Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, Madrid, Spain 28922, and Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos.
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos and Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos.
Phys Ther. 2020 Oct 30;100(11):1987-1996. doi: 10.1093/ptj/pzaa150.
No study to our knowledge has investigated the effects longer than 1 year of manual therapy in carpal tunnel syndrome (CTS). The purpose of this study was to investigate the effects of manual therapy versus surgery at 4-year follow-up and to compare the post-study surgery rate in CTS.
This randomized controlled trial was conducted in a tertiary public hospital and included 120 women with CTS who were randomly allocated to manual therapy or surgery. The participants received 3 sessions of physical therapy, including desensitization maneuvers of the central nervous system or carpal tunnel release combined with a tendon/nerve gliding exercise program at home. Primary outcome was pain intensity (mean and the worst pain). Secondary outcomes included functional status, symptom severity, and self-perceived improvement measured using a global rating of change scale. Outcomes for this analysis were assessed at baseline, 1 year, and 4 years. The rate of surgical intervention received by each group was assessed throughout the study.
At 4 years, 97 (81%) women completed the study. Between-group changes for all outcomes were not significantly different at 1 year (mean pain: mean difference [MD] = -0.3, 95% CI = -0.9 to 0.3; worst pain: MD = -1.2, 95% CI = -3.6 to 1.2; function: MD = -0.1, 95% CI = -0.4 to 0.2; symptom severity: MD = -0.1, 95% CI = -0.3 to 0.1) and 4 years (mean pain: MD = 0.1, 95% CI = -0.2 to 0.4; worst pain: MD = 0.2, 95% CI = -0.8 to 1.2; function: MD = 0.1, 95% CI = -0.1 to 0.3; symptom severity: MD = 0.2, 95% CI = -0.2 to 0.6). Self-perceived improvement was also similar in both groups. No between-group differences (15% physical therapy vs 13% surgery) in surgery rate were observed during the 4 years.
In the long term, manual therapy, including desensitization maneuvers of the central nervous system, resulted in similar outcomes and similar surgery rates compared with surgery in women with CTS. Both interventions were combined with a tendon/nerve gliding exercise program at home.
This is the first study to our knowledge to report clinical outcomes and surgical rates during a 4-year follow-up and will inform decisions regarding surgical versus conservative management of CTS.
Women with CTS may receive similar benefit from a more conservative treatment-manual therapy-as they would from surgery.
据我们所知，没有研究调查过手部疗法超过 1 年对腕管综合征（CTS）的影响。本研究的目的是在 4 年随访时调查手部疗法与手术的效果，并比较 CTS 研究后的手术率。
这是一项在三级公立医院进行的随机对照试验，纳入了 120 名患有 CTS 的女性，随机分为手部疗法组或手术组。参与者接受了 3 次物理治疗，包括中枢神经系统脱敏操作或腕管松解术，同时还结合了家庭中的肌腱/神经滑动运动方案。主要结局是疼痛强度（平均和最剧烈疼痛）。次要结局包括功能状态、症状严重程度和自我感知的改善，使用整体变化量表进行评估。本分析的结果在基线、1 年和 4 年时进行评估。在整个研究过程中，评估了每组接受手术干预的比率。
4 年后，97 名（81%）女性完成了研究。在 1 年和 4 年时，所有结局的组间变化均无显著差异（平均疼痛：平均差值[MD]=-0.3，95%置信区间[CI]=-0.9 至 0.3；最剧烈疼痛：MD=-1.2，95%CI=-3.6 至 1.2；功能：MD=-0.1，95%CI=-0.4 至 0.2；症状严重程度：MD=-0.1，95%CI=-0.3 至 0.1）。自我感知的改善在两组之间也相似。在 4 年内，未观察到手术率的组间差异（手部疗法 15% vs 手术 13%）。
在长期随访中，手部疗法（包括中枢神经系统脱敏操作）在女性 CTS 患者中与手术相比，结果相似，手术率也相似。两种干预措施均结合了家庭中的肌腱/神经滑动运动方案。
这是我们所知的第一项报告 4 年随访时临床结果和手术率的研究，将为 CTS 的手术与保守治疗决策提供信息。
CTS 女性可能会从更保守的治疗（手部疗法）中获得与手术相同的益处。
