Health economic evaluation of different treatment strategies for peripheral entrapment mononeuropathies: a systematic review.

Introduction: In this era of cost-conscious health systems, it is of utmost importance to identify and establish the most cost-effective treatment option. However, in the case of peripheral entrapment mononeuropathies there is alack of data regarding economically effective treatment strategies. Therefore, the objective was to conduct an economic evaluation including both costs and benefits of various treatment strategies applied to peripheral entrapment mononeuropathies to estimate the relative cost-effective treatment regimens.Areas covered: Over the 19 years, seven excellent-high quality economic evaluations of three types of peripheral entrapment mononeuropathies were identified in four countries. Our findings showed that surgery was the most cost-effective therapy followed by same cost efficacy of infiltrative therapy and conservative therapy for peripheral entrapment mononeuropathies. However, the fact that surgery was the most common comparator (n = 6) in our selected studies cannot be neglected.Expert opinion: Due to huge methodological variability, the finding of surgery as the cost-effective treatment strategy remains tentative and the decision about the most suitable clinical and cost-effective therapy should be individualized from case to case. Moreover, the economic evaluation of all possible treatment strategies for peripheral entrapment mononeuropathies over alonger period of analysis is required in future studies.

Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment.

Proximal median (PMNE) and radial (RNE) nerve entrapment syndromes are uncommon. This article provides an evidenced-based treatment guideline for PMNE and RNE based on the available literature. Arriving at an accurate diagnosis must involve an electrodiagnostic (EDx) workup. EDx, including nerve conduction velocity studies and needle electromyography, should corroborate the clinical diagnosis and must be done before consideration of any surgical treatment. Conservative care includes rest, modified activities, splinting at wrist and elbow, physical therapy, antiinflammatory drug therapy, and corticosteroid injections. Conservative care should be required for at least 6 weeks before any operative interventions are considered.

[Significance of unresolved financial compensation for the course of cervical root compression]. / Betydningen af uafklaret økonomisk kompensation for forløbet af nerverodstryk i nakken.

The aim of this study was to examine the influence of claims for financial compensation on the results of physiotherapeutic McKenzie treatment for cervical nerve root compression. This study was based on prospectively collected data for quality assurance purpose with baseline classification and included a follow-up postal questionnaire to measure the outcomes: Neck and arm pain, disability, use of analgesics and the perceived effect of the treatment registered by the patient. At baseline, patients with or without compensation issues were identical in regard to their neurological and clinical signs. The study showed that 6-12 months later there was no improvement in six out of seven patients with claims for compensation involvement, in contrast to the 21 patients without claims for financial compensation who all showed significant improvement. The results applied to all five outcome measures. In conclusion, compensation involvement seems to act as a negative factor on treatment results for patients with cervical nerve root compression who were treated conservatively.

Age, outcome, and rehabilitation costs after paraplegia caused by traumatic injury of the thoracic spinal cord, conus medullaris, and cauda equina.

The object of this study was to investigate the relationships of age on neurologic and functional outcome, hospitalization length of stay (LOS), and hospital charges after spinal cord injury (SCI). At 20 medical centers, 2,169 consecutive adult patients with paraplegia SCI were assessed in acute care and inpatient rehabilitation. Outcome and treatment measures included the ASIA motor index score, functional independence measure, discharge to community ratio, LOS, and hospital charges. Age differences were examined by separating the sample into 11 age categories and conducting one-way analyses of variance on treatment, medical expense, and outcome measures that included the Functional Independence Measure (FIM) and ASIA motor index scores. Cramer's statistic was used to derive a chi-square value that indicated whether variables differed significantly in terms of age. Post-hoc Tukey tests were also performed. Age-related differences were found with multiple demographic variables. Significant differences between age categories were found with regard to the following treatment measures: ASIA motor index scores at acute-care admission and at discharge, rehabilitation LOS, inpatient rehabilitation hospitalization charges, total LOS, total hospitalization charges, FIM scores at inpatient rehabilitation admission and discharge, FIM change, and FIM efficiency. In conclusion, in patients with paraplegia, age appears to adversely affect functional outcome, rehabilitation LOS, and hospital costs. However, neurologic recovery as defined by the ASIA motor scores does not appear to be related to age.