Fernández-de-Las Peñas César, Ortega-Santiago Ricardo, de la Llave-Rincón Ana I, Martínez-Perez Almudena, Fahandezh-Saddi Díaz Homid, Martínez-Martín Javier, Pareja Juan A, Cuadrado-Pérez Maria L
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain.
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Alcorcón, Madrid, Spain.
J Pain. 2015 Nov;16(11):1087-94. doi: 10.1016/j.jpain.2015.07.012. Epub 2015 Aug 15.
This randomized clinical trial investigated the effectiveness of surgery compared with physical therapy consisting of manual therapies including desensitization maneuvers in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled between February 2013 and January 2014, with 1-year follow-up completed in January 2015. Interventions consisted of 3 sessions of manual therapies including desensitization maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity (mean pain and the worst pain), and secondary outcomes included functional status and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%) women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses showed an advantage (all, P < .01) for physical therapy at 1 and 3 months in mean pain (Δ -2.0 [95% confidence interval (CI) -2.8 to -1.2]/-1.3 [95% CI -2.1 to -.6]), the worst pain (Δ -2.9 [-4.0 to -2.0]/-2.0 [-3.0 to -.9]), and function (Δ -.8 [-1.0 to -.6]/-.3 [-.5 to -.1]), respectively. Changes in pain and function were similar between the groups at 6 and 12 months. The 2 groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical therapy may result in similar outcomes on pain and function to surgery.
http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT01789645.
This study found that surgery and physical manual therapies including desensitization maneuvers of the central nervous system were similarly effective at medium-term and long-term follow-ups for improving pain and function but that physical therapy led to better outcomes in the short term.
本随机临床试验研究了手术与物理治疗（包括腕管综合征（CTS）的脱敏手法等手法治疗）相比的有效性。研究地点为西班牙马德里的一家公立医院和两家物理治疗诊所。2013年2月至2014年1月期间招募了120名患有CTS的女性，2015年1月完成了为期1年的随访。干预措施包括3次手法治疗，其中包括中枢神经系统脱敏手法（物理治疗组，n = 60）或腕管减压/松解术（手术组，n = 60）。主要结局为疼痛强度（平均疼痛和最严重疼痛），次要结局包括波士顿腕管问卷的功能状态和症状严重程度子量表以及自我感觉的改善情况。由一名盲法评估者在基线以及1、3、6和12个月时进行评估。分析采用意向性分析。在12个月时，111名（92%）女性完成了随访（物理治疗组55/60，手术组56/60）。校正分析显示，在1个月和3个月时，物理治疗在平均疼痛（差值-2.0 [95%置信区间（CI）-2.8至-1.2] / -1.3 [95% CI -2.1至-.6]）、最严重疼痛（差值-2.9 [-4.0至-2.0] / -2.0 [-3.0至-.9]）和功能（差值-.8 [-1.0至-.6] / -.3 [-.5至-.1]）方面具有优势（均P <.01）。在6个月和12个月时，两组之间疼痛和功能的变化相似。在所有随访中，两组在波士顿腕管问卷症状严重程度子量表上的改善情况相似。对于患有CTS的女性，物理治疗在疼痛和功能方面可能产生与手术相似的结果。
http://www.clinicaltrials.gov，ClinicalTrials.gov，NCT01789645。
本研究发现，手术和包括中枢神经系统脱敏手法在内的物理手法治疗在改善疼痛和功能的中期和长期随访中效果相似，但物理治疗在短期内效果更好。
Zotero 插件