Background In De Quervain's disease (DQD), as well as many other mechanical musculoskeletal conditions, patients have therapeutic expectations that clinicians find difficult to fulfil in the short term. Due to that, it is not uncommon that patients modify, increase doses or interrupts treatments. In order to improve the management of DQD we must understand what the real rate of therapeutic adherence is and why patients disobey or interrupts the facultative prescriptions.
Objectives To determine proportions of different levels of therapeutic adherence in patients diagnosed by DQD and its causes.
Methods Prospective study, common clinical practice-based. Patients diagnosed by DQD where contacted 5 to 7 days after been assessed by the first time. DQD diagnostic identification was performed using the electronic registry of the A&E department. Patients included visited our department from October 2012 to March 2014 (18 months). During the phone contact, patients were required to answer if they accomplished the faculty prescription at all or in 25% intervals of the full prescription (0-25%, 25 to 50%, 50 to 75% and 75 to 100%). Causes of leak of adherence to treatments were analyzed separately: Immobilization splint or ferula (IS), non-steroidal anti-inflammatory drugs (NSAIDs) and percutaneous NSAIDs (pNSAIDs).
Results 69 patients were contacted by phone. Treatments delivered were 65/69 IS, 39/69 NSAIDs and 29/69 pNSAIDs. No patient was instructed to combine NSAIDs and pNSAIDs. 92% of IS intervention got more than 75% adherence. The same magnitude was reached by 38.4% of NSAID and 96.5% of pNSAID intervention groups (P<0.0001, OR 54.13 95% CI [6.694 to 437-8] for pNSAID-NSAID and P=0.6624, OR 2.333 95% CI [0.2601 to 20.93] for pNSAID-SI comparisons, respectively). 18 patients in the NSAID intervention group got an adherence rate between 50 and 75%. From them, 16 pointed their lack of adherence to the persistence of symptoms and 2 tp adverse events (hypertension and gastric issues). 6 patients treated with NSAIDs and 1 treated with pNSAID got an adherence rate less than 50%. These NSAIDs intervention group pointed their lack of adherence to the persistence of symptoms. The single patient of the pNSAID intervention group abandoned the treatment due to an allergic local reaction.
Conclusions Our study points that systemic treatment of patients with DQD has the higher lack of adherence compared with physical immobilization and percutaneous administration of NSAIDs due to its worst therapeutic results in the short term (insufficient pain control). Although our study no dot discriminates the kind of NSAID intervention, our data shows that in any case, percutaneous treatment has more probabilities to reach a therapeutic adherence higher than 75%. By the other hand, it is well known that adherence is not the same that therapeutic success, however, percutaneous interventions could ensure an enough adherence, an essential requisite to decide if an intervention has been really of not successful.
Disclosure of Interest None declared