| Author: | Chu, Man Lai Mary |
| Title: | Predicting factors for outcomes of conservative treatment in patients presenting with carpal tunnel syndrome in an out-patient occupational therapy clinic |
| Advisors: | Chan, Chetwyn (RS) |
| Degree: | DHSc |
| Year: | 2019 |
| Subject: | Hong Kong Polytechnic University -- Dissertations Carpal tunnel syndrome -- Treatment -- Evaluation Outcome assessment (Medical care) |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xii, 106 pages : color illustrations |
| Language: | English |
| Abstract: | Objective: The aim was to identify predicting factors of treatment outcomes of a two-stage non-surgical intervention program for patients with carpal tunnel syndrome (CTS) in an out-patient occupational therapy clinic. Methods: A prospective cohort study where 166 patients diagnosed with CTS underwent a two-stage non-surgical CTS program. Stage One program consisted of two 2-hour sessions of four weeks apart. The program included splinting and educational talks in a group format. Those patients requiring further treatment after Stage One program would enter the Stage Two program. It consisted of four one-hour weekly individual sessions aiming at providing psychosocial support, reinforcing correct ergonomics and mobilization of upper limbs. Baseline assessment was done for all patients on six potential predicting factors identified from literature review including age, symptom duration, Symptom Severity Scale (SSS), Functional Status Scale (FSS), Chinese QuickDASH and positive Phalen's Test. There are four outcome measures. The first two which served also as discharge criteria for both Stage One and Stage Two programs were Global Assessment of Outcome with a rating of three or above and absence of nocturnal awakening. The last two were numeric rating scale (NRS) scores on pain and numbness. Other measures used for evaluating psychosocial and occupational aspects included Patient Health Questionnaire-9 and Job Content Questionnaire. Baseline predicting factors were used to predict the outcomes of treatment by binary logistic regression adjusted for baseline covariates. It was hypothesized that the Chinese SSS baseline score would be the primary predicting factor and the Chinese QuickDASH baseline score be the secondary predicting factor because the level of symptom severity could be assessed by Chinese SSS and the functional impairments by Chinese QuickDASH. Results: All patients completed the Stage One program and were re-assessed at one-month. Seventy patients met the discharge criteria and were discharged as achieving "successful" treatment outcomes. The remaining 96 patients had "unsuccessful" treatment outcomes and they were invited to join the Stage Two program. Only 49 patients joined and three defaulted treatment after attending two sessions. Re-assessment was conducted at the 2-month time point. The Chinese SSS baseline score was the only significant predictor for the Stage One program outcomes (AUC for ROC was 0.708) with an optimum cut-off score of 23.5 (i.e. a case with the Chinese SSS baseline score ≤ 23.5 is highly predicted to be successful after completing Stage One program). On the other hand, the Chinese QuickDASH baseline score was the only significant predictor for the Stage Two program outcomes (AUC for ROC was 0.801) with an optimum cut-off score of 27.4. Conclusions: Findings of the study suggested that the Chinese SSS baseline score was the only significant predictor for the Stage One Program outcomes and the Chinese QuickDASH baseline score was the only significant predictor for the Stage Two program outcomes. The Chinese SSS and the Chinese QuickDASH cut-off scores identified in this study may be applied clinically to construct a clinical decision tree for guiding client-centered treatment planning and managing patients' expectations for the interventions they receive. |
| Rights: | All rights reserved |
| Access: | restricted access |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| 991022378657103411.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 3.45 MB | Adobe PDF | View/Open |
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