Table 4.

Comparison of RAND/UCLA CTS quality-of-care measures with the ACOEM guideline [49]

RAND/UCLA measure title	Concordance with ACOEM guideline	Comments
1. New symptoms characteristic of CTS require detailed assessment	Concordant
2. New symptoms characteristic of CTS should lead to suspicion	Concordant
3. New hand or forearm pain requires evaluation for “red flags”	Concordant
4. Symptoms inconsistent with CTS require evaluation	Concordant	Some relevant content is in guideline sections that are not specific to CTS.
5. New CTS diagnosis requires assessment of medical risk factors	Concordant
6. New suspicion of CTS requires specific physical examination	Concordant
7. New suspicion of CTS requires evaluation for overweight	Not Addressed (N/A)	Guideline does not explicitly link overweight/obesity and CTS.
8. Imaging should be used selectively for suspected CTS	Concordant
9. Symptoms should be monitored after new diagnosis of CTS	N/A	Guideline does not specify which symptoms should be monitored at follow-up visits.
10. Splints should be placed in neutral position	Concordant
11. An attempt at splinting should last at least six weeks	Somewhat Concordant	Guideline states that an attempt at splinting can last about four weeks before steroid injections is attempted
Certain medications should not be used for CTS
12. NSAIDs	Discordant	Guideline recommends NSAIDs for hand disorders in general, states that corticosteroids may be more effective than NSAIDs for CTS, but notes that the side effects of steroids are a concern
13. Muscle relaxants	N/A	Guideline does not mention the use of muscle relaxants for CTS
14. Opioids	N/A	Guideline considers a short course of opiods to be an option for hand disorders in general but does not discuss the use of opioids for CTS
15. Diuretics	N/A	Guideline does not mention the use of diuretics for CTS
16. Lasers should not be used for CTS	Concordant
17. Discuss benefits of surgery when offering steroids to patients with severe CTS	N/A
18. First time steroid treatment requires discussion of risks	N/A
19. Steroids for work-associated symptoms require follow-up	Somewhat Concordant	Guideline recommends that follow-up visits for work-related CTS be performed at a frequency of 4–7 or 7–14 days, depending upon whether the patient is working. The measure sets the minimum acceptable standard for follow-up at 4 weeks after the injection.
20. Limit steroid injections to 4	Concordant	Guideline suggests steroid injections should be used for 8-12 weeks but does not specify the number of injections, whereas the measures specify the number but not the total duration of use.
21. New CTS diagnosis requires detailed occupational history	Concordant
22. New CTS diagnosis requires assessment of occupational factors	Concordant	The CTS chapter in guideline does not specify how to assess occupational factors. The ACOEM Return to Work Position Statement provides more specific recommendations [69].
23. New CTS diagnosis requires assessment of non-occupational factors	N/A	Guideline does not discuss assessing non-occupational factors that may be associated with the CTS symptoms.
24. Exacerbating activities should be identified when CTS limits functioning	Concordant
25. Rationale for work-association should be documented	Concordant
26. Patients diagnosed with CTS should be educated about the condition	Concordant	Guideline is less specific about how patients should be educated.
27. Exposures to vibration, force, and repetition should be minimized	Somewhat Concordant	Guideline mentions force and repetition but not vibration.
28. Work-associated CTS symptoms require prompt follow-up	Somewhat Concordant	Guideline recommends that all follow-up visits for work-related CTS be performed at a frequency of 4–7 or 7–14 days, depending upon whether the patient is working. The measure sets the minimum acceptable standard for follow-up frequency at 4 weeks.
29. Work status should be monitored when CTS appears work associated	Concordant
30. Return to work after CTS-related disability requires follow-up assessment	Somewhat Concordant	Guideline does not specify a time frame for follow-up in this specific situation. Its overall recommended frequency for follow-up would suggest within 4–7 days, whereas the measure sets the minimum acceptable standard at 4 weeks after return to work.
31. Prolonged CTS-related disability should trigger evaluation	Concordant