neural exercise in patients with carpal tunnel syndrome
OBJECTIVE: The aim objective is to compare the neurophysiological effects of the surgery versus neural mobilization exercises added to surgery versus only neural mobilization exercises on temporal summation and noxious inhibitory pain system and their relationship with the improve of symptoms, with pain and disability in patients with Carpal tunnel syndrome. STUDY DESIGN: Randomized parallel-group trial. BACKGROUND: Carpal tunnel syndrome (CTS) such as a neuropathic pain condition with altered pain modulation and wind-up, but there is a clack of knowledge if some therapies could have a positive effect. METHODS: In the Humans study, 54 patients with CTS will be randomly allocated to either a surgery group (n=18) or Surgery with neural exercises group (n=18) or neural exercise group (n=18), the groups with neural exercise will received 10 sessions. The primary outcome will be conditioned pain modulation, temporal summation, pain intensity,. Secondary outcomes will be hand disability assessed with the Boston Carpal Tunnel Questionnaire, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire, neuropathic pain questionnaire (DN4), psychological questionnaires (anxiety, catastrophizing, kinesiophobia depression and fear avoid questionnaires), and pressure pain threshold. Patients will be assessed baseline and post-treatment, 1, 3 and 6 months after the last treatment by an assessor unaware of group assignment Patients were assessed at. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
54
neural exercise Will be performed in the patients
open or endoscopic surgery will be permed in the patients with tunnel carpal syndrome
following the surgery patients will be treat with neural mobilization exercises.
Universidad Rey Juan Carlos
Alcorcón, Madrid, Spain
RECRUITINGPhysiological parameter
Conditioned pain modulation: Diffuse noxious inhibitory control system will be measure with tourniquet test
Time frame: Change from Baseline Conditioned pain modulation at 6 months
Neuropathic pain
Neuropathic pain Questionnaire DN4
Time frame: Baseline and 6 months
Pain intensity
Visual analog scale. A 100mm VAS, ranging from 0mm (no pain) to 100mm (worst imaginable pain).
Time frame: Baseline and 6 months
Pain expansion
Body pain maps
Time frame: Change from baseline and 6 months
Pressure pain threshold
Three consecutive trials of pressure pain threshold on the active trigger point at a rate of 1 kg/sec at intervals of 30 seconds were conducted.
Time frame: Baseline and 6 months
Psychological factors_Anxiety
State Trait Anxiety Inventory (STAI-T)
Time frame: Baseline and 6 months
Psychological factors_Depression
Beck Depression Inventory (BDI-II)
Time frame: Baseline and 6 months
Psychological factors_Kinesiophobia
Tampa Scale for Kinesiophobia.. The score goes from 11 to 44. A higher value indicates a worse outcome.
Time frame: Baseline and 6 months
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Psychological factors_catastrophizing
Pain Catastrophizing Scale. The scores goes from 0 to 52. A higher value indicates a worse outcome.
Time frame: Baseline and 6 months
Psychological factors_Fear avoidance
Fear Avoidance Belief Questionnaire (FABQ)
Time frame: Baseline and 6 months
Disability_DASH
Disabilities of Arm, Shoulder and Hand (DASH)
Time frame: Baseline and 6 months
Disability_BOSTON
Boston Carpal Tunnel Questionnaire
Time frame: Baseline and 6 months
Strength_grip
grip strength without pain
Time frame: Baseline and 6 months
Strength_pinch
pinch strength
Time frame: Baseline and 6 months