Practice patterns in the conservative treatment of carpal tunnel syndrome: Survey results from members of the American Society of Hand Therapy.

STUDY DESIGN: A cross-sectional descriptive design was used. INTRODUCTION: Carpal tunnel syndrome (CTS) is a complex combination of symptoms resulting from compression of the median nerve within the carpal tunnel. A study that compares the conservative interventions identified in the literature with the actual conservative interventions being implemented by therapists for the treatment of CTS is not presently available. PURPOSE OF THE STUDY: The purpose of this study was to examine conservative interventions for CTS as reported by certified hand therapists (CHTs) within various clinical settings. The study also aimed to identify the decision-making process for the selection of CTS interventions. METHOD: CHT members of the American Society of Hand Therapists were surveyed electronically to obtain quantitative data. RESULTS: Patient education, nocturnal orthosis, and ergonomic modifications ranked among the top conservative interventions utilized for CTS, whereas treatments such as magnet therapy, C-TRAC, and heating lamps ranked among the least utilized interventions. When selecting interventions, clinical expertise, research evidence, and patient preferences were all highly valued considerations for CHT. DISCUSSION: Our study offers a unique summary of CHT practice patterns for CTS interventions and the associated decision-making processes. It compares findings with existing literature on this topic, offering researchers and clinicians a glimpse of the CTS practice trends. CONCLUSION: This study may serve to prioritize future research studies based on the prevalence of intervention usage among the experts. It also serves as a guide to those seeking to understand the most common interventions utilized for conservative CTS treatment.

A Narrative Review of Patient and Family Engagement: The "Foundation" of the Medical "Home".

BACKGROUND: Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE: To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. METHODS: We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. RESULTS: Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. CONCLUSIONS: Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.