Burton Claire L, Chesterton Linda S, Chen Ying, van der Windt Daniëlle A
Arthritis Research UK Primary Care Center, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom.
Arthritis Research UK Primary Care Center, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom.
Arch Phys Med Rehabil. 2016 May;97(5):836-852.e1. doi: 10.1016/j.apmr.2015.09.013. Epub 2015 Oct 9.
To summarize the available evidence regarding the course of symptoms and prognostic factors in patients with diagnosed carpal tunnel syndrome (CTS) who are treated conservatively.
Computerized databases, reference checking, and experts in the field were used to identify studies for inclusion in the review.
Multiple reviewers were used to identify studies which included adults (aged ≥18y) diagnosed with CTS in either a clinical setting or population setting. The study must have observed the course of CTS over at least a 6-week period in patients receiving no treatment or usual care that included conservative (nonsurgical) treatments. The design was of a longitudinal cohort study with either prospective or retrospective data collection. There were no language restrictions, and none of the research identified was only reported in abstract form.
Methodological bias was assessed using the Quality in Prognosis Studies tool. A high risk of bias (predominantly relating to study attrition, confounding, and/or statistical analysis and reporting) was judged to be present in 8 studies. Designs showed wide variability with respect to characteristics of the included population, definition of CTS, assessment of prognostic factors, types of interventions provided, and types of outcome measures applied. This prevented pooled estimates from being produced.
A negative outcome at 3 years' follow-up of conservatively treated participants ranged from 23% to 89%. Four included studies observed the rate of surgical intervention after initial conservative management and found this to be 57% to 66%. Evidence regarding factors predicting the negative outcome of no treatment or conservative treatment was graded, taking into account the number of studies evaluating the factor, the methodological quality of these studies, and the consistency of the available evidence. There was 100% agreement in at least 3 cohorts with a medium or high risk of bias that symptom duration, a positive Phalen's test, and thenar wasting were associated with a negative outcome of conservative management; however, not all results were statistically significant, and hence the overall judgment remained inconclusive.
Results of this review should be treated with caution because of the heterogeneity of studies and the risks of bias identified. However, the course of CTS appears variable, and poor prognosis may be predicted by a longer symptom duration, a positive Phalen's test, and thenar wasting.
总结关于确诊为腕管综合征（CTS）且接受保守治疗患者的症状病程及预后因素的现有证据。
使用计算机数据库、参考文献核对以及该领域专家来确定纳入综述的研究。
由多名评审员确定研究，这些研究纳入了在临床环境或人群环境中被诊断为CTS的成年人（年龄≥18岁）。该研究必须观察了未接受治疗或接受包括保守（非手术）治疗在内的常规护理的患者至少6周的CTS病程。研究设计为纵向队列研究，数据收集方式为前瞻性或回顾性。无语言限制，且所确定的研究均非仅以摘要形式报道。
使用预后研究质量工具评估方法学偏倚。8项研究被判定存在高偏倚风险（主要与研究失访、混杂因素和/或统计分析及报告有关）。各项研究在纳入人群特征、CTS定义、预后因素评估、所提供干预措施类型以及所应用结局指标类型方面差异很大。这使得无法得出合并估计值。
保守治疗参与者3年随访的不良结局发生率在23%至89%之间。4项纳入研究观察了初始保守治疗后的手术干预率，发现该率为57%至66%。考虑到评估该因素的研究数量、这些研究的方法学质量以及现有证据的一致性，对预测未治疗或保守治疗不良结局的因素的证据进行了分级。至少3个存在中度或高度偏倚风险的队列一致认为，症状持续时间、Phalen试验阳性和大鱼际肌萎缩与保守治疗的不良结局相关；然而，并非所有结果都具有统计学意义，因此总体判断仍无定论。
由于研究的异质性以及所识别的偏倚风险，本综述结果应谨慎对待。然而，CTS的病程似乎存在差异，症状持续时间较长、Phalen试验阳性和大鱼际肌萎缩可能预示预后不良。
