Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial

作者：Fernandez de las Penas Cesar^*; Ortega Santiago Ricardo; de la Llave Rincon Ana I; Martinez Perez Almudena; Fahandezh Saddi Diaz Homid; Martinez Martin Javier; Pareja Juan A; Cuadrado Perez Maria L

来源：Journal of Pain, 2015, 16(11): 1087-1094.

DOI：10.1016/j.jpain.2015.07.012

• Carpal tunnel syndrome
• surgery
• physical therapy
• manual therapy
• pain

This randomized clinical trial investigated the effectiveness of surgery compared with physical therapy consisting of manual therapies including desensitization maneuvers in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled between February 2013 and January 2014, with 1-year follow-up completed in January 2015. Interventions consisted of 3 sessions of manual therapies including desensitization maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity (mean pain and the worst pain), and secondary outcomes included functional status and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%) women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses showed an advantage (all, P < .01) for physical therapy at 1 and 3 months in mean pain (Delta -2.0 [95% confidence interval (Cl) -2.8 to -1.2]/-1.3 [95% Cl -2.1 to -.6]), the worst pain (Delta -2.9 [-4.0 to -2.0]/-2.0 [-3.0 to -.9]), and Delta -.8 [-1.0 to -.6]/-.3 [-.5 to -.1]), respectively. Changes in pain and function were similar between the groups at 6 and 12 months. The 2 groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical therapy may result in similar outcomes on pain and function to surgery.
Perspective: This study found that surgery and physical manual therapies including desensitization maneuvers of the central nervous system were similarly effective at medium-term and long-term follow-ups for improving pain and function but that physical therapy led to better outcomes in the short term.

• 出版日期2015-11