J Orthop Sports Phys Ther. 2016 Jun;46(6):443-51. doi: 10.2519/jospt.2016.6348. Epub 2016 Mar 23.
Study Design Secondary analysis of a randomized trial. Background A clinical prediction rule to identify patients with carpal tunnel syndrome (CTS) most likely to respond to manual physical therapy has been published but requires further testing to determine its validity. Objective To assess the validity of a clinical prediction rule proposed for the management of patients with CTS in a different group of patients with a variety of treating clinicians. Methods A preplanned secondary analysis of a randomized controlled trial investigating the efficacy of manual physical therapies, including desensitization maneuvers of the central nervous system, in 120 women suffering from CTS was performed. Patients were randomized to receive 3 sessions of manual physical therapy (n = 60) or surgical release/decompression of the carpal tunnel (n = 60). Self-perceived improvement with a global rating of change was recorded at 6- and 12-month follow-ups. Pain intensity (mean pain and worst pain on a 0-to-10 numeric pain-rating scale) and scores on the Boston Carpal Tunnel Questionnaire (functional status and symptom severity subscales) were assessed at baseline and at 1, 3, 6, and 12 months. A baseline assessment of status on the clinical prediction rule was performed (positive status on the clinical prediction rule was defined as meeting at least 2 of the following criteria: pressure pain threshold of less than 137 kPa over the affected C5-6 joint; heat pain threshold of less than 39.6°C over the affected carpal tunnel; and general health score [Medical Outcomes Study 36-Item Short-Form Health Survey] of greater than 66 points). Linear mixed models with repeated measures were used to examine the validity of the rule. Results Participants with a positive status on the rule who received manual physical therapy did not experience greater improvements compared to those with a negative status on the rule for mean pain (P = .65), worst pain (P = .86), function (P = .99), or symptom severity (P = .85). Further, the clinical prediction rule performed no better than chance in identifying the individuals with CTS most likely to respond to manual physical therapy or surgery (mean pain, P = .87; worst pain, P = .91; function, P = .60; severity, P = .66). No differences in self-perceived improvement were observed at either 6 (P = .68) or 12 (P = .36) months, according to the rule. Conclusion The results of this study did not support the validity of the previously developed clinical prediction rule for manual physical therapy in women with CTS. Level of Evidence Prognosis, level 1b. J Orthop Sports Phys Ther 2016;46(6):443-451. Epub 23 Mar 2016. doi:10.2519/jospt.2016.6348.
随机试验的二次分析。
为识别最有可能对手法物理治疗有反应的腕管综合征（CTS）患者，已发表了一种临床预测规则，但需要进一步的测试来确定其有效性。
在一组不同的、由不同治疗医生治疗的 CTS 患者中，评估用于管理 CTS 患者的临床预测规则的有效性。
对一项随机对照试验的预先计划的二次分析，该试验研究了包括中枢神经系统脱敏操作在内的手动物理疗法对 120 名 CTS 女性患者的疗效。患者被随机分配接受 3 次手动物理治疗（n = 60）或腕管切开减压手术（n = 60）。在 6 个月和 12 个月的随访中，通过全球变化感知评分记录自我感知的改善。在基线和 1、3、6 和 12 个月时，评估疼痛强度（0 到 10 数字疼痛评分量表上的平均疼痛和最痛）和波士顿腕管问卷（功能状态和症状严重程度子量表）得分。在基线时进行临床预测规则的状态评估（阳性状态定义为符合以下至少 2 项标准：受累 C5-6 关节处的压力疼痛阈值小于 137kPa；受累腕管处的热痛阈值小于 39.6°C；一般健康评分[医疗结局研究 36 项简短健康调查]大于 66 分）。使用具有重复测量的线性混合模型来检验规则的有效性。
接受手动物理治疗且规则阳性的参与者在平均疼痛（P =.65）、最痛（P =.86）、功能（P =.99）或症状严重程度（P =.85）方面的改善并不大于规则阴性的参与者。此外，该临床预测规则在识别最有可能对手法物理治疗或手术有反应的 CTS 患者方面的表现并不优于机会（平均疼痛，P =.87；最痛，P =.91；功能，P =.60；严重程度，P =.66）。根据规则，在 6 个月（P =.68）或 12 个月（P =.36）时，自我感知的改善没有差异。
这项研究的结果不支持先前为 CTS 女性制定的手动物理治疗临床预测规则的有效性。
预后，1b 级。美国骨科物理治疗协会杂志 2016；46（6）：443-451。2016 年 3 月 23 日在线发布。doi：10.2519/jospt.2016.6348。
