Technology-Enhanced Group Based model of care following Carpal Tunnel Release (CTR) surgery

Occupational Therapist Emma Taylor is investigating the acceptability and feasibility of a technology-enhanced group based (TEG) model of care for people following carpal tunnel release (CTR) surgery.

Carpal tunnel syndrome is a condition where there is pressure on the median nerve in the wrist. It is characterised by pain, numbness and/or pins and needles in the hand and can result in permanent nerve damage if left untreated.

CTR surgery involves cutting the ligament that is placing pressure on the median nerve. CTR surgery is performed at the Surgical, Treatment and Rehabilitation Service (STARS) as a day procedure.

Following CTR surgery, patients usually receive in-person, one-to-one hand therapy sessions to improve the range of motion, functionality and the management of scar tissue.

In the pilot randomised controlled trial, the TEG model of care involving group based, app-based home program with a telehealth follow-up was compared to the usual care model of one-to-one, paper-based home program, in-person follow-up.

The TEG model aims to increase efficiency and outcomes, using telehealth delivery to improve patient access and app-based video-guided exercise and monitoring to improve self-management, adherence and outcomes.

“Participants in the TEG mode of care received a home therapy program using a mobile phone or computer-based app that included interactive videos, reminders and prompts to increase self-monitoring to the program,” Ms Taylor said.

“Patients receiving the usual model of care received a written home therapy program, including patient handouts with text and photo descriptions and a written log to prompt completion.”

Of the 61 patients screened, 40 were eligible and approached, with 33 patients randomised to the study. Seventeen received TEG and 16 received the usual care (with one patient withdrawal).

Results of the study found that acceptability and feasibility were high for both groups, as was appointment attendance and home program adherence.

Most TEG participants felt comfortable with the group format and valued the peer interactions. The ease and convenience of the app-based home program and telehealth follow-up were highly valued by participants. In addition, the average cost per participant for TEG was $68 compared to $110 for the usual care.

“The study indicates that the TEG model of post-CTR hand therapy is both feasible and acceptable to patients and there are potential cost-savings to the healthcare system,” Ms Taylor said.

“The next step is to conduct a larger randomised controlled trial to determine the clinical and cost-effectiveness of the TEG model of care.”

This research study was a joint project between the University of Queensland and STARS Education and Research Alliance, QIMR Berghofer Medical Research Institute, and UQ’s RECOVER Injury Research Centre and Centre for the Business and Economics of Health.