哪些治疗方法可用于治疗腕管综合征患者？一项商业保险的回顾性分析。
What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance.
机构信息
Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15218.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
出版信息
PM R. 2018 Aug;10(8):826-835. doi: 10.1016/j.pmrj.2018.02.004. Epub 2018 Feb 13.
BACKGROUND
Treatment of carpal tunnel syndrome (CTS) in commercially insured patients across the spectrum of provider types rarely has been described.
OBJECTIVE
To describe patterns of types of treatment for patients with CTS using a large commercial insurance database.
DESIGN
Retrospective cohort descriptive study.
SETTING
Administrative health data from the Clinformatics Data Mart (OptumInsight, Eden Prairie, MN).
PATIENTS
Adults with a primary diagnosis of CTS seen from between January 2010 to December 2012 who had a total of 48 months of continuous data (12 months before diagnosis and 36 months after diagnosis) (n = 24,931).
OUTCOMES
Frequency of types of treatment (heat, manual therapy, positioning, steroids, stretching, surgery) by number of treatments, number of visits, provider type, and characteristics.
RESULTS
Fifty-four percent of patients received no reported treatment, and 50.4% had no additional visits. Surgery (42.5%) and positioning (39.8%) were the most frequent single treatments. Patients who were seen by orthopedist for their first visit more frequently received some treatment (75.1%) and at least 1 additional visit (74.1%) compared with those seen by general practitioners (59.5%, 57.5%, respectively) or other providers (65.4%, 68.4, respectively). Orthopedists more frequently prescribed positioning devices (26.8%) and surgery (36.8%) than general practitioners (18.8%, 14.1%, respectively) or other providers (15.7%, 19.7%, respectively). Older adults more frequently had CTS surgery, as did people who lived in the Midwest. Overall, only 24% of patients with CTS had surgery.
CONCLUSIONS
For more than one-half of patients with CTS no treatment was provided after an initial visit. Surgery rates were much lower than what has previously been reported in the literature. Generally, patients with CTS receive treatments that are supported by current treatment guidelines.
LEVEL OF EVIDENCE
NA.
背景
在各种类型的医疗机构中，对商业保险患者的腕管综合征（CTS）的治疗方法很少有描述。
目的
使用大型商业保险数据库描述 CTS 患者的各种治疗类型模式。
设计
回顾性队列描述性研究。
设置
来自 Clinformatics Data Mart（OptumInsight，Eden Prairie，MN）的行政健康数据。
患者
2010 年 1 月至 2012 年 12 月期间接受过原发性 CTS 诊断的成年人，在诊断前 12 个月和诊断后 36 个月内总共具有 48 个月的连续数据（n=24931）。
结局
根据治疗次数、就诊次数、治疗类型、患者特征，描述治疗类型（热疗、手法治疗、定位、类固醇、拉伸、手术）的频率。
结果
54%的患者未接受报告的治疗，50.4%的患者未增加就诊次数。手术（42.5%）和定位（39.8%）是最常见的单一治疗方法。首次就诊时由矫形外科医生治疗的患者更频繁地接受某种治疗（75.1%）和至少 1 次额外就诊（74.1%），而由全科医生（59.5%，57.5%）或其他提供者（65.4%，68.4%）治疗的患者则较少。矫形外科医生比全科医生（18.8%，14.1%）或其他提供者（15.7%，19.7%）更频繁地开定位设备（26.8%）和手术（36.8%）。老年人更频繁地进行 CTS 手术，居住在中西部地区的人也是如此。总体而言，只有 24%的 CTS 患者接受了手术。
结论
超过一半的 CTS 患者在首次就诊后没有接受治疗。手术率远低于文献中先前报道的水平。通常，CTS 患者接受的治疗方法符合当前治疗指南。
证据水平
无。
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