职业治疗师、物理治疗师和整形外科医生就腕管手术的决定达成一致。
Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery.
作者信息
Lewis Karina J, Coppieters Michel W, Vicenzino Bill, Hughes Ian, Ross Leo, Schmid Annina B
机构信息
Occupational Therapy Department, Gold Coast University Hospital, Southport, QLD, Australia.
Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia.
出版信息
Int J Health Policy Manag. 2022 Jul 1;11(7):1001-1008. doi: 10.34172/ijhpm.2020.227. Epub 2020 Dec 16.
BACKGROUND
Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS.
METHODS
This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1).
RESULTS
Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)).
CONCLUSION
Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.
背景
在公立医院，治疗师主导的路径已被提议作为腕管综合征（CTS）等疾病手术前的等待名单管理策略。这些护理模式通常将患者的初始护理和决策从外科医生转移到治疗师，并且已被证明可以减少需要手术的患者数量并缩短等待时间。尽管在诸如手术必要性等关键决策上，外科医生和治疗师达成一致的证据有限，但这种情况仍会发生。本研究的目的是评估治疗师与骨科医生在CTS患者手术必要性方面的一致性。
方法
这项双盲的相互评级一致性研究纳入了一项多中心随机平行组试验，该试验涉及105名被转诊至四个骨科科室并等待预约的CTS患者。该试验评估了治疗师主导的护理路径对手术必要性以及与症状和功能相关结果的影响。患者被随机分配，要么留在骨科等待名单上，要么接受团体教育、佩戴夹板和进行家庭锻炼。6个月时手术必要性的决定由骨科顾问团队成员或14名参与研究的治疗师之一做出。治疗师和外科医生对彼此的决定不知情。使用百分比一致性、kappa系数（k）、患病率调整和偏差调整kappa（PABAK）以及Gwet一阶一致性系数（AC1）来确定一致性。
结果
治疗师和外科医生在手术必要性方面达成了高度一致（PABAK = 0.74（0.60 - 0.88））。一致性与经验显著相关（= 0.02）。具有丰富经验和执业范围的治疗师与外科医生表现出完全一致（PABAK = 1.00（95% CI：1.00 - 1.00））。职业生涯中期的治疗师表现出高度一致（PABAK = 0.67（95% CI：0.42 - 0.91）），职业生涯早期的治疗师表现出中等一致（PABAK = 0.43（95% CI： - 0.04 - 0.90））。
结论
具有丰富执业范围的治疗师做出的决策与骨科医生一致。
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