Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, West Wing Level 6 OX39DU, 01865 223254, Oxford, UK.
Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
BMC Musculoskelet Disord. 2024 Jul 27;25(1):590. doi: 10.1186/s12891-024-07713-6.
Physiotherapeutic management is the first-line intervention for patients with entrapment neuropathies such as carpal tunnel syndrome (CTS). As part of physiotherapy, neurodynamic interventions are often used to treat people with peripheral nerve involvement, but their mechanisms of action are yet to be fully understood. The MONET (mechanisms of neurodynamic treatment) study aims to investigate the mechanisms of action of neurodynamic exercise intervention on nerve structure, and function.
This mechanistic, randomised, single-blind, controlled trial will include 78 people with electrodiagnostically confirmed mild or moderate CTS and 30 healthy participants (N = 108). Patients will be randomly assigned into (1) a 6-week progressive home-based neurodynamic exercise intervention (n = 26), (2) a steroid injection (= 26), or (3) advice (n = 26) group. The primary outcome measure is fractional anisotropy of the median nerve at the wrist using advanced magnetic resonance neuroimaging. Secondary outcome measures include neuroimaging markers at the wrist, quantitative sensory testing, electrodiagnostics, and patient reported outcome measures. Exploratory outcomes include neuroimaging markers at the cervical spine, inflammatory and axonal integrity markers in serial blood samples and biopsies of median nerve innervated skin. We will evaluate outcome measures at baseline and at the end of the 6-week intervention period. We will repeat questionnaires at 6-months. Two-way repeated measures ANCOVAs, followed by posthoc testing will be performed to identify differences in outcome measures among groups and over time.
This study will advance our understanding of the mechanisms of action underpinning neurodynamic exercises, which will ultimately help clinicians to better target these treatments to those patients who may benefit from them. The inclusion of a positive control group (steroid injection) and a negative control group (advice) will strengthen the interpretation of our results.
NCT05859412, 20/4/2023.
物理治疗管理是治疗卡压性神经病（如腕管综合征）的一线干预措施。作为物理治疗的一部分，神经动态干预通常用于治疗周围神经受累的患者，但它们的作用机制尚未完全了解。MONET（神经动态治疗的机制）研究旨在调查神经动态运动干预对神经结构和功能的作用机制。
这是一项机制性、随机、单盲、对照试验，将包括 78 名经电诊断证实的轻度或中度腕管综合征患者和 30 名健康参与者（N=108）。患者将被随机分为（1）6 周渐进式家庭神经动态运动干预组（n=26）、（2）类固醇注射组（n=26）或（3）建议组（n=26）。主要结局测量指标是使用先进的磁共振神经影像学测量腕部正中神经的分数各向异性。次要结局测量指标包括腕部神经影像学标志物、定量感觉测试、电诊断和患者报告的结局测量指标。探索性结局包括颈椎的神经影像学标志物、连续血液样本中的炎症和轴突完整性标志物以及正中神经支配皮肤的活检。我们将在基线和 6 周干预期结束时评估结局测量指标。我们将在 6 个月时重复问卷调查。将进行双向重复测量方差分析，然后进行事后检验，以确定组间和随时间的结局测量指标的差异。
这项研究将增进我们对神经动态运动作用机制的理解，这最终将帮助临床医生更好地针对那些可能从中受益的患者进行这些治疗。纳入阳性对照组（类固醇注射）和阴性对照组（建议）将加强对我们结果的解释。
NCT05859412，2023 年 4 月 20 日。
