Author Names

Wolny T, Saulicz E, Linek P, Shacklock M, Myśliwiec A

Reviewer Name

Margaret Pohl, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Objective: The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS).  Methods: The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions.  Results: A baseline assessment revealed group differences in sensory conduction of the median nerve (P < .01) but not in motor conduction (P = .82). Four weeks after the last treatment procedure, nerve conduction was examined again. In the MT group, median nerve sensory conduction velocity increased by 34% and motor conduction velocity by 6% (in both cases, P < .01). There was no change in median nerve sensory and motor conduction velocities in the EM. Distal motor latency was decreased (P < .01) in both groups. A baseline assessment revealed no group differences in pain severity, symptom severity, or functional status. Immediately after therapy, analysis of variance revealed group differences in pain severity (P < .01), with a reduction in pain in both groups (MT: 290%, P < .01; EM: 47%, P < .01). There were group differences in symptom severity (P < .01) and function (P < .01) on the Boston Carpal Tunnel Questionnaire. Both groups had an improvement in functional status (MT: 47%, P < .01; EM: 9%, P < .01) and a reduction in subjective CTS symptoms (MT: 67%, P < .01; EM: 15%, P < .01).  Conclusion: Both therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the MT group.  Keywords: Carpal Tunnel Syndrome; Manual Therapy; Physical Therapy.

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • No
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Yes
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. 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?
  • Yes
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Yes

 

Key Finding #1

Participants who were in the manual therapy group benefited more from therapy and saw more significant improvements than those in the electrophysical modalities group.

Key Finding #2

Both groups experiences a significant reduction in pain and increase in function, but the manual therapy group had a larger magnitude of pain reduction and function increase.

Key Finding #3

In comparison to other studies, this study looked at manual therapy performed by a physical therapist, rather than self manual therapy techniques.  The study found that techniques performed by a PT were effective in decreasing pain and increasing function.

 

Please provide your summary of the paper

This study looked to compare the efficacy of manual therapy and neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS).  The study consisted of 140 patients with CTS who were randomly put into one of two groups, the manual therapy group (MT) or the electrophysical modalities group (EM).  The MT treatment included the use of neurodynamic techniques, functional massage and carpal bone mobilizations while the EM group included laser and ultrasound therapy.  Both groups received 20 therapy sessions in total.  Overall, both therapies had a positive impact on nerve conduction, reduced pain, increased functional status and improved subjective symptoms of the patients and the MT therapy group had better results in pain reduction, subjective symptoms and functional abilities.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

This paper supports the idea that both manual therapy and electrophysical modalities can be effective in treatment of CTS, and neither increases pain or decreases function.  It also supports the idea that while both are effective, manual therapy may be more effective in increasing functional abilities and decreasing pain related to CTS.  This study is important to clinical practice as many other studies have not looked at manual therapy’s effect when performed by a physical therapist, but rather a self manual therapy technique.  As this study is a large sample size and showed significant improvements when manual therapy was performed by a clinician, manual therapy should be considered as a treatment technique, by a PT, for individuals with CTS in practice.