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Article type: Research Article
Authors: Wasiak, Radoslaw; | Pransky, Glenn; | Yao, Peikang
Affiliations: Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA | Occupational Health Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA | Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA | University of Massachusetts, Amherst, MA, USA
Note: [] Address for correspondence: Radoslaw Wasiak, Liberty Mutual Center for Disability Research, 71 Frankland Road, Hopkinton, MA 01748, USA. Tel.: +1 508 497 0242; Fax: +1 508 435 8136; E-mail: radoslaw.wasiak@libertymutual.com
Abstract: Medical treatment of compensated work-related conditions has two objectives-improve injured workers' health status and allow safe and sustained return to work (RTW). Theoretically, the choice of treatment method should be based primarily on these objectives. Surgical treatment of work-related carpal tunnel syndrome (CTS) provides an opportunity to evaluate whether this occurs. The traditional method of open release has been complemented by an endoscopic procedure, particularly useful in work-related cases due to the anticipated benefit of earlier RTW. The objective of this study was to investigate the differences in surgical treatment for work-related CTS across eight US workers' compensation (WC) jurisdictions, and the factors associated with these differences. From all WC claims reported to a single insurer during the 1995–1999 period, we identified individuals with a one or two surgical procedures for work-related CTS. Among selected individuals (n=4,421), about 20% were treated using the endoscopic procedure; this percentage had a ten-fold variation across the eight jurisdictions. However, utilization of endoscopic release did not increase during the study period, despite reports of better RTW outcomes. The highly jurisdictional nature of the US WC system, with significant differences in reimbursement levels for endoscopic procedures, and geographical differences in medical training were among the potential contributors to the observed variation in utilization.
Keywords: Carpal tunnel, endoscopic release, utilization of medical care, workers' compensation, return to work
Journal: Work, vol. 26, no. 1, pp. 3-11, 2006
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