Quality of Patient Education Handouts for Carpal Tunnel Syndrome Available on the Internet

PURPOSE: Carpal tunnel syndrome (CTS) is the most prevalent and expensive upper-extremity musculoskeletal disorder in the United States. Previous studies have examined online health information available for CTS, but these studies reviewed general content and were primarily focused on physician and commercial audiences. This study focused specifically on strengths, weakness, and inconsistencies in CTS patient education handouts, to identify the best resources for occupational therapy practitioners and clients.

DESIGN: We conducted a systematic, quantitate document review. CTS patient education handouts were identified using an internet search with 8 different combinations of search terms on both Google and Bing. We also conducted a manual search of the websites of professional associations and large healthcare organizations.

METHOD: Two researchers independently screened the first 50 search results for all 8 search terms combinations from both search engines. Any downloadable site or document identified as general patient education for CTS was included; descriptive websites, videos, blogs, research studies were excluded. Content analysis was conducted using a revised version of the Information Score (IS) tool to evaluate completeness of information (i.e., symptoms, diagnosis, treatment options) [0%-100%]. We identified misleading recommendations based on the results of a meta-synthesis of CTS clinical practice guidelines. Quality analysis was conducted using the Patient Material Assessment Tool (PEMAT) [0-100] and two widely-used readability indicies, Flesch Reading Ease (FRE) and Flesch Kincaid Grade Level (FKGL). We ranked the handouts using a 12-point scale using results of content and quality evaluations.

RESULTS: Of 805 unique search results, we included 56 handouts. The average IS was 75.0% ± 17.7%. 62.5% of the handouts mentioned interventions that are not highly supported by practice guidelines (e.g., NSAIDS, Vitamin B6, yoga). The average PEMAT score was 70.3 ± 11.1 and the average readability grade level was 7.8 ± 1.8. The median overall score was 5, and only 3 handouts scored above 7 points, the highest scoring 10 out of 12 points.

CONCLUSION: This study suggested that there is a lack of reliable and understandable CTS patient education handouts available on the internet. Although handouts were more complete than noted in previous studies, but a majority of handouts recommended treatments that have limited evidence or provided a generic description of certain conservative interventions that could be misleading. Improvements are needed in the way information is written and shared to ensure readability does not negatively impact a patients' ability to understand and manage the condition. Findings of this study can assist practitioners and clients to identify the best materials to use, and support improvements in the quality of health information available to patients with CTS.

References

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Cassidy, J. T., & Baker, J. F. (2016). Orthopaedic patient information on the World Wide Web: an essential review. The Journal of Bone and Joint Surgery, 98(4), 325-338. https://doi.org/10.2106/JBJS.N.01189

Steimle, J., Gabriel, S., Tarr, R., Kohrs, B., Johnston, P., & Martineau, D. (2019). Comparing diagnostic and treatment recommendations of carpal tunnel syndrome available on the internet with AAOS Clinical Practice Guidelines. HAND (00)0, 1-7. https://doi.org/10.1177/1558944718821417