Research
Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial

https://doi.org/10.1016/j.jphys.2020.03.007Get rights and content
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Abstract

Question

In people with carpal tunnel syndrome who are waitlisted for surgical consultation, does a therapist-led care pathway involving education, splinting and exercises reduce the need for surgery and improve patient outcomes?

Design

A multicentre, randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis.

Participants

One hundred and five people with electrodiagnostically confirmed carpal tunnel syndrome on a waitlist for surgical consultation and recruited from four public hospitals in Australia.

Interventions

The experimental group (n = 52) received a one-off group session of education, splinting, and nerve and tendon gliding exercises. The control group (n = 53) continued on the waitlist without additional care.

Outcome measures

The primary outcome measures were conversion to surgery by 24 weeks, the global rating of change (GROC) scale and patient satisfaction. Secondary outcomes included symptom severity and functional limitation.

Results

At 24 weeks, conversion to surgery was 59% in the experimental group and 80% in the control group (risk difference −0.21, 95% CI −0.38 to −0.03). More participants in the experimental group identified as improved at 6 weeks (20% vs 4%; risk difference 0.15, 95% CI 0.03 to 0.28) but not at 24 weeks (24% vs 10%; risk difference 0.14, 95% CI −0.01 to 0.29). The intervention was also estimated to be beneficial on some measures of satisfaction, symptom severity and functional limitation. The study’s estimates of the benefits came with some uncertainty, which makes it unclear whether the wider population of people awaiting carpal tunnel surgery would consider that the benefits make the intervention worthwhile. No serious adverse effects were reported.

Conclusions

A therapist-led pathway reduced conversion to carpal tunnel surgery and increased perceived improvement and satisfaction in people who were already on a waitlist for surgical consultation.

Registration

ACTRN12613001095752.

Key words

Carpal tunnel syndrome
Surgery
Rehabilitation
Physical therapy
Occupational therapy

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Footnotes: a Stata 14.2, College Station, Texas, USA.

eAddenda: Appendices 1 to 3, Box 1, and Tables 1, 2 and 8 can be found online at https://doi.org/10.1016/j.jphys.2020.03.007.

Ethics approval: The Metro South Human Research Ethics Committee approved this study (HREC/13/QPAH/434). All participants gave written informed consent before data collection began.

Competing interest: The authors have no competing interest.

Sources of support: This work was supported by a Health Practitioner Stimulus Grant from Queensland Health and a Small Project Investment Grant of the Private Practice Trust Fund (PPTF) of Gold Coast Hospital and Health Service. ABS is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) Oxford. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in the study design, data collection, analysis and interpretation of data as well as in the writing of the report and the decision to submit the article for publication.

contributed equally to this work.