Table 4 Evidence table for accepted randomized control trials on multimodal care and carpal tunnel syndrome

Jarvik et al., 2009 [61]

Participants (≥18 y.o.) recruited from Washington State and New Hampshire.

Case definition: symptoms ≥2 weeks in at least 2 digits including thumb, index, ring finger; CTS on hand pain diagram, electrodiagnostic testing (motor latency, ulnar sensory difference, radial sensory difference); night pain waking; positive flick test. (n = 116).

Multimodal Care by physician and hand therapist: NSAIDS (ibuprofen 200 mg/3x /day), opioid, corticosteroid; hand therapy (6 visits/6 weeks): educational booklet, exercises, stretching, tendon gliding, wrist splint and work/activity modifications; ultrasound if no improvement 6 weeks after randomization (maximum 12 15-min sessions; 2–4 per week/6 weeks): 1Mhz, 1.0 W/cm² in 1:4 pulsed mode. (n = 59)

Surgery: open or endoscopic decompression, followed by hand therapy (median nerve and tendon gliding exercises). (n = 57)

6 and 12 months

Primary Outcome: Function (CTSAQ Functional Status Scale)

Secondary Outcomes: Symptom severity (CTSAQ Symptom Severity Scale); hand/wrist pain intensity (NRS 0–10); hand/wrist pain interference (NRS 0–10); work days lost (0–28); limited activity days; general health-related quality of life (SF-36 0–100).

Successful outcome:

≥0.5 points improvement from baseline

CTSAQ function; ≥0.5 points

CTSAQ symptom severity; and a score of 0 or 1 on hand/ wrist pain interference

with work or housework

Adverse events.

^*Difference in Mean Change Score (Multimodal Care-Surgery)

CTSAQ Function

6 months: -0.46 (95 % CI -0.72; -0.20)

12 months: -0.40 (95 % CI -0.70; -0.11)

CTSAQ Symptom Severity

6 months: -0.42 (95 % CI -0.77; -0.07)

12 months: -0.34 (95 % CI -0.65; -0.02)

There were no clinically or statistically differences between groups in days of reduced work/housework, work days lost, pain intensity, pain interference or SF-36 at any follow-up point.

Successful Outcome^a

6 months: Multimodal Care: RR 0.51 (95 % CI 0.25; 1.05)

12 months: Multimodal Care: RR 0.62 (95 % CI 0.35; 1.08)

Adverse Events: No clinically important adverse events; no surgical complications.