ANF Development Grant Fosters Ongoing Discoveries

Teryl Nuckols, MD, MSHS, received a Development Grant from the American Neuromuscular Foundation (ANF) in 2017 for her research titled, "The Value of High Quality Electrodiagnostic Study (EDX) in Work-Associated Carpal Tunnel Syndrome (CTS)." Since her research in 2017, Dr. Nuckols has published numerous influential scholarly articles, several focusing on improving healthcare practices and outcomes.

Her most recent publication in Muscle & Nerve is, “Refining Quality Measures for Electrodiagnostic Testing in Suspected Carpal Tunnel Syndrome to Account for Acceptable Variations in Practice: Expert Review Process.” This study brought together 13 national and international experts in electrodiagnosis for suspected CTS, who were recommended to the research team by 5 major specialty societies. The resulting refined measures are more comprehensive and nuanced than earlier versions, allowing electrodiagnosticians greater latitude in how they deliver high-quality care.

Dr. Nuckols' journey into healthcare policy began two decades ago when she started collaborating with policymakers in the California workers' compensation system, whose primary interest was in the quality of healthcare and appropriateness of treatments, emphasizing improving patient outcomes and facilitating better return-to-work rates. This collaboration led to the selection of CTS as a focal point for research. Dr. Nuckols expanded on her initial research with the 2017 research grant project.

The focus of this research was on quality care and EDX testing. Dr. Nuckols and her team had three primary aims. First, to assess the quality of EDX studies for the diagnosis of CTS in the workers' compensation setting. Second, to examine the relationship between the quality of EDX studies and clinical outcomes for patients with CTS. Lastly, to examine the relationship between the quality of EDX studies and the appropriateness and utilization of surgery, total healthcare expenditures for CTS, and duration of temporary disability.

The research resulted in two scholarly articles published in Muscle & Nerve: "Quality of Care and Patient-Reported Outcomes in Carpal Tunnel Syndrome: A Prospective Observational Study" and "The Quality of Electrodiagnostic Tests for Carpal Tunnel Syndrome: Implications for Surgery, Outcomes, and Expenditures." These studies established the critical role of high-quality EDX testing in patient care, underscoring the variability in testing practices and the necessity of adhering to quality standards to ensure optimal patient outcomes. This project demonstrated that better quality EDX testing was associated with improved symptoms, better function, and more accurate surgical decision-making, influencing the appropriateness of surgery in roughly one-third of cases.

Building on this foundation, the AANEM Quality Improvement Committee, led by Dr. Pushpa Narayanaswami, adapted and endorsed Dr. Nuckols' quality measures. This collaborative effort highlighted the importance of incorporating diverse expert opinions to further refine and validate these measures.

Looking ahead, Dr. Nuckols envisions a future where the variability in healthcare practices is addressed through improved quality measurement and implementation strategies. She emphasizes the need for specialty societies to engage in quality measurement and improvement efforts, potentially through certification or accreditation programs, to drive better care practices and outcomes.

Dr. Nuckols continues to advocate for collaborative efforts that enhance the quality of care across the healthcare system. Although the research Dr. Nuckols produces now is independently funded, she says the ANF grant was instrumental in sparking this line of research and demonstrates the profound impact that targeted funding can have on advancing quality healthcare. "Without having had that relationship with the ANF and seeing this variation in practice among the EDX testing, we wouldn't have taken on [further research]."

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