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

From: Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Author(s), Year Subjects and Setting; Number (n) Enrolled Interventions; Number (n) of Subjects Comparisons; Number (n) of Subjects Follow-up Outcomes Key Findings
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 Outcomea
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.
  1. aCalculated by OPTIMa team (Follman (1992); Abrams (2005))
  2. *ANCOVA adjusted for baseline value of the outcome measure and treatment site
  3. Acronyms: CI Confidence Interval, CTSAQ Carpal Tunnel Syndrome Assessment Questionnaire, NRS numeric rating scale, SF-36 short form 36, y.o. years old