Occupational Therapy Department, Gold Coast University Hospital, Gold Coast, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
J Physiother. 2020 Apr;66(2):97-104. doi: 10.1016/j.jphys.2020.03.007. Epub 2020 Apr 11.
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?
A multicentre, randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis.
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.
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.
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.
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.
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.
ACTRN12613001095752.
在等待手术咨询的腕管综合征患者中，由治疗师主导的护理路径，包括教育、夹板和运动，是否可以减少手术需求并改善患者结局？
一项多中心、随机对照试验，采用隐蔽分组、盲法评估和意向治疗分析。
105 名在澳大利亚四家公立医院等待手术咨询的经电诊断证实的腕管综合征患者。
实验组（n=52）接受一次性小组教育、夹板以及神经和肌腱滑动运动。对照组（n=53）继续在等候名单上，不接受额外护理。
主要结局测量是 24 周内手术转化率、总体变化评级（GROC）量表和患者满意度。次要结局包括症状严重程度和功能受限。
24 周时，实验组手术转化率为 59%，对照组为 80%（风险差异-0.21，95%CI-0.38 至-0.03）。实验组更多的参与者在 6 周时自我评估为改善（20%比 4%；风险差异 0.15，95%CI 0.03 至 0.28），但在 24 周时无显著差异（24%比 10%；风险差异 0.14，95%CI-0.01 至 0.29）。该干预措施还估计在一些满意度、症状严重程度和功能受限的测量指标上有益。该研究对益处的估计存在一定的不确定性，这使得尚在等待腕管手术的更广泛人群是否认为该干预措施的益处值得关注并不明确。没有报告严重不良事件。
在已经等待手术咨询的患者中，由治疗师主导的治疗路径减少了腕管手术的转化率，并增加了患者的感知改善和满意度。
ACTRN12613001095752。
