
- Liberty Mutual Research Institute for Safety; Hopkinton MA USA
- Department of Gerontology; University of Massachusetts-Boston; Boston MA USA
| | - Steven J. Linton
- CHAMP; School of Law, Psychology, and Social Work; Örebro University; Örebro Sweden
| | - William S. Shaw
- Liberty Mutual Research Institute for Safety; Hopkinton MA USA
- University of Massachusetts Medical School; Worcester MA USA
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Nuckols T, Conlon C, Robbins M, Dworsky M, Lai J, Roth CP, Levitan B, Seabury S, Seelam R, Asch SM. Quality of Care for Work-Associated Carpal Tunnel Syndrome. J Occup Environ Med 2017; 59:47-53. [PMID: 28045797 PMCID: PMC5382986 DOI: 10.1097/jom.0000000000000916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the quality of care provided to individuals with workers' compensation claims related to Carpal tunnel syndrome (CTS) and identify patient characteristics associated with receiving better care. METHODS We recruited subjects with new claims for CTS from 30 occupational clinics affiliated with Kaiser Permanente Northern California. We applied 45 process-oriented quality measures to 477 subjects' medical records, and performed multivariate logistic regression to identify patient characteristics associated with quality. RESULTS Overall, 81.6% of care adhered to recommended standards. Certain tasks related to assessing and managing activity were underused. Patients with classic/probable Katz diagrams, positive electrodiagnostic tests, and higher incomes received better care. However, age, sex, and race/ethnicity were not associated with quality. CONCLUSIONS Care processes for work-associated CTS frequently adhered to quality measures. Clinical factors were more strongly associated with quality than demographic and socioeconomic ones.
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Affiliation(s)
- Teryl Nuckols
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
- Division of General Internal Medicine, Cedars-Sinai Medical Center, 8700 Beverly Drive, Becker 113, Los Angeles, CA 90048
| | - Craig Conlon
- Employee Health, The Permanente Medical Group, 1950 Franklin Street, 16th Floor, Oakland, CA 94612
| | - Michael Robbins
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
| | - Michael Dworsky
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
| | - Julie Lai
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
| | - Carol P. Roth
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
| | - Barbara Levitan
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
| | - Seth Seabury
- University of Southern California, USC Schaeffer Center, 635 Downey Way, VPD Suite 210, Los Angeles, CA 90089
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
| | - Steven M. Asch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. 90407
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025
- Division of General Medical Disciplines, Stanford University School of Medicine, Medical School Office Building X336, 1265 Welch Road, Stanford, Palo Alto, CA 94305
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Conlon C, Asch S, Hanson M, Avins A, Levitan B, Roth C, Robbins M, Dworsky M, Seabury S, Nuckols T. Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design. Perm J 2016; 20:15-220. [PMID: 27723446 DOI: 10.7812/tpp/15-220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Little is known about quality of care for occupational health disorders, although it may affect worker health and workers' compensation costs. Carpal tunnel syndrome (CTS) is a common work-associated condition that causes substantial disability. OBJECTIVE To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs. DESIGN Prospective observational study of 477 individuals with new workers' compensation claims for CTS without acute trauma who were treated at 30 occupational health clinics from 2011 to 2013 and followed for 18 months. MAIN OUTCOME MEASURES Timing of key clinical events, adherence to 45 quality measures, changes in scores on the Boston Carpal Tunnel Questionnaire and 12-item Short Form Health Survey Version 2 (SF-12v2), and costs associated with medical care and disability. RESULTS Two hundred sixty-seven subjects (56%) received a diagnosis of CTS and had claims filed around the first visit to occupational health, 104 (22%) received a diagnosis before that visit and claim, and 98 (21%) received a diagnosis or had claims filed after that visit. One hundred seventy-eight (37%) subjects had time off work, which started around the time of surgery in 147 (83%) cases and lasted a median of 41 days (interquartile range = 42 days). CONCLUSIONS The timing of diagnosis varied, but time off work was generally short and related to surgery. If associations of quality of care with key medical, economic, and quality-of-life outcomes are identified for work-associated CTS, systematic efforts to evaluate and improve quality of medical care for this condition are warranted.
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Affiliation(s)
- Craig Conlon
- Medical Director of Employee Health Services for Kaiser Permanente in Oakland, CA.
| | - Steven Asch
- Chief of Health Services Research for the Veterans Administration Palo Alto Health Care System in Menlo Park, and Co-Chief of the Division of General Medical Disciplines at Stanford University in Palo Alto, CA.
| | - Mark Hanson
- Senior Project Associate for the RAND Corporation in Santa Monica, CA.
| | - Andrew Avins
- Research Scientist at the Division of Research in Oakland, CA.
| | - Barbara Levitan
- Survey Researcher for the RAND Corporation in Santa Monica, CA.
| | - Carol Roth
- Project Associate for the RAND Corporation in Santa Monica, CA.
| | - Michael Robbins
- Associate Statistician for the RAND Corporation in Santa Monica, CA.
| | - Michael Dworsky
- Associate Economist for the RAND Corporation in Santa Monica, CA.
| | - Seth Seabury
- Associate Professor of Research in Emergency Medicine at the Keck School of Medicine at the University of Southern California in Los Angeles.
| | - Teryl Nuckols
- Health Services Researcher for the RAND Corporation in Santa Monica and the Director of the Division of Internal Medicine at Cedars-Sinai Medical Center in Los Angeles, CA.
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Peters S, Johnston V, Hines S, Ross M, Coppieters M. Prognostic factors for return-to-work following surgery for carpal tunnel syndrome. ACTA ACUST UNITED AC 2016; 14:135-216. [DOI: 10.11124/jbisrir-2016-003099] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Evanoff B, Gardner BT, Strickland JR, Buckner-Petty S, Franzblau A, Dale AM. Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers. Am J Ind Med 2016; 59:357-68. [PMID: 26909521 DOI: 10.1002/ajim.22564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown. METHODS We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours. RESULTS Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims. CONCLUSIONS Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment.
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Affiliation(s)
- Bradley Evanoff
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Bethany T. Gardner
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Jaime R. Strickland
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Skye Buckner-Petty
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
| | - Alfred Franzblau
- Department of Environmental Health Sciences; University of Michigan School of Public Health; Ann Arbor Michigan
| | - Ann Marie Dale
- Division of General Medical Sciences; Washington University School of Medicine; Saint Louis Missouri
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Montgomery AS, Cunningham JE, Robertson PA. The Influence of No Fault Compensation on Functional Outcomes After Lumbar Spine Fusion. Spine (Phila Pa 1976) 2015; 40:1140-7. [PMID: 25943088 DOI: 10.1097/brs.0000000000000966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study and systematic literature review. OBJECTIVE To compare the functional outcomes for lumbar spinal fusion in both compensation and noncompensation patients in an environment of universal no fault compensation and then to compare these outcomes with those in worker's compensation and nonworkers compensation cohorts from other countries. SUMMARY OF BACKGROUND DATA Compensation has an adverse effect on outcomes in spine fusion possibly based on adversarial environment, delayed resolution of claims and care, and increased compensation associated with prolonged disability. It is unclear whether a universal no fault compensation system would provide different outcomes for these patients. New Zealand's Accident Compensation Corporation (ACC) provides universal no fault compensation for personal injury secondary to accident and offers an opportunity to compare results with differing provision of compensation. METHODS A total of 169 patients undergoing lumbar spinal fusion were assessed preoperatively, at 1 year, and at long-term follow-up out to 14 years, using functional outcome measures and health-related quality-of-life measures. Comparison was made between those covered and not covered by ACC for 3 distinct diagnostic categories. A systematic literature review comparing outcomes in Worker's Compensation and non-Compensation cohorts was also performed. RESULTS The functional outcomes for both ACC and non-ACC cohorts were similar, with significant and comparable improvements over the first year that were then sustained out to long-term follow-up for both cohorts. At long-term follow-up, the health-related quality-of-life measures were the same between the 2 cohorts.The literature review revealed a marked difference in outcomes between worker's compensation and non-worker's compensation cohorts with a near universal inferior outcome for the compensation group. CONCLUSION The similarities in outcomes of patients undergoing lumbar spine fusion under New Zealand's universal no fault compensation system, when compared with the dramatically inferior outcomes for these patients under other worker's compensation systems, suggest that the system of compensation has a major influence on patient outcomes, and that change of compensation to a universal no fault system is beneficial for patients undergoing lumbar fusion surgery. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Alexander Sheriff Montgomery
- *St Bartholomews Hospital and The Royal London Hospital, London, England †The Royal Melbourne Hospital and the Epworth Richmond, Melbourne, Australia; and ‡Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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