Orthopaedic Surgery and Indusry: What our Potential Patients Believe.

PURPOSE: Physician and surgeon involvement in industry has received considerable attention in recent decades. In this study, we outline the perspective of the general US population regarding (1) disclosure, (2) ownership, and (3) compensation between physicians/surgeons and industry. We hypothesize that the general population would be largely supportive of the physician/surgeon-industry relationship. METHODS: An online, survey-based, descriptive study was conducted through a crowdsourcing platform, Amazon Mechanical Turk. Survey respondents were presented with a seven-item questionnaire inquiring about the physician/surgeon and industry relationship. An "attention check" question was included; those who failed this question were excluded. Descriptive statistics were used to assess the data and a McNemar chi-squared test for paired, dichotomous data. RESULTS: A total of 993 respondents were included. Survey responses are summarized in Table 1. 70.6% of respondents stated that it was "important" or "extremely important" to disclose that the patient be informed whether implants used in surgery had been developed by the operating surgeon. 71.1% of respondents reported that it was "important" or "extremely important" to disclose partial ownership within industry. Seventy-one percent of respondents stated it was "important" or "extremely important" to disclose royalty payments pertaining to surgical implants. 95.6% of respondents suggested that it was acceptable for surgeons to accept free airfare and lodging, and 95.2% of respondents stated that it was acceptable for the surgeon to be compensated for time away from practice to learn about new equipment. DISCUSSION: In our survey of 993 respondents, we found that relationships with industry are considered acceptable if appropriate disclosure is given to patients. We also found that although respondents suggested that physicians and surgeons may be influenced by a free meal, compensation for trips to try new equipment and time spent away from practice is considered appropriate. LEVEL OF EVIDENCE: 2c, Ecological studies.

De Quervain's Tenosynovitis: As Seen from the Perspective of the Patient.

Purpose: Patient preferences and expectations following both nonsurgical and operative treatment of de Quervain's tenosynovitis are unclear. In this study, we aim to better delineate patient preferences for initial management of de Quervain's tenosynovitis. For patients considering surgical treatment, we hope to identify which factors of surgical care are most important for patients to receive counseling. Methods: An online crowdsourcing platform, Amazon Mechanical Turk, was used to recruit study participants. Study participants were then led through a clinical scenario pertaining to de Quervain's tenosynovitis. They were then asked a series of questions regarding initial treatment options, important factors to consider during surgery, and postoperative expectations. A Likert scale was used for responses. Descriptive statistics and one-way analysis of variance were used to assess survey responses. Results: In total, 199 survey responses were included, and 84% of respondents chose nonsurgical modalities for initial treatment of de Quervain's tenosynovitis. Survey items asking about the importance of cost, risks of surgery, expected recovery time, and expected pain level following surgery revealed that all factors were considered important to respondents. There were no differences between groups in the one-way analysis of variance. Conclusions: Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management. The vast majority of respondents rated the importance of cost, risks of surgery, expected recovery time, and expected pain level as having some level of importance when considering surgical care. When discussing outcomes of surgery, respondents were nearly divided on what would be considered a successful outcome of surgery. This suggests that treating physicians may benefit from clarifying expected outcomes during surgical discussions. Type of study/level of evidence: Diagnostics IIb.

Lateral Epicondylitis: Treatment Preferences from the Potential Patient Perspective.

Background: Knowing the questions and concerns that patients have regarding treatment options for lateral epicondylitis may allow for shared-decision making and potentially superior patient outcomes and satisfaction. In the present study, we aimed to further delineate patient preferences with treatment of lateral epicondylitis. Methods: An online, survey-based, descriptive study was conducted through Amazon Mechanical Turk. Survey participants were presented with a clinical scenario regarding lateral epicondylitis and asked four questions regarding treatment preferences for nonoperative treatment, whether they would consider platelet-rich plasma (PRP) injection, and whether they would consider surgical intervention for recalcitrant symptoms. A Likert scale was used for responses. McNemar chi-square test was used for paired nominal data for statistical analysis. Results: A total of 238 survey responses were included. A majority (63%) of respondents elected to proceed with formal physical therapy. When given additional information regarding corticosteroid injections, 50.8% of respondents reported preferring physical therapy. There were no differences between groups for questions 1 and 2 (P = 0.90). Of the respondents, 75.2% were "likely" or "extremely likely" to consider PRP injection. When asked about surgical intervention, 74.8% of respondents were "likely" or "extremely likely" to proceed with continued symptoms. Conclusions: It is important to include patient preferences in treatment discussions of lateral epicondylitis. Survey respondents preferred formal physical therapy for initial treatment. A surprising majority of respondents were likely to consider a PRP injection. With prolonged symptoms, respondents were interested in discussions of surgical intervention and thus, it should continue to be offered to patients with recalcitrant symptoms.

Carpal Tunnel Syndrome: As Seen from the Perspective of the Patient.

Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome in the upper extremity and is one of the most common problems treated by hand surgeons. Despite its ubiquity-or perhaps because of it-there is a lack of unanimity regarding how best to treat CTS and what the options for treatment are. This study aimed to explore what patients find important when deciding on treatment of CTS in an effort to improve the physician-patient shared decision-making process. Methods: An online crowdsourcing platform was used to recruit participants for this study. Study participants were first led through a clinical scenario in which the symptoms of CTS were explained. They were then asked a series of questions regarding what was important to them when deciding upon treatment. A Likert scale was used for responses. Results: In total, 268 participant responses were included in the study. A majority of patients responded that all surveyed factors were either very important or important when considering treatment. The risk of surgery was most important, whereas postoperative pain was least important. The risk of surgery was significantly more important to patients than postoperative pain and time out of work. The cost of surgery was significantly more important to patients than postoperative pain. Conclusions: Given the lack of consensus regarding an algorithm for the treatment of CTS, the patient's preference is increasingly important when formulating a treatment plan. The results of this study may better help physicians frame the discussion of treatment options for CTS with their patients.