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Citation: Kamal Ahmad M. Thoracic outlet syndrome: Flexible approach to patient-centred education. Jr.med.res. 2023; 6(1):2.

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Editorial

Thoracic outlet syndrome: Flexible approach to patient-centred education.

Dr. Manar Ahmad Kamal

Faculty of Medicine, Benha University,

Benha, Egypt.

Thoracic outlet syndrome (TOS) is a disorder caused by compression of the brachial plexus and/or the

subclavian vessels in the thoracic outlet region. TOS classifications are based on the pathophysiology of

symptoms with subgroups consisting of neurogenic (nTOS), venous (vTOS), and arterial (aTOS) [1]. nTOS

is the most common presentation described more than 95% of cases. TOS may include several sensorial

and vasomotor disorders of the upper extremity [2]. Wide range of nonsurgical treatments are available

for TOS. However, surgery is still indicated in some carefully selected cases of severe TOS. In all the

cases, treatment plan must be implemented according to the etiology and associated complications. The

management directed by TOS familiarized physician is a predictor of better prognosis [3]. TOS

conservative management remains non-consensual and mainly based on specific rehabilitation associated

to pharmacologic therapies. However, the past few years of practice demonstrated the crucial contribution

of patient education in the healthcare delivery. Patient-centered education for effective daily self-

management might be an essential component in the TOS treatment plan [4]. Patient and their relatives

education was mandated as part of the health care systems by the Joint Commission on the Accreditation

of Healthcare Organizations (JCAHO) since early nineties. However, the one-to-one verbal education

model adopted initially was not contributive to the enhancement of services quality specially for long term

patient follow-ups. Written informative educational tools remained insufficient to establish shared

decision-making model [5]. The involvement of digitalized education modalities such as smartphone

applications, videos, web-based content, or virtual reality is increasingly embraced in patient education

in many clinical disciplines. Several randomized trials demonstrated a significant increase in patient

perception for procedure and follow up benefits as well as a decrease in the related stress. This could

improve the patient discipline and quality of life during the treatment plan [6]. Teaching patients via

digitalized content is nowadays feasible since patients increasingly possess their personal computers and

smartphones. The limits of this delivery mode are the absence of consensual educational materials, the

lack of availability in busy clinics and difficult disclosure of ethical considerations. Video-based education

seems to be less effective than interactive content and smartphones applications. The web-based

education is always a flexible non-stressful environment for patients with low literacy skills in which they

can deal with the disease in its epidemiologic, ethiopathogenic and therapeutic aspects. An application

with simplified video-based TOS description ,personalized prescription and a detailed rehabilitation

schedule with tutorials for basic self-management skills would transform the prognosis of this entity.

References

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[2] Jones MR, Prabhakar A, Viswanath O, Urits I, Green JB, Kendrick JB, et al. Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment. Pain Ther. 2019 ;8:5-18.

[3] Garraud T, Pomares G, Daley P, Menu P, Dauty M, Fouasson-Chailloux A. Thoracic Outlet Syndrome in Sport: A Systematic Review. Front Physiol. 2022 ;13:838014.

[4] Luu D, Seto R, Deoraj K. Exercise rehabilitation for neurogenic thoracic outlet syndrome: a scoping review. J Can Chiropr Assoc. 2022 ;66:43-60.

[5] Oudkerk Pool MD, Hooglugt JQ, Schijven MP, Mulder BJM, Bouma BJ, de Winter RJ, et al. Review of Digitalized Patient Education in Cardiology: A Future Ahead? Cardiology. 2021;146:263-71.

[6] Stoxen DC J. The Human Spring Approach to Thoracic Outlet Syndrome.1

-ed.USA:Master’s Academy Publishing Inc;2019. Chapter 3,human spring engineering;p.81-94.