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首页> 外文期刊>Journal of Hand Surgery. American Volume >Variation in recommendation for surgical treatment for compressive neuropathy
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Variation in recommendation for surgical treatment for compressive neuropathy

机译：压缩性神经病手术治疗建议的变化

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Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that-at least in a survey setting-surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery.
机译：目的我们的印象是，手外科医生对周围性单神经病的治疗方法存在大量无法解释的建议。我们检验了零假设，即特定的患者和提供者因素不影响手术建议。方法手外科医师使用基于网络的调查，建议在2种不同情况下对患者进行手术或非手术治疗。第一种情况的六个要素（症状，情况，思维方式，诊断，客观测试和期望）具有2个可能性，分别独立地随机分配给每个评估者。对于第二种情况，将两个不同的情况随机分配给每个评估者。多变量逻辑回归分析寻求与手术建议相关的因素。结果变异科学小组的186名外科医生根据临床情况完成了针对2位不同患者的手术建议的调查。根据提供者的特征，对手术的建议没有显着差异。对于方案1中的各种要素，对于自雇且继续工作且具有客观电诊断异常的患者，更可能推荐手术。对于方案2中使用的2个小插曲，手术建议与异常的电生理相关。结论：这项研究的结果表明，至少在一项调查中，外科医生倾向于为电生理异常的患者，特别是那些具有有效应对策略的患者提供周围神经减压。临床相关性病理生理学客观验证的作用尚有争议，但这是建议手部手术的影响因素。

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