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Better Patient-Reported Experiences with Health Care Are Associated with Improved Clinical Outcome after Carpal Tunnel Release Surgery

Schrier, Verena J. M. M. M.D.; Poelstra, Ralph M.D.; Selles, Ruud W. Ph.D.; Slijper, Harm P. Ph.D.; Amadio, Peter C. M.D.; Hovius, Steven E. R. M.D., Ph.D.; Porsius, Jarry T. Ph.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1677-1684
doi: 10.1097/PRS.0000000000005516
Hand/Peripheral Nerve: Original Articles
Outcomes: Patient-Reported Health
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Background: In hand surgery, and specifically carpal tunnel syndrome, it is currently unknown whether experiences with health care influence surgical outcome. To investigate whether there is an association between patient-reported experience measures and symptom relief, data were gathered using a cohort of patients undergoing surgical treatment for carpal tunnel syndrome.

Methods: Patient-reported experience measures and patient-reported outcome measures were registered in a national database of 16 hand surgery practices. The experience measure data were gathered at 3 months after surgery and included six subscales on different health care delivery aspects (e.g., provided information, communication, facility, operative care). The outcome measure data were acquired before and 3 months after surgery with the Boston Carpal Tunnel Assessment Questionnaire. The association was tested using linear regression analyses.

Results: A total of 1607 patients were included in the analysis. The experience measure scores were good to excellent, with a median value between 8.0 and 8.5 on a 10-point scale. Regression analyses showed a significant (p < 0.001) association with the Boston Carpal Tunnel Assessment Questionnaire for all individual patient-reported experience measure subscales. The greatest effects were found in physician communication and treatment information. Patient-reported experience measures accounted for more than 5 percent of the explained variance, with patient characteristics explaining an approximately additional 3 percent.

Conclusions: In this large data set of carpal tunnel syndrome patients who underwent surgical release, a significant impact of health care experiences on self-reported clinical outcome was found. This is relevant information, not only for directing care providers in improving health care experiences as a quality-of–health care measure but now also potentially to achieve better clinical outcome.


Evidence-Based Outcomes Article.

Rochester, Minn.; and Rotterdam, Hilversum, and Nijmegen, The Netherlands; and Boston, Mass.

From the Department of Orthopedic Surgery, Mayo Clinic; the Departments of Plastic, Reconstructive and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Department of Plastic and Reconstructive Surgery, Radboudumc University Hospital; and the Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School.

Received for publication May 7, 2018; accepted October 3, 2018.

Disclosure:Dr. Porsius was supported by a Rubicon Fellowship (446-16-017) from the Netherlands Organisation for Scientific Research (NWO) and by the Medical Delta. The funding sources did not influence the design, analysis, or reporting of this study. None of the other authors has a financial interest in any of the products or devices mentioned in this article.

Verena J. M. M. Schrier, M.D., Mayo Clinic, Rochester 200 1st Street SW, Rochester, Minn. 55905,, Twitter: @vschrier

Copyright © 2019 by the American Society of Plastic Surgeons