Abstract | November 18, 2023

Comparison of the Original and Updated American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on Carpal Tunnel Syndrome

Charlotte Pecot, BA, MS4, Tulane University School of Medicine, New Orleans, LA

Sophia Mavrommatis, BSBA, University of Minnesota Medical School, Minneapolis, MN; Ramesses Akamefula, BS, Tulane University School of Medicine, New Orleans, LA; Tessa R. Lavorgna, BS, Tulane University School of Medicine, New Orleans, LA; Dainn Woo, MD, Orthopaedic Surgery, PGY4, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew D. Sobel, MD, Assistant Professor of Clinical Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Learning Objectives

  1. Describe the characteristics of studies referenced in the original vs. updated AAOS Carpal Tunnel Syndrome Clinical Practice Guidelines in terms of level of evidence, country of study origin, time since published, and funding status.
  2. Discuss how changes in the above findings may direct or influence future research.

Introduction:
The American Academy of Orthopaedic Surgeons publishes Clinical Practice Guidelines (CPGs) intended to provide up-to-date and evidence-based recommendations regarding the treatment of musculoskeletal pathologies. The aim of this study is to analyze the included studies within the original (2008) and updated (2016) CPGs on Carpal Tunnel Syndrome (CTS) and compare their characteristics.

Methods:
Manuscripts of studies included in the 2008 and 2016 versions of the CTS CPG were reviewed. The level of evidence (LOE), date of publication, journal of publication, country of origin, and funding status were determined for all eligible references. T-tests and chi-square tests were utilized in comparing continuous and categorical variables between CPGs.

Results:
There was no difference between the mean LOE (2.0 vs. 2.0, p =0.98) or the proportion of high-quality (LOE 1 and 2) studies included in the two CPGs (69.4% vs. 67.1%, p = 0.69) (Figure 1). The mean time from study publication to inclusion in the CPG in the 2008 and 2016 versions of the CTS CPG was 7.12 and 10.71 years, respectively (p<0.001). There was a difference in the percentage of studies that had been published within 5 years of the CPGs’ publications (60.8% vs. 31.1%, p<0.0001). There was no difference in the percentage of studies conducted at institutions outside of the US (66.3% vs. 67.5%, p=0.83). Approximately 15% of studies in the 2008 CPG were funded by foundations within the United States and this value was not different from the 11.4% in the 2016 CPG (p=0.33) (Figure 2). Finally, studies published in hand-specific journals comprised 28.6% and 17.1% of the 2008 and 2016 CTS CPG, respectively (p=0.018).

Conclusion:
The characteristics of the original and updated CPGs are similar with regard to quality of LOE and the proportions of studies with international origins and funding from sources within the US. However, the studies included in the 2016 CPG were older, on average, and included fewer studies published within 5 years of the guidelines being published. This could suggest the limited availability of recently published, well-funded, high-quality studies that could be used to drive changes in practice.

References and Resources

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