Author Names

Du, J., Yuan, Q., Wang, XY., Qian, JH., An, J., Dai, Q., Yan, XY., Xu, B., Luo, J., & Wang, HZ.

Reviewer Name

Hope Reynolds, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Objective: Systematic review and meta-analysis to assess the efficacy of Manual therapy and related interventions in the treatment of carpal tunnel syndrome (CTS) based on Boston carpal tunnel questionnaire. Design: Systematic review and meta-analysis. Subjects: Carpal tunnel syndrome. Interventions: Manual therapy and related interventions versus other therapies or manual therapy and related interventions plus other therapies versus other therapies. Outcomes measures: Boston carpal tunnel questionnaire. Results: A total of 6 studies were included, including 211 cases in the manual therapy group and 211 cases in the control group. The quality of the included articles was high, and the results of meta-analysis showed that manual therapy and related interventions were superior in terms of improving the Boston carpal tunnel questionnaire Symptom Severity score in patients with CTS (standardised mean difference [SMD] -1.13, 95% CI -1.40 to -0.87), were superior to control groups in terms of improving the Boston carpal tunnel questionnaire functional capacity scale in patients with CTS (SMD -1.01,95% CI -1.24 to -0.77). Conclusion: The results of this meta-analysis suggested that manual therapy and related interventions were better than control groups in treating CTS. Manual therapy and related interventions could relieve the symptoms of patients with CTS and promote the recovery of hand function. Manual therapy and related interventions should be considered clinically effective methods for treating CTS. Registration: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; No. CRD 42020201389). Contribution of the Article: Manual therapy and related interventions could relieve the symptoms of patients with CTS and promote the recovery of hand function. Manual therapy and related interventions should be considered clinically effective methods for treating CTS.

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

  1. Is the review based on a focused question that is adequately formulated and described?
  • Yes
  1. Were eligibility criteria for included and excluded studies predefined and specified?
  • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
  • Yes
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
  • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  1. Were the included studies listed along with important characteristics and results of each study?
  • Yes
  1. Was publication bias assessed?
  • Yes
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
  • Yes

 

Key Finding #1

The results of this systematic review and meta-analysis support manual therapy and related interventions, including osteopathic manipulation, manual therapy, and massage techniques as effective treatments for CTS.

Key Finding #2

Manual therapy and associated interventions are superior to control groups, including laser, physical, surgical, and other treatment methods, in terms of improving the Symptom Severity score and functional capacity scale on the Boston carpal tunnel questionnaire in patients with CTS.

 

Please provide your summary of the paper

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome and includes symptoms such as numbness, tingling, pain, and weakness following the median nerve distribution distal to the carpal tunnel in the affected limb. Laser therapy, pharmacotherapy, therapeutic ultrasound, manipulation and splinting, and surgical treatment are among the current treatments for CTS. The purpose of this review was to assess the potential role of manual therapy in the management and treatment of CTS and its impacts on symptom severity and function in these patients. Results showed that manual therapy and related interventions were superior to control groups in terms of improving the Symptom Severity score and functional capacity scale on the Boston carpal tunnel questionnaire in patients with CTS. Therefore, manual therapy is supported as an effective and conservative treatment strategy for patients with CTS and is widely utilized as such. However, due to a lack of clinical evidence, there is no specific guidance for clinical practice of manual therapy to treat CTS. Therefore, more research is needed to determine the short-, medium-, and long-term effects of manual therapy on patients with CTS and specifically its effect for patients with varying levels of severity of CTS.

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

Manual therapy and its related interventions, including manipulations and massage techniques, are effective in treating CTS, decreasing symptom severity, and improving hand function in patients with CTS. Therefore, these techniques, are recommended as a conservative therapy option in the treatment of CTS. However, more research is needed to determine the short- and long-term effects of manual therapy on CTS patients and the effect of manual therapy on patients with different severities of CTS.