Monash University, Melbourne, Victoria, Australia; The Alfred, Melbourne, Victoria, Australia.
J Hand Ther. 2013 Oct-Dec;26(4):318-22; quiz 322. doi: 10.1016/j.jht.2013.06.003. Epub 2013 Aug 3.
Retrospective cohort study.
To measure the impact of initial treatment by a hand therapist of people referred to a hand surgeon for common hand conditions.
This retrospective cohort study included 224 patients with Carpal Tunnel Syndrome, Trigger Finger/Thumb, de Quervain's tenosynovitis, and trapeziometacarpal osteoarthrosis. All were invited to attend for assessment and non-operative treatment and were followed up for at least one year. Between groups comparisons for who attended (N = 164) and those who did not (N = 60) were conducted.
40.8% of the non-operative treatment group and 65% of the no treatment group underwent surgery, which was statistically significant (p = 0.02). Univariate analysis found that the variable "attending non-operative treatment" was able to predict those who did not have surgery (p = 0.02). Multivariate analysis using logistic regression also showed that this was the only significant predictor of not progressing to surgery (p = 0.001).
Assessment and treatment by a non-operative provider were associated with a decrease in the rate of operative treatment. Prospective, randomized studies could help determine if this observed difference is related to the treatment approach.
回顾性队列研究。
测量手部治疗师对因常见手部疾病而转介到手外科医生处的患者进行初始治疗的效果。
这项回顾性队列研究纳入了 224 名患有腕管综合征、扳机指/拇指、De Quervain 腱鞘炎和腕掌关节炎的患者。所有患者均被邀请进行评估和非手术治疗，并至少随访一年。对参加（N=164）和未参加（N=60）的两组患者进行组间比较。
非手术治疗组中有 40.8%的患者和未治疗组中有 65%的患者接受了手术，这具有统计学意义（p=0.02）。单因素分析发现，“接受非手术治疗”这一变量能够预测未接受手术的患者（p=0.02）。使用逻辑回归的多因素分析也表明，这是非手术治疗后未进展为手术的唯一显著预测因素（p=0.001）。
由非手术提供者进行评估和治疗与手术治疗率的降低相关。前瞻性、随机研究可以帮助确定观察到的差异是否与治疗方法有关。
