Author Names
Ballestero-Pérez, R. et. al.
Reviewer Name
Miranda Frohlich, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS).
Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale. Conclusions: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59)
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Cannot Determine, Not Reported, Not Applicable
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
- The majority of the studies found that nerve gliding, combined with or not combined with additional therapies, improved pain, pressure pain threshold, and function of CTS.
Key Finding #2
- The results show that use of standard conservative care (splint or tendon/carpal mobilization) continues to be the best option to improve pain and function of individuals with CTS; and nerve gliding exercise can be utilized as an additional modality to decrease recovery time of CTS.
Key Finding #3
- More than half the studies reviewed had a quality of 5/11 or less, according to the PEDro scale, impacting results.
Key Finding #4
- There has been studies conducted that show patients to have a significant decrease in symptoms after tendon and nerve gliding exercises, post surgical intervention.
Please provide your summary of the paper
This research study was performed to assess literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). The study was conducted as a systematic review for which 13 of the 118 articles considered met the inclusion/exclusion criteria. All studies applied neural mobilization by nerve gliding with the exception of 1 study which compared neural mobilization with increasing stress on the nerve to neural mobilization with decreasing stress on the nerve. The majority of the articles (8) compared nerve gliding with standard care consisting of volar wrist splint and medication. The remaining (5) articles either compared nerve gliding with carpal or tendon mobilization, nerve gliding with ultrasound therapy, or no additional intervention to nerve gliding. Reliable outcome measures were utilized to compare changes in pain and/ or function including the numerical pain rating scale (NPRS), visual analog scale (VAS), pain relief scale, Disabilities of the Arm, Shoulder, and Hand questionnaire, Functional Status scale, Functional status box, pinch and grip strength, Symptom Severity Scale, 24-hour symptom diary, Carpal Tunnel Specific Questionnaire, and Symptom Total Point Score. It can be strongly suggested from the results of this systematic review that standard conservative care is the best treatment option for patients with CTS. However, patients may demonstrate improved outcomes and a faster recovery with the addition of nerve gliding as a compliment to treatment. The PEDro scale was utilized to assess the quality of the articles. It was found that all articles had some form of limitation. Some of these limitations include a strict inclusion criteria, lack of blinding treatment, concealed allocation, and lack of comparison with a controled intervention. With the lack of high-quality research on neural mobilization, further research should be conducted to distinguish neural mobilization with the glissade and/or tension parameter to form a better understanding on the effects of both neural techniques.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
I believe this systematic review provided a great insight to the lack of evidence on neural gliding exercises and it’s different techniques. I appreciate that specifics were given with regards to the research and computer-based strategy. The study has a variance of low to high quality literature which make findings difficult to tract and implement in practice. Personally, I feel neural gliding exercises are a great tool to have in ones tool box as a physical therapist, but I continue to feel that they are best utilized as a compliment to other therapy treatment.
