TY - JOUR
T1 - Variation in treatment for trapeziometacarpal arthrosis
AU - Becker, Stéphanie J. E.
AU - Bruinsma, Wendy E.
AU - Guitton, Thierry G.
AU - van der Horst, Chantal M. A. M.
AU - Strackee, Simon D.
AU - Ring, David
N1 - Funding Information: SJEB is supported by Dutch research grants from Anna Foundation|NOREF, Genootschap Noorthey, Stichting Fonds Doctor Catharine van Tussenbroek, and Stichting Vreedefonds, the Nether?ands, for scienti 퀀ic research. Publisher Copyright: © 2021 Mashhad University of Medical Sciences. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis. Forty-two observers were randomly assigned to review clinical information alone and 50 to review clinical information as well as radiographs. The degree of limitation of daily activities, time since diagnosis, prior treatment, pain with grind, crepitation with grind, and metacarpal adduction with metacarpophalangeal hyperextension were randomized for each patient scenario to determine the influence of these factors on offers of surgery. A cross-classified binary logistic multilevel regression analysis identified factors associated with surgeon offer of surgery. Results: Surgeons were more likely to offer surgery when they viewed radiographs (42% vs. 32%, P = 0.01). Other factors associated variation in offer of surgery included greater limitation of daily activities, symptoms for a year, prior splint or injection, deformity of the metacarpophalangeal joint. Factors not associated included limb dominance, prominence of the TMC joint, crepitation with the grind test, and pinch and grip strength. Conclusion: Surgeons that view radiographs are more likely to offer surgery to people with TMC arthrosis. Surgeons are also more likely to offer surgery when people do not adapt with time and nonoperative treatment. Given the notable influence of surgeon bias, and the potential for surgeon and patient impatience with the adaptation process, methods for increasing patient participation in the decision-making process merit additional attention and study.
AB - Background: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis. Forty-two observers were randomly assigned to review clinical information alone and 50 to review clinical information as well as radiographs. The degree of limitation of daily activities, time since diagnosis, prior treatment, pain with grind, crepitation with grind, and metacarpal adduction with metacarpophalangeal hyperextension were randomized for each patient scenario to determine the influence of these factors on offers of surgery. A cross-classified binary logistic multilevel regression analysis identified factors associated with surgeon offer of surgery. Results: Surgeons were more likely to offer surgery when they viewed radiographs (42% vs. 32%, P = 0.01). Other factors associated variation in offer of surgery included greater limitation of daily activities, symptoms for a year, prior splint or injection, deformity of the metacarpophalangeal joint. Factors not associated included limb dominance, prominence of the TMC joint, crepitation with the grind test, and pinch and grip strength. Conclusion: Surgeons that view radiographs are more likely to offer surgery to people with TMC arthrosis. Surgeons are also more likely to offer surgery when people do not adapt with time and nonoperative treatment. Given the notable influence of surgeon bias, and the potential for surgeon and patient impatience with the adaptation process, methods for increasing patient participation in the decision-making process merit additional attention and study.
KW - Decision-making
KW - Interobserver variation
KW - Osteoarthritis
KW - Surgery
KW - Trapeziometacarpal arthrosis
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85108816872&partnerID=8YFLogxK
U2 - https://doi.org/10.22038/ABJS.2020.42060.2144
DO - https://doi.org/10.22038/ABJS.2020.42060.2144
M3 - Article
C2 - 34026932
SN - 2345-4644
VL - 9
SP - 158
EP - 166
JO - Archives of bone and joint surgery
JF - Archives of bone and joint surgery
IS - 2
ER -