Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Design
2.2. Research Team and Reflexivity
2.3. Participants, Setting, and Sampling Strategies
2.4. Data Collection and Management
2.5. Analysis
2.6. Rigor
2.7. Ethics
3. Results
3.1. Seeking Help and Waiting for the Diagnosis
“… then I decided to go to the doctor, because I couldn’t stand it, and it was getting harder and harder for me to do things.”.(P10)
“…first, I had to wait for the primary care doctor send me to the neurologist, about three months, then it was the appointment of the specialist to do the EMG test, about six to eight months, and then when they did everything, almost a year for the diagnosis since I asked for help.”.(P15)
“The diagnosis hasn’t been clear; I don’t know if I need surgery. The traumatologist told me that he isn’t ready to operate, that I should take vitamins and wear a splint and in three months he will assess it... what exactly?”.(P3)
“…I don’t want to have surgery; they can’t assure you that everything will function properly after the surgery…”.(P4)
3.2. Trying Non-Surgical Therapeutic Options
“When the doctor recommended me to use the splint, I had already been using it for a few weeks. I was advised by my neighbor who has the same one, and by the neighborhood pharmacist.”.(P17)
“… The doctor told me it was good for me to get [the splints] so I could sleep. But with my pay roll, I don’t have enough to cover my daily needs, so I haven’t been able to buy them.”.(P12)
“… there have been days when I didn’t need to wear the wristband and I have worn I all the same, so that people are aware that I can’t do all the things I did before…”.(P1)
“…the options are very limited, surgery if you are sick, and if you are not very sick, to put up with it and wait for it to get worse. He didn’t tell me anything specific.”.(P4)
3.3. Avoiding Invasive Options
“… If the pain becomes more acute, they will do infiltrations that will give me more pain. Obviously, I want to avoid them.”.(P17)
“…I go to a private physio to avoid another infiltration because I was told they were not good... I do not know very well why they are not good for, but I did not infiltrate again.”.(P1)
“…I am afraid. My daughters depend on me a lot, because of my job. When I have the operation, I won’t be able to rest to recover, I will have to go back to work.”.(P14)
“… the pills cure one thing and spoil four things, so it’ s best to avoid them, […] they give it to you because of course it will give you some relief, but it’ s not advisable.”.(P6)
3.4. Treatment Expectations
“…to have a good quality working life, because I work a lot with my hands, having strength in my hands is important to me, because I have to use them a lot.”.(P8)
“…To sleep through the night, that’s my greatest luxury in life which was taken away from me because of the carpal tunnel problem.”.(P16)
“…the worst thing would be for the pain to increase, for it to increase and for them to forget about me.”.(P9)
“…when they offer you surgery, they don’t guarantee that they are going to take away the pain. That’s the bad thing, that they can’t give you any further treatment, and you continue to have pain for the rest of your life.”.(P18)
3.5. The Relationship with Clinicians
“… he wouldn’t even give me a written piece of paper with what happened to me. And I need it because I must take it to the company. If I leave because I can’t stand the pain anymore, the company must know that it’ s been painful for a long time.”.(P1)
“…The doctor hasn’t even suggested that I do exercises or go to a physiotherapist. Nobody gives you options, well yes, one, the usual one, surgery, and they have already decided for you.”.(P2)
“…The doctor who examined me did not listen to me. She just wanted me to tell her if I was going to have surgery or not. When I told her no, she told me that I was therefore opting out of the operation, that I should inform the primary care medical doctor and that if the clinical situation worsened, I should come back”.(P1)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Issue/Topic | Questions |
---|---|
Disease | How would you describe your pain and your condition? What do you know about the disease you suffer from? What aspects of the disease are most relevant to you? What does the disease mean to you? |
Diagnosis | What prompted you to seek medical help? Can you explain the process of your diagnosis? What is your opinion regarding the time it took to reach a diagnosis for your symptoms? |
Treatment | What treatment(s) have you received and has it solved your problem? What do you consider to be the most relevant aspect of the treatment that has been prescribed to you? What are your thoughts regarding the treatment? Do you adhere to the treatment? Why? What do you expect from the treatment(s)? What expectations of a cure do you have? |
Criteria | Techniques Performed and Application Procedures |
---|---|
Credibility | Investigator triangulation: each interview was analyzed by two researchers. Team meetings were performed in which the analyses were compared, and categories and themes were identified. Triangulation of methods of data collection: unstructured, semi-structured interviews were conducted, and researcher field notes were kept. Member checking: asking the participants to confirm the data obtained at the stages of data collection. All participants were offered the opportunity to review the audio and/or video records to confirm their experience. None of the participants made additional comments. |
Transferability | In-depth descriptions of the study were performed, providing details of the characteristics of researchers, participants, contexts, sampling strategies, and the data collection and analysis procedures. |
Dependability | Audit by an external researcher: an external researcher assessed the research protocol, focusing on aspects concerning the methods applied and study design. An external researcher specifically checked the description of the coding tree, the major themes, participants’ quotations, identification of quotations, and descriptions of themes. |
Investigator triangulation, member checking, and data collection triangulation. | |
Confirmability | Researcher reflexibility was encouraged via the performance of reflexive reports and by describing the rationale behind the study. |
Age | Sex | Diagnostic Time (Months) | Duration of Symptoms (Months) | Affected Side | Pain Intensity | Type of Work | Treatments before Recruitment | |
---|---|---|---|---|---|---|---|---|
P1 | 47 | Female | 48 | 48 | Right | 7 | Clothing Clerk | Splint, wristband, kinescoping, and physiotherapy |
P2 | 36 | Female | 12 | 18 | Bilateral | 5 | Chef | Rigid wristband and stretching |
P3 | 43 | Female | 6 | 7 | Left | 6 | Housewife | - |
P4 | 24 | Female | 12 | 24 | Bilateral | 5 | Shop Manager | - |
P5 | 35 | Female | 24 | 24 | Right | 5 | Occasional worker | Splint and injection |
P6 | 40 | Female | 7 | 36 | Right | 6 | Housekeeper | - |
P7 | 32 | Female | 12 | 24 | Right | 5 | Waitress | Splint and exercise |
P8 | 50 | Female | 18 | 24 | Bilateral | 3 | Midwife | Splint |
P9 | 22 | Female | 5 | 12 | Bilateral | 5 | Clothing Clerk | Splint and exercise |
P10 | 54 | Female | 6 | 6 | Bilateral | 8 | Civil Servant | Splint, paraffin bath and exercise |
P11 | 45 | Female | 18 | 24 | Bilateral | 3 | Clothing Clerk | - |
P12 | 43 | Female | 5 | 5 | Bilateral | 6 | Housekeeper | Splint, paracetamol, and injection |
P13 | 32 | Female | 18 | 18 | Right | 3 | Optician | Splint, physiotherapy and exercise |
P14 | 29 | Female | 12 | 36 | Left | 5 | Clothing Clerk | Bandage |
P15 | 47 | Female | 24 | 30 | Bilateral | 6 | Civil Service Administrator | Splint, physiotherapy, anti-inflammatory, and exercise |
P16 | 56 | Female | 24 | 30 | Bilateral | 3 | Computer Expert | Splint |
P17 | 49 | Female | 3 | 18 | Bilateral | 3 | Massage Therapist | Splint and anti-inflammatory |
P18 | 37 | Female | 18 | 36 | Bilateral | 3 | Hairdresser | Splint, physiotherapy, and medication |
Meaning Units | Groups of Common Meaning | Themes |
---|---|---|
Professional performing the diagnosis Delay of diagnosis Delay factors (symptoms, increased pain intensity and duration) Characteristics of diagnostic information | Diagnosis | Seeking help and waiting for the diagnosis |
Triggers for seeking help Professionals they turn to | Seeking help | |
First therapeutic options offered Severe vs. mild cases Surgery and other invasive measures Other non-invasive measures | Therapeutic options | |
Medical prescription of the splint Daytime splint use Discomfort versus symptom improvement and rest Delayed application | Night splint | Trying non-surgical therapeutic options |
Splint replacement Disease visibility | Soft wrist support or bandage | |
Most commonly used non-pharmacological treatment Techniques and forms of treatment | Physiotherapy | |
Use of analgesics and/or anti-inflammatory drugs | Drugs | |
Rejection due to pain in its administration Rejection due to advice from third parties | Infiltrations | Avoiding invasive options |
Refusal of surgery Reasons for refusal (fear, loss of autonomy) Uncertainty about post-surgical recovery Perception of risk Last therapeutic resort | Surgery | |
Too little effect Too much of risk in relation to benefit | Medication consumption | |
Avoidance of surgery Improved hand functionality Rest and sleep Being independent and maintaining autonomy | Good treatment outcome | Treatment expectations |
Physician abandonment Ending up in surgery | Poor treatment outcome | |
Limited information on alternatives to surgical treatment Gaps in information | Medical information | Relationship with clinicians |
Absence of medical reports for sick leave No opinion in decision making No therapeutic options | Conflict with physicians | |
Lack of willingness to listen Limited choice of treatments No possibility of non-surgical treatment Lack of time in consultation No option to ask questions | Poor relationship with the physician |
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Moro-López-Menchero, P.; García-Bravo, C.; Fernández-de-las-Peñas, C.; Güeita-Rodríguez, J.; Jiménez-Antona, C.; Palacios-Ceña, D. Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study. Int. J. Environ. Res. Public Health 2022, 19, 12349. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912349
Moro-López-Menchero P, García-Bravo C, Fernández-de-las-Peñas C, Güeita-Rodríguez J, Jiménez-Antona C, Palacios-Ceña D. Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(19):12349. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912349
Chicago/Turabian StyleMoro-López-Menchero, Paloma, Cristina García-Bravo, César Fernández-de-las-Peñas, Javier Güeita-Rodríguez, Carmen Jiménez-Antona, and Domingo Palacios-Ceña. 2022. "Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study" International Journal of Environmental Research and Public Health 19, no. 19: 12349. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912349