Audit of a Therapist-led Clinic for Carpal Tunnel Syndrome in Primary Care

Abstract

An audit was designed to evaluate the effect on waiting times, did not attend (DNA) rates and quality of clinical management of a hand therapist-led clinic for Carpal Tunnel Syndrome (CTS) in Primary Care, and to investigate whether the clinic acted as an effective threshold mechanism for the Pulvertaft Hand Centre consultant clinics. Following a period of training with a senior consultant at the Pulvertaft Centre, an experienced hand therapist from the Centre worked out in Primary Care seeing patients with a provisional diagnosis of CTS who had been referred directly from General Practitioners (GPs). The referrals were assisted by the use of a local referral protocol. Tinel's and Phalen's tests were performed and areas of sensory loss were documented. A Levine Questionnaire was completed by the patient at an initial appointment and subsequently at review four to eight weeks later. Grip and pinch measurements were taken using a Jamar® Dynamometer. Mild and moderate CTS can be effectively managed by a community-based Hand Therapy Clinic. Forty five percent of GP-referred CTS patients were successfully managed without referral onto the Hand Centre and did not require further treatment for CTS in the subsequent two years. The consultation length was 30 minutes per patient at the therapist-led clinic, compared with 15 minutes at the Hand Centre. Waiting times were reduced from 90 to 20 days, and the clinic had a low (3%) DNA rate. Wrist splints were expertly chosen and fitted and patients were educated and empowered about their condition. The Hand Therapy Clinic acted as a useful threshold mechanism for Tertiary Care Hand Centre CTS referrals, removing 46% of CTS referrals from the Hand Centre clinics. The proportion of Hand Clinic-referred patients requiring carpal tunnel decompression (CTD) was therefore increased to 62% from 33%. This community-based, hand therapist-led clinic for CTS management is consistent with current Health Service initiatives.