Author Names
Junaid Ijaz, M, Karimi, H, Ahmad, A, Amer Gillani, S, Anwar, N, and Asad Chaudhary, M
Reviewer Name
Anne Jacob
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- No
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Cannot Determine, Not Reported, or Not Applicable
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Cannot Determine, Not Reported, or Not Applicable
Key Finding #1
Repeated measurement ANOVA (Table 3) revealed that there was a significant increase in range of motion in all four movements and muscle strength of all four groups, i.e., flexors, extensor, ulna, and radial deviators (<0.001).
Key Finding #2
Pain measured at Numeric Pain Rating Scale, the severity of symptoms measured by symptom severity scale index, activity limitation measured by functional status scale index, and overall change in symptoms measured by BCTQ (Boston Carpal Tunnel Syndrome Questionnaire) also improved statistically with <0.001 shown by repeated measurement ANOVA.
Key Finding #3
After the treatment, flexion, extension, pain intensity at NPRS, symptom severity at SSS index, FSS, and BCTQ all differed statistically and denoted that the addition of neuromobilization was much better for management of CTS as compared to routine physical therapy.
Please provide your summary of the paper
This was a randomized control trial looking at the effects of median nerve mobilization on patients with carpal tunnel syndrome. Patients were split into two groups, once receiving conservative treatment and group two receiving both conservative treatment as well as neuromobilization techniques. This study found that addition of neuromobilization had significant effects, despite not having direct strength improvements.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study showed the clinical value of incorporating median nerve mobilizations into treatment of mild to moderate carpal tunnel syndrome. They result in better outcomes in range of motion, pain, functional outcomes, and symptom severity. While the effects of this treatment are short term, they are still important to take note of. Helping patients report less pain in the moment can allow for more effective treatment through the remainder of the plan of care, since pain can often be seen as a fairly limiting factor for effective treatment.
