Journal of Orthopaedic & Sports Physical Therapy, 2016 Volume:0 Issue:0 Pages:1–28
Authors: César Fernández-de-las-Peñas, PT, PhD, DMSc
Study Design
Prospective cohort study.
Background
A clinical prediction rule to identify patients with carpal tunnel syndrome (CTS) most likely to respond to manual physical therapy has been published but requires further testing to determine its validity.
Objective
To assess the validity of a clinical prediction rule proposed for the management of patients with CTS in a different group of patients with a variety of treating clinicians.
Methods
A preplanned secondary analysis of a randomized controlled trial investigating the efficacy of manual physical therapies including desensitization manoeuvres of the central nervous system in 120 women suffering from CTS was performed. Patients were randomized to receive 3 sessions of manual physical therapy (n=60) or surgical release/decompression of the carpal tunnel (n=60). Self-perceived improvement with a Global Rating of Change (GROC) was recorded at 6 and 12 months follow-up. Pain intensity (mean pain and the worst pain, NPRS 0-10), and Boston Carpal Tunnel Questionnaire (functional status and symptoms severity scales), were assessed at baseline, and 1, 3, 6, and 12 months. Status on the clinical prediction rule (responders were those who met at least 2 of the following criteria: PPT over the affected C5-C6 joint <137kPa; HPT over the affected carpal tunnel <39.6ºC, and general health > 66 points) was measured at baseline. Different linear mixed model with repeated measures were used to examine the validity of the rule.
Results
Women with a positive status on the rule who received manual physical therapy did not experience greater improvements compared to those with a negative status on the rule for: mean pain (P=0.65), worst pain (P=0.86), function (P=0.99) or symptoms severity (P=0.85). Further, the clinical prediction rule performed no better than chance in identifying individual with CTS most likely to respond to manual physical therapy or surgery (mean pain, P=0.87; worst pain, P=0.91; function, P=0.60; severity P=0.66). No differences in self-perceived improvement was observed at either 6 (P=0.67) or 12 (P=0.37) months according to the rule.
Conclusions
The results of this study did not support the validity of the previously developed clinical prediction rule for manual physical therapy in women with CTS.
Level of Evidence
Prognosis, Level 1b. J Orthop Sports Phys Ther, Epub 23 Mar 2016. doi:10.2519/jospt.2016.6348