Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial

Fernández‐de‐las‐Peñas, César; Ortega‐Santiago, Ricardo; Díaz, Homid Fahandezh-Saddi; Salom‐Moreno, Jaime; Cleland, Joshua A.; Pareja, Juan A.; Arias-Buría, José Luis

doi:10.2519/jospt.2019.8483

Cited by 27 publications

(30 citation statements)

References 34 publications

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“…This promising clinical trial showed that the application of manual therapies following altered nociceptive gain reasoning exhibited better short-term (1-and 3-month) and similar long-term (6-and 12-month) effects on pain and function than surgery in women with CTS 46 . In fact, the cost-effectiveness analysis of this trial also revealed better economic aspects in favor of manual physical therapy 47 .…”

Section: Implications For Clinical Practicementioning

confidence: 73%

Understanding central sensitization for advances in management of carpal tunnel syndrome

Fernández‐de‐las‐Peñas

Arias-Buría

Ortega‐Santiago

et al. 2020

F1000Res

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Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).

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Section: Implications For Clinical Practicementioning

confidence: 73%

Understanding central sensitization for advances in management of carpal tunnel syndrome

Fernández‐de‐las‐Peñas

Arias-Buría

Ortega‐Santiago

et al. 2020

F1000Res

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“…However, there is still much research in related disciplinary areas (e.g. physiotherapy, occupational therapy, chiropractic) that may be used to inform osteopathy practice [47, 48]. Thus, it is possible that the perceived ‘lack of clinical evidence’ was identified as a barrier to EBP uptake due to a poor understanding of the nature and activities of EBP.…”

Section: Discussionmentioning

confidence: 99%

An investigation of Australian osteopaths’ attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey

Leach

Sundberg

Fryer

et al. 2019

BMC Health Serv Res

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Background Osteopaths are an integral member of the health care team, playing a pivotal role in the provision of care for patients with musculoskeletal disorders. Osteopaths, like other health care providers, are under increasing pressure to deliver evidence-based health care and to improve patient outcomes. However, the extent to which osteopaths engage in evidence-based practice (EBP), particularly in Australia, is not well understood. This study therefore set out to investigate the attitudes, skills and use of EBP, and perceived barriers and enablers of EBP uptake, among osteopaths practicing in Australia. Methods National cross-sectional survey of Australian registered osteopaths. Eligible participants were invited by email and other digital media recruitment strategies to complete the online Evidence-Based Practice Attitude and Utilisation Survey (EBASE). Results A total of 332 osteopaths completed the survey. The demographic characteristics of respondents were generally consistent with the characteristics of the Australian osteopathy workforce. The respondents were mostly favourable of EBP, with the majority agreeing or strongly agreeing that EBP assists in making decisions about patient care (86.7%) and improves the quality of patient care (75.6%). While most respondents (88.3%) had some training in EBP, most reported a moderate level of perceived skill in EBP. The majority of respondents engaged infrequently (0–5 times) in EBP activities within the last month, and most indicated that a very small or small proportion of their clinical practice was based on clinical research evidence. Leading barriers to the uptake of EBP were lack of time and lack of clinical evidence in osteopathy. Key enablers of EBP uptake were access to the internet and online databases at work, and access to full-text articles and EBP education materials. Conclusions Osteopaths participating in the survey were largely supportive of evidence-based practice, yet engaged infrequently in EBP activities. An important next step in this research is to identify suitable strategies that effectively improve EBP uptake in osteopathy, and perchance, improve patient outcomes.

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“…Therefore, the objective of this study was to evaluate the outcomes changes six months after manual therapy based only on the neurodynamic techniques treatment of CTS patients. In some studies, the follow-up 6 months period is considered as a long-term (Dakowicz et al, 2011; Fernández-de Las-Peñas et al., 2019a; Fernández-de Las-Peñas et al., 2019b).…”

Section: Introductionmentioning

confidence: 99%

Long-term patient observation after conservative treatment of carpal tunnel syndrome: a summary of two randomised controlled trials

Wolny

Linek

2019

PeerJ

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BackgroundPhysiotherapy of carpal tunnel syndrome (CTS) involves manual therapy based on neurodynamic techniques. Until now, two randomized controlled trials have shown that immediately after therapy, CTS patients who received neurodynamic techniques had significant improvement in nerve conduction, pain, symptom severity (SSS), functional state (FSS), muscle strength (MS) and two-point discrimination (2PD). However, long-term effects seem to be more important, as they are the only ones that can significantly improve the patient’s health and influence economic and social costs. Thus, the objective of this study was to evaluate the long-term (six months) effects of neurodynamic techniques in the conservative treatment of CTS patients.MethodsCarpal tunnel syndrome patients (107) from two previously published randomised clinical trials were observed for six months after the treatment based on neurodynamic techniques.ResultsThe sensory conduction velocity, motor conduction velocity, and motor latency were not subject to statistically significant changes within six months after therapy (p > 0.05). In both groups, there was further pain reduction (p < 0.05). In Group B, the symptom severity improved significantly (p < 0.05), while the functional status in both groups remained unchanged (p > 0.05). In both groups, there was muscle strength improvement (p < 0.05). Two-point discrimination remained unchanged six months after the therapy.ConclusionThe use of manual therapy based on neurodynamic techniques maintains the beneficial effects 6 months after therapy in CTS patients.

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Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial

Cited by 27 publications

References 34 publications

Understanding central sensitization for advances in management of carpal tunnel syndrome

Understanding central sensitization for advances in management of carpal tunnel syndrome

An investigation of Australian osteopaths’ attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey

Long-term patient observation after conservative treatment of carpal tunnel syndrome: a summary of two randomised controlled trials

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