Patient-Directed Care After Carpal Tunnel Release Using Video Integration and Digital Education After Operations (VIDEO Trial): A Randomized Controlled Trial

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BACKGROUND: Carpal tunnel release (CTR) is a successful procedure with consistent outcomes. Routine in-person postoperative visits are of questionable value. It remains to be seen whether video education and patient-directed care after CTR can replace in-person postoperative visits. METHODS: Eighty-three patients undergoing CTR were analyzed in a prospective, randomized, controlled trial comparing in-person follow-up to an experimental program with Video Integration and Digital Education after Operations (VIDEO). Patients underwent open, wide-awake, local-anesthetic, no-tourniquet CTR in-office. Those in the control (in-person) group returned for week 2 and week 6 postoperative in-person visits. Those in the experimental (VIDEO) group did not have scheduled in-person visits but were provided 3 educational videos (1-2 minutes). All patients had access to electronic messaging and could call or come in-person for unplanned visits. The Patient-Reported Outcome Measurement Information System Upper Extremity Computer Adaptive Test 2.0 (PROMIS UE CAT v2.0) was assessed for noninferiority. Patient satisfaction, time off work, time traveling, complications, unplanned visits, phone calls, and messages were assessed. RESULTS: Compared to the in-person group, the VIDEO group demonstrated noninferior PROMIS UE CAT 2.0 score improvements. Patients in both groups were generally satisfied with care, while some expressed higher or lower satisfaction than others. Patients in the VIDEO group missed less time from work and spent less time traveling. There was no difference in complications, unplanned visits, phone calls, or patient messages between groups. CONCLUSIONS: For select patients, video education and patient-directed care should be considered as an alternative to in-person follow-up after CTR.

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