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Hernández-Secorún M, Abenia-Benedí H, Lucha-López MO, Durán-Serrano M, Hamam-Alcober JS, Krauss J, Booth-Smith C, Hidalgo-García C. Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study. Brain Sci 2024; 14:615. [PMID: 38928615 PMCID: PMC11201705 DOI: 10.3390/brainsci14060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon's visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman's rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman's rho = -0.353) and moderately with SF-36 subscale, Social Functioning (Spearman's rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.
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Affiliation(s)
- Mar Hernández-Secorún
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
| | - Hugo Abenia-Benedí
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
| | - María Durán-Serrano
- Unit of Reconstructive Surgery of the Locomotor System, Hand-Microsurgery, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.D.-S.); (J.S.H.-A.)
| | - Javier Sami Hamam-Alcober
- Unit of Reconstructive Surgery of the Locomotor System, Hand-Microsurgery, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.D.-S.); (J.S.H.-A.)
| | - John Krauss
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (J.K.); (C.B.-S.)
| | - Christie Booth-Smith
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (J.K.); (C.B.-S.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
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Iogna Prat P, Milan N, Huber J, Ridehalgh C. The effectiveness of nerve mechanical interface treatment for entrapment neuropathies in the limbs: A systematic review with metanalysis. Musculoskelet Sci Pract 2024; 69:102907. [PMID: 38217928 DOI: 10.1016/j.msksp.2024.102907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/19/2023] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Neurodynamic approach employs neural mobilization and mechanical nerve interface techniques. While published studies investigated the efficacy of neural mobilization, it is currently unknown whether manual treatment of the nerve mechanical interface is effective in the treatment of people with entrapment neuropathies. OBJECTIVES Assess the effectiveness of mechanical interface treatment, including joint and soft tissue techniques, on pain and function in people with peripheral entrapment neuropathies. DESIGN Intervention systematic review with metanalysis. METHODS the databases MEDLINE, CINAHL, AMED, APA PsycINFO, SPORTDiscus, PubMed and ScienceDirect were searched from their inception to October 2022. Randomized controlled trials investigating mechanical interface treatment in isolation in patients with peripheral entrapment neuropathies were included. Two independent reviewers performed study selection, data extraction and risk of bias assessment using the Cochrane RoB 2.0 tool. Certainty of evidence for each outcome was judged using the GRADE framework. RESULTS 11 studies were included in the review, all investigating carpal tunnel syndrome (CTS). Due to high heterogeneity of interventions and comparators, only five studies were pooled in a random-effects meta-analysis. There was evidence of mechanical interface techniques being more effective in reducing pain than sham (MD -2.47 [-3.94;-0.99]) and similarly effective as neural mobilization (MD -0.22 [-0.76; 0.33]) in CTS, albeit with low to very low certainty in the results. CONCLUSION mechanical interface techniques are effective for improving pain and function in people with CTS. However, the marked heterogeneity of included interventions and comparators prevents clinical recommendation of specific treatments.
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Affiliation(s)
- Pietro Iogna Prat
- University of Brighton, School of Sport and Health Sciences, Brighton, UK.
| | - Nicolò Milan
- University of Brighton, School of Sport and Health Sciences, Brighton, UK.
| | - Jorg Huber
- University of Brighton, School of Sport and Health Sciences, Brighton, UK.
| | - Colette Ridehalgh
- University of Brighton, School of Sport and Health Sciences, Brighton, UK.
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Lucha-López MO, Hidalgo-García C, Monti-Ballano S, Márquez-Gonzalvo S, Krauss J, Tricás-Vidal HJ, Tricás-Moreno JM. Diacutaneous Fibrolysis: An Update on Research into Musculoskeletal and Neural Clinical Entities. Biomedicines 2023; 11:3122. [PMID: 38137343 PMCID: PMC10741169 DOI: 10.3390/biomedicines11123122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Diacutaneous Fibrolysis (DF) is an instrumentally assisted manual therapy technique defined as "a specific instrumental intervention for normalizing the musculoskeletal system function after a precise diagnosis and preserving the skin's integrity". The aim of this technique is soft tissue mobilization with the assistance of specially designed, hook-shaped steel instruments in different musculoskeletal structures, such as the myofascia, aponeurosis, tendons, ligaments and scar tissues. Due to discrepant results between previous reviews and the quite abundant new evidence provided by recently published randomized clinical trials, we propound this narrative review to provide an update on the scientific evidence related to the fundamentals and clinical efficacy of DF. Current evidence primarily supports the mechanical effect of DF on connective soft tissues. Diminished deep tendon reflex and rigidity have been registered after the implementation of DF in healthy subjects. Though there is still much to uncover, scientific evidence supports the use of the technique for the clinical treatment of subacromial impingement syndrome, chronic lateral epicondylalgia, chronic patellofemoral pain syndrome, mild to moderate carpal tunnel syndrome, hamstring shortening, temporomandibular disorders, tension-type headache and chronic low back pain. Additional data are essential for better recommendations in the clinical practice of DF.
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Affiliation(s)
- María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - Sofía Monti-Ballano
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - Sergio Márquez-Gonzalvo
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - John Krauss
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA;
| | - Héctor José Tricás-Vidal
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
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Paraskevopoulos E, Karanasios S, Gioftsos G, Tatsios P, Koumantakis G, Papandreou M. The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis. Physiother Theory Pract 2023; 39:2037-2076. [PMID: 35481794 DOI: 10.1080/09593985.2022.2068097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). METHODS Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. RESULTS Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = -2.36, 95% CI -4.31 to -0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = -1.27 95% CI -1.60 to -0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. CONCLUSION Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.
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Affiliation(s)
- Eleftherios Paraskevopoulos
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Stefanos Karanasios
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Georgios Gioftsos
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Petros Tatsios
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Georgios Koumantakis
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
| | - Maria Papandreou
- Department of Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, Ag. Spiridonos 28 Street, 12243, Athens, Greece
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Cabanillas-Barea S, Pérez-Guillén S, López-de-Celis C, Rodríguez-Sanz J, Fanlo-Mazas P, Carrasco-Uribarren A. Effects of diacutaneous fibrolysis in patients with tension-type headache: A randomized controlled trial. PLoS One 2023; 18:e0273877. [PMID: 36972231 PMCID: PMC10042356 DOI: 10.1371/journal.pone.0273877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Manual therapy appears to be effective for the relief of tension-type headache (TTH), just as diacutaneous fibrolysis (DF) has shown to be a beneficial technique for the relief of symptoms in other dysfunctions. However, no studies have evaluated the potential beneficial effect of DF in TTH. The aim of this study is to analyze the effect of three sessions of DF in patients with TTH. METHODS Randomized controlled trial in 86 subjects (43 intervention/ 43 control group). The headache frequency, the headache intensity, the pressure pain thresholds (PPTs) at trapeziometacarpal joint, upper trapezius, suboccipital, frontal and temporal muscles, parietal sutures and the cervical mobility were measured at baseline, at the end of the third intervention and one-month after the last intervention. RESULTS Statistically significant differences with p values <0.05 were observed between groups in favor of the intervention group in the one-month follow-up in the following variables: headache frequency, headache intensity, flexion, extension, right and left side-bending, right and left rotation, PPTs in left trapeziometacarpal joint, right suboccipital muscle, right and left temporal muscle, left frontal muscle and right and left parietal. CONCLUSIONS DF provides a beneficial effect in reducing headache frequency, relieving pain, and improving cervical mobility in patients with TTH.
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Affiliation(s)
- Sara Cabanillas-Barea
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Silvia Pérez-Guillén
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Carlos López-de-Celis
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Department of Basic Sciences, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Pablo Fanlo-Mazas
- Department of Physiatry and Nursery, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Andoni Carrasco-Uribarren
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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The Addition of Diacutaneous Fibrolysis to a Pharmacological Intervention in Patients with Tension-Type Headache: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11226716. [PMID: 36431193 PMCID: PMC9697407 DOI: 10.3390/jcm11226716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Tension-type headache (TTH) is the most common headache worldwide. Pharmacological interventions are the most investigated therapies in patients with TTH. The addition of physical therapy treatments such as diacutaneous fibrolysis (DF) may have promising results. The aim of this study was to investigate the addition of three sessions of DF to a pharmacological intervention in patients with TTH. Methods: A single-blinded randomized controlled trial was carried out. Participants were randomly assigned to the standard care group or to the DF group. Both groups received a pharmacological intervention. Three sessions of DF in the thoracic and cervicocranial region were added in the DF group. The impact caused by headache (HIT-6), headache intensity, and cervical range of motion were measured by blinded assessors at baseline, after the intervention, and at 1 month follow-up. Results: Eighty-two patients with TTH were included (41 standard care group; 41 DF group). Statistically significant differences were found between both groups in all the variables after the intervention and at 1 month follow-up (p < 0.001). No adverse effects or side-effects were reported during the study. Conclusions: The addition of three sessions of DF to a pharmacological therapy provided improvements in the impact caused by headache, headache intensity, and cervical range of motion after the intervention and at 1 month follow-up compared to a pharmacological therapy in isolation. Further research is needed to investigate long-term effects.
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Jiménez-del-Barrio S, Ceballos-Laita L, Bueno-Gracia E, Rodríguez-Marco S, Caudevilla-Polo S, Estébanez-de-Miguel E. Diacutaneous Fibrolysis Intervention in Patients with Mild to Moderate Carpal Tunnel Syndrome May Avoid Severe Cases in Elderly: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10983. [PMID: 36078691 PMCID: PMC9518553 DOI: 10.3390/ijerph191710983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS. METHODS a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance. RESULTS The DF group reduced CSA with a mean of 0.45 mm2 (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01). CONCLUSIONS DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age.
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Affiliation(s)
- Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, 47002 Valladolid, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, 47002 Valladolid, Spain
| | - Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sonia Rodríguez-Marco
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Santos Caudevilla-Polo
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
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Hu H, Hui Y. Letter to the editor regarding "The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta‑analysis". INTERNATIONAL ORTHOPAEDICS 2022; 46:1899-1900. [PMID: 35536365 DOI: 10.1007/s00264-022-05433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Hengda Hu
- Department of Orthopedics, Jiangyin People's Hospital, 3 Yingrui Road, Jiangyin, Jiangsu, 214400, People's Republic of China.
| | - Yujian Hui
- Department of Orthopedics, Jiangyin People's Hospital, 3 Yingrui Road, Jiangyin, Jiangsu, 214400, People's Republic of China
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Liew BXW, de-la-Llave-Rincón AI, Scutari M, Arias-Buría JL, Cook CE, Cleland J, Fernández-de-Las-Peñas C. Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial. Phys Ther 2022; 102:6534401. [PMID: 35194646 DOI: 10.1093/ptj/pzac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/24/2021] [Accepted: 12/27/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS). METHODS Data from a randomized clinical trial (n = 104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity. RESULTS Manual physical therapy improved function in women with CTS (between-groups difference: 0.09; 95% CI = 0.07 to 0.11). The Bayesian network showed that early improvements (at 1 month) in function and symptom severity led to long-term (at 12 months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI = 0.11 to 0.17 point) poorer function at 12 months than those with mild CTS and 0.12-point (95% CI = 0.09 to 0.15 point) poorer function at 12 months than those with severe CTS. CONCLUSION Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects. IMPACT Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS.
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Affiliation(s)
- Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Ana I de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Marco Scutari
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Chad E Cook
- Doctor of Physical Therapy Program, Duke University, Durham, North Carolina, USA
| | - Joshua Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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Jiménez-del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E, Pérez-Bellmunt A. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:301-312. [PMID: 34862562 PMCID: PMC8782801 DOI: 10.1007/s00264-021-05272-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
AIM OF THE STUDY Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies. METHOD MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies. RESULTS Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of - 2.13 with 95% confidence interval (CI) (- 2.39, - 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of - 1.67 with 95% CI (- 1.92, - 1.43) on symptoms severity, and a SMD of - 0.89 with 95% CI (- 1.08, - 0.70) on functional status. Nerve conduction studies showed a SMD of - 0.19 with 95% CI (- 0.40, - 0.02) on motor conduction and a SMD of - 1.15 with 95% CI (- 1.36, - 0.93) on sensory conduction. CONCLUSIONS This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.
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Affiliation(s)
- Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Calle Universidad S/N, 42002 Soria, Spain
| | - Aida Cadellans-Arróniz
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Calle Universidad S/N, 42002 Soria, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Carles López-de-Celis
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
- Jordi Gol I Gurina University Institute for Research in Primary Health Care Foundation, Barcelona, Spain
| | - Elena Bueno-Gracia
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Albert Pérez-Bellmunt
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
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