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Frequently Asked Questions

As a computer freak consumer, I do all my research for cars, vacuums, goods and services (including health care) while on-line. I'm currently looking for a good hand surgeon to treat my De Quervain's disease. Everything I read says I should find someone who is evidence-based. I'd like to be evidence-based in my research, too. What do you recommend?

Taking the time to review the evidence collected so far on the treatment of medical conditions is an important activity. This is how health care specialists know what is the most effective treatment for patients with various problems such as De quervain's disease. De Quervain's disease is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb. It was also named after a physician, a Swiss surgeon Fritz de Quervain who first wrote about it in the late 1800s. Researchers who review the literature on topics like this one start with well-known search engines such as PubMed, the database provided by the National Library of Medicine. You will need to identify some words that help you search for articles on the topic of interest. In this case, it is fairly easy to just use the name of the condition as the primary search word. Once the articles of interest are found, it's necessary to examine them closely to decide whether or not the study has merit. Is the design of each study and are the methods used of high enough quality to count on the results as reliable and true evidence to support that particular methodology? You may want to limit your search to randomized controlled trials (RCTs). Patients in such studies are assigned to a group without knowing which group they are in. A double blind RCT means the clinicians treating the patients don't know who the real patients are and who is getting the placebo treatment versus the real treatment. Create a list of questions to help you assess the quality of each study. For example, in a blinded study, the patient, clinician, and person who assessed the results should all be blinded to the treatment. Look to see if patients in the groups being compared to one another were similar before treatment began (similar ages, gender, health condition, specific hand disorder). How was the data handled for patients who dropped out of the study? Every possible source of bias should be examined carefully. Sometimes there are researchers who do the work of systematically reviewing studies on a specific topic for you. That's always nice! Watch for studies listed as a Cochrane review. The Cochrane Collaboration is a group of over 15,000 volunteers in more than 90 countries. They review the effects of health care interventions tested in biomedical randomized controlled trials. You can depend on and trust the results of those reviews in your research. Don't hesitate to ask your surgeon what evidence he or she bases his or her recommendations and treatments on. If there are specific articles mentioned, go to your local hospital library and ask to read the summaries or conclusions of those articles. Don't be put off by the medical terms used. You won't understand them all but just reading what's available will get you pointed in the right direction.

Marienke van Middelkoop, PhD, et al. Effectiveness of Interventions of Specific Complaints of the Arm, Neck, or Shoulder (CANS). Musculoskeletal Disorders of the Hand. In The Clinical Journal of Pain. July-August 2009. Vol. 25. No. 6. Pp. 537-552.

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