Table 2.
Quality measures: measure titles, ratings, and evidence level*
| Measure title | Validity | Feasibility | Importance | Evidence | ||
|---|---|---|---|---|---|---|
| Median† | N (%) of Ratings >=7 | Median† | N (%) of Ratings >=4 | Median | level† | |
| Initial evaluation of hand and forearm symptoms | ||||||
| 1. New symptoms characteristic of CTS require detailed assessment | 8 (2–9) | 9 (82%) | 8 (7–9) | 11 (100%) | 8 (6–9) | 2 |
| 2. New symptoms characteristic of CTS should lead to suspicion | 8 (7–9) | 11 (100%) | 8 (7–9) | 11 (100%) | 7 (5–8) | 2 |
| 3. New hand or forearm pain requires evaluation for “red flags” | 8 (1–9) | 10 (91%) | 8 (1–9) | 10 (91%) | 8 (1–9) | 3 |
| 4. Symptoms inconsistent with CTS require evaluation | 8 (6–9) | 10 (91%) | 8 (4–9) | 11 (100%) | 8 (5–9) | 3 |
| 5. New CTS diagnosis requires assessment of medical risk factors | 8 (1–9) | 9 (82%) | 8 (7–9) | 11 (100%) | 8 (5–9) | 3 |
| 6. New suspicion of CTS requires specific physical examination | 8 (5–9) | 10 (91%) | 8 (4–9) | 11 (100%) | 8 (5–9) | 2 |
| 7. New suspicion of CTS requires evaluation for overweight | 7 (5–9) | 9 (82%) | 7 (7–9) | 11 (100%) | 6 (2–9) | 3 |
| 8. Imaging should be used selectively for suspected CTS | 8 (7–9) | 11 (100%) | 8 (8–9) | 11 (100%) | 7 (3–9) | 3 |
| 9. Symptoms should be monitored after new diagnosis of CTS | 8 (7–8) | 11 (100%) | 8 (7–9) | 11 (100%) | 7 (4–8) | 3 |
| Non-operative treatment of CTS | ||||||
| 10. Splints should be placed in neutral position | 8 (7–9) | 11 (100%) | 8 (5–9) | 11 (100%) | 7 (4–9) | 1 |
| 11. An attempt at splinting should last at least six weeks | 7 (1–8) | 8 (73%) | 7 (1–8) | 11 (100%) | 7 (1–8) | 1 |
| Certain medications should not be used for CTS | ||||||
| 12. NSAIDs | 7 (4–8) | 9 (82%) | 7 (6–9) | 11 (100%) | 7 (3–9) | 1 |
| 13. Muscle Relaxants | 7 (6–9) | 10 (91%) | 8 (6–9) | 11 (100%) | 7 (3–9) | 3 |
| 14. Opioids | 8 (7–9) | 11 (100%) | 8 (7–9) | 11 (100%) | 7 (3–9) | 3 |
| 15. Diuretics | 8 (2–9) | 11 (100%) | 8 (7–9) | 11 (100%) | 7 (2–9) | 1 |
| 16. Lasers should not be used for CTS | 8 (7–9) | 11 (100%) | 8 (3–9) | 10 (91%) | 7 (1–9) | 1 |
| 17. Discuss benefits of surgery when offering steroids to patients with severe CTS | 8 (6–8) | 10 (91%) | 8 (6–9) | 11 (100%) | 8 (5–8) | 1 |
| 18. Steroid treatment requires discussion of risks | 8 (6–9) | 10 (91%) | 8 (7–9) | 11 (100%) | 6 (3–9) | 3 |
| 19. Steroids for work-associated symptoms require follow-up | 7 (6–9) | 10 (91%) | 8 (7–9) | 11 (100%) | 7 (5–9) | 3 |
| 20. Limit steroid injections to 4 | 7 (4–9) | 10 (91%) | 8 (5–9) | 11 (100%) | 7 (3–9) | 3 |
| Addressing activities and functional limitations potentially associated with CTS symptoms | ||||||
| 21. New CTS diagnosis requires detailed occupational history | 7 (2–9) | 9 (82%) | 7 (7–9) | 11 (100%) | 6 (2–9) | 3 |
| 22. New CTS diagnosis requires assessment of occupational factors | 7 (5–9) | 8 (73%) | 8 (5–9) | 11 (100%) | 7 (5–9) | 2 |
| 23. New CTS diagnosis requires assessment of non-occupational factors | 7 (5–9) | 8 (73%) | 8 (5–9) | 11 (100%) | 7 (5–9) | 2 |
| 24. Exacerbating activities should be identified when CTS limits functioning | 7 (4–9) | 6 (55%) | 7 (6–9) | 11 (100%) | 7 (5–9) | 3 |
| 25. Rationale for work-association should be documented | 7 (4–8) | 6 (55%) | 6 (3–8) | 9 (82%) | 7 (4–9) | 3 |
| 26. Patients diagnosed with CTS should be educated about the condition | 7 (5–9) | 6 (55%) | 7 (4–9) | 11 (100%) | 7 (5–9) | 3 |
| 27. Exposures to vibration, force, and repetition should be minimized | 7 (3–9) | 7 (64%) | 7 (4–8) | 11 (100%) | 7 (4–9) | 2–3 |
| 28. Work-associated CTS symptoms require prompt follow-up | 8 (6–9) | 10 (91%) | 8 (5–9) | 11 (100%) | 8 (2–9) | 3 |
| 29. Work status should be monitored when CTS appears work associated | 7 (5–9) | 9 (82%) | 7 (5–9) | 11 (100%) | 7 (5–9) | 3 |
| 30. Return to work after CTS-related disability requires follow-up assessment | 7 (5–9) | 6 (55%) | 7 (6–9) | 11 (100%) | 6 (5–9) | 3 |
| 31. Prolonged CTS-related disability should trigger evaluation | 7 (6–9) | 10 (91%) | 7 (6–9) | 11 (100%) | 7 (6–9) | 2–3 |
* The table lists measure titles. The actual text of the measures is provided in Table 1
†Validity Ratings >=7 indicated panelists thought the measure was valid. Feasibility Ratings >=4 indicated panelists thought the measure was potentially feasible. Level of Evidence: 1 = randomized controlled trial, 2 = observational data, 3 = case series or expert consensus