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

Objective: To achieve consensus on a multidisciplinary treatment guideline for carpal tunnel syndrome (CTS). Design: Delphi consensus strategy. Setting: Systematic reviews reporting on the effectiveness of surgical and nonsurgical interventions were conducted and used as an evidence-based starting point for a European Delphi consensus strategy. Participants: In total, 35 experts (hand surgeons selected from the Federation of European Societies for Surgery of the Hand, hand therapists selected from the European Federation of Societies for Hand Therapy, physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Interventions: Not applicable. Main Outcome Measures: Each Delphi round consisted of a questionnaire, analysis, and feedback report. Results: After 3 Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of CTS. The experts agreed that patients with CTS should always be instructed, and instructions combined with splinting, corticosteroid injection, corticosteroid injections plus splinting, and surgery are suitable treatments for CTS. Relevant details for the use of instructions, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of the aforementioned treatment options were identified as follows: severity and duration of the disorder and previous treatments received. A relation between the severity/duration and choice of therapy was found by the experts and reported in the guideline. Conclusions: This multidisciplinary treatment guideline may help physicians and allied health care professionals to provide patients with CTS with the most effective and efficient treatment available. (C) 2014 by the American Congress of Rehabilitation Medicine