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The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures
Author(s) -
Shetty Kanaka D.,
Robbins Michael,
Aragaki Dixie,
Basu Aashna,
Conlon Craig,
Dworsky Michael,
Benner Douglas,
Seelam Rachana,
Nuckols Teryl K.
Publication year - 2020
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.26874
Subject(s) - carpal tunnel syndrome , medicine , confidence interval , test (biology) , physical therapy , receipt , health care , quality (philosophy) , carpal tunnel release , quality of life (healthcare) , surgery , nursing , paleontology , philosophy , epistemology , world wide web , computer science , economics , biology , economic growth
The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health‐care expenditures. Methods We evaluated test quality among 338 adults with workers’ compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12‐item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. Results In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (−0.50 point; 95% confidence interval [CI], −0.89 to −0.12) and functional impairment (−0.42 point; 95% CI, −0.78 to −0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. Discussion Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.