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Does Insurance Coverage Affect Use of Tests and Treatments for Working Age Individuals With Carpal Tunnel Syndrome in the United States? Analysis of the National Ambulatory Medical Care Survey (2005-2014)

Published:April 16, 2019DOI:https://doi.org/10.1016/j.apmr.2019.03.014

      Highlights

      • People with carpal tunnel syndrome (CTS) are much more likely to use private insurance than workers’ compensation insurance (WCI).
      • People with CTS using WCI often receive less diagnostic testing and more treatments.
      • Treatment for people with CTS may not match best practice guidelines.

      Abstract

      Objective

      Carpal tunnel syndrome (CTS) is frequently seen as a work-related disorder. Few studies have examined the treatment of CTS by insurance coverage, and none have used a large, population-based dataset. This study examined the extent to which the use of CTS tests and treatments varied for those on workers’ compensation insurance (WCI) vs private insurance and Medicaid, controlling for patient and provider characteristics.

      Design

      Analysis of 10 years of data (2005-2014) from the National Ambulatory Medical Care Survey.

      Setting

      United States office-based physician practices.

      Participants

      Adults 18-64 years who had a physician visit for CTS (N=23,236,449).

      Interventions

      Not applicable.

      Main Outcome Measures

      We examined use of 2 diagnostic tests, imaging and electromyography, and 7 treatments: casting, splinting, occupational therapy (OT), physical therapy (PT), carpal tunnel release surgery, steroid injections, and nonsteroidal anti-inflammatory drug (NSAID).

      Results

      Individuals who sought care for CTS were more likely to be covered by private insurance (56.9%) than WCI (9.8%) or Medicaid (6.5%). The most commonly prescribed treatment for all types of insurance coverage was splints, followed by NSAID prescription, and OT or PT therapies. Steroid injections (1.2%) and CTS surgery (4.5%) were used significantly less than other treatment types. Patients on WCI were less likely to receive diagnostic tests, and more likely to receive OT or PT than those on other types of insurance coverage.

      Conclusion

      Patients with CTS who seek ambulatory care are most likely to be covered by private insurance. Insurance coverage appears to play a role in treatment and diagnostic choices for CTS.

      Keywords

      List of abbreviations:

      CTS (carpal tunnel syndrome), EMG (electromyography), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), NAMCS (National Ambulatory Medical Care Survey), NSAID (nonsteroidal anti-inflammatory drug), OT (occupational therapy), PT (physical therapy), WCI (workers’ compensation insurance)
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      References

        • Moore J.S.
        Biomechanical models for the pathogenesis of specific distal upper extremity disorders.
        Am J Ind Med. 2002; 41: 353-369
        • Luckhaupt S.E.
        • Dahlhamer J.M.
        • Ward B.W.
        • Sweeney M.H.
        • Sestito J.P.
        • Calvert G.M.
        Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey.
        Am J Ind Med. 2013; 56: 615-624
        • Ibrahim I.
        • Khan W.S.
        • Goddard N.
        • Smitham P.
        Carpal tunnel syndrome: a review of the recent literature.
        Open Orthop J. 2012; 6: 69-76
        • Newington L.
        • Harris E.C.
        • Walker-Bone K.
        Carpal tunnel syndrome and work.
        Best Pract Res Clin Rheumatol. 2015; 29: 440-453
        • Harris-Adamson C.
        • Eisen E.A.
        • Kapellusch J.
        • et al.
        Biomechanical risk factors for carpal tunnel syndrome: a pooled study of 2474 workers.
        Occup Environ Med. 2015; 72: 33-41
        • Barcenilla A.
        • March L.M.
        • Chen J.S.
        • Sambrook P.N.
        Carpal tunnel syndrome and its relationship to occupation: a meta-analysis.
        Rheumatology (Oxford). 2012; 51: 250-261
        • Bureau of Labor Statistics
        Nonfatal occupational injuries and illnesses requiring days away from work, 2014.
        (Available at:)
        • Palmer D.H.
        • Hanrahan L.P.
        Social and economic costs of carpal tunnel surgery.
        Instr Course Lect. 1995; 44: 167-172
        • New York State Workers’ Compensation Board
        New York carpal tunnel syndrome medical treatment guidelines.
        1st ed. New York State Workers’ Compensation Board, New York2013
        • Burton C.L.
        • Chesterton L.S.
        • Chen Y.
        • van der Windt D.A.
        Clinical course and prognostic factors in conservatively managed carpal tunnel syndrome: a systematic review.
        Arch Phys Med Rehabil. 2016; 97: 836-852
        • Baker N.A.
        • Stevans J.
        • Terhorst L.
        • Haas A.M.
        • Kuo Y.F.
        • Al Snih S.
        What types of treatment are provided for patients with carpal tunnel syndrome? A retrospective analysis of commercial insurance.
        PM R. 2018; 10: 826-835
        • Sperka P.
        • Cherry N.
        • Burnham R.
        • Beach J.
        Impact of compensation on work outcome of carpal tunnel syndrome.
        Occup Med (Lond). 2008; 58: 490-495
        • Dunn J.C.
        • Kusnezov N.A.
        • Koehler L.R.
        • et al.
        Outcomes following carpal tunnel release in patients receiving workers' compensation: a systematic review.
        Hand (NY). 2018; 13: 137-142
        • de Moraes V.Y.
        • Godin K.
        • dos Santos J.B.G.
        • Faloppa F.
        • Bhandari M.
        • Belloti J.C.
        Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis.
        Patient Saf Surg. 2013; 7: 1
        • Centers for Disease Control and Prevention
        Ambulatory Health Care Data.
        (Available at:)
        https://www.cdc.gov/nchs/ahcd/index.htm
        Date accessed: February 19, 2019
        • Centers for Disease Control and Prevention
        NAMCS Estimation Procedures.
        (Available at:)
        • Cumming G.
        Inference by eye: reading the overlap of independent confidence intervals.
        Stat Med. 2009; 28: 205-220
        • Sears J.M.
        • Bowman S.M.
        • Blanar L.
        • Hogg-Johnson S.
        Industrial injury hospitalizations billed to payers other than workers' compensation: characteristics and trends by state.
        Health Serv Res. 2017; 52: 763-785
        • McGann S.A.
        • Flores R.H.
        • Nashel D.J.
        Entrapment neuropathies and compartment syndromes.
        in: Hochberg M.C. Silman A.J. Smolen J.S. Weinblatt M.E. Weisman M.H. Rheumatology. Vol 1. Mosby, Philadelphia2011: 783-820
        • Alfonso C.
        • Jann S.
        • Massa R.
        • Torreggiani A.
        Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review.
        Neurol Sci. 2010; 31: 243-252
        • Graham B.
        The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome.
        J Bone Joint Surg Am. 2008; 90: 2587-2593
        • American Academy of Orthopaedic Surgeons
        Management of carpal tunnel syndrome evidence-based clinical practice guideline.
        (Available at:)
        http://www.aaos.org/ctsguideline.pdf
        Date accessed: February 29, 2016
        • Sonoo M.
        • Menkes D.L.
        • Bland J.D.
        • Burke D.
        Nerve conduction studies and EMG in carpal tunnel syndrome: do they add value?.
        Clin Neurophysiol Pract. 2018; 3: 78-88
        • Huisstede B.M.
        • Friden J.
        • Coert J.H.
        • Hoogvliet P.
        Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline--results from the European HANDGUIDE Study.
        Arch Phys Med Rehabil. 2014; 95: 2253-2263