Conservative Management of Non-Traumatic Wrist Disorders: Exploring Evidence, Practice, and Experience

Background:

Non-traumatic wrist disorders (NTWD) are a significant clinical burden in the United Kingdom yet are under-investigated and poorly understood. The overarching research aim was to understand current management and its clinical justification for adults with NTWD in the UK, and to recommend future improvements.

Methods:

Three linked phases of research were completed, within a multi-methods framework. Informed by an initial series of stakeholder interviews, Phase 1 comprised three review studies of 185 sources of published evidence on diagnosis, care pathways, conservative management and outcome measures (Study 1), 82 public-facing English-language websites (Study 2), and 15 UK-based clinical pathways and practice guidelines (Study 3) to assess existing evidence and guidance. Phase 2 examined current UK practice through a national survey of 330 healthcare professionals (Study 4) and 15 semi-structured interviews (Study 5). Phase 3 identified priority recommendations for future improvement through online nominal group technique workshops with 15 healthcare professionals (Study 6).

Findings:

A literature map identified evidence gaps throughout the patient journey. There was considerable variation in the quality and trustworthiness of information on public-facing websites hosted by a range of organisations spanning different sectors. Care pathways and guidance were found for De Quervain’s tenosynovitis, ganglion and other tendinopathies, and osteoarthritis, but not for other NTWDs. Among survey respondents, confidence in diagnosis and management varied by professional group, care setting, and by NTWD. No single outcome measure was used by a majority of respondents. Qualitative interviews provided a deeper understanding of clinical decision-making with themes emerging on ‘listening and acknowledging concerns’, ‘what this means to me’, ‘having an honest conversation’, ‘managing what matters’, and ‘sitting with uncertainty’. 24 consensus statements and recommendations were produced relating to initial reporting of symptoms, boundaries of diagnosis, practice behaviour across clinicians and settings and care pathways and patient information.

Conclusion:

There is an imbalance between the prevalence of NTWD and the quality of resource currently available for clinicians, commissioners of care and patients. This research provides a foundation to move NTWD toward a more structured, evidence-based model of care within the UK healthcare system.