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Published in: Trials 1/2019

Open Access 01-12-2019 | Carpal Tunnel Syndrome | Study protocol

Treatment of carpal tunnel syndrome with wrist splinting: study protocol for a randomized placebo-controlled trial

Authors: Isam Atroshi, Kamelia Tadjerbashi, Steven J. McCabe, Jonas Ranstam

Published in: Trials | Issue 1/2019

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Abstract

Background

Carpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak. The treatment is associated with costs and may cause discomfort and limit daily and work activities. No placebo-controlled trials have been performed.

Methods

This is a randomized controlled trial designed to assess the efficacy of a rigid wrist splint compared with soft wrist bandage (placebo) in patients with primary idiopathic CTS. The trial will be conducted at an orthopedic department. Patients, 25 to 65 years old, who seek primary health-care with symptoms of CTS will be screened, and potentially eligible patients will be referred to the study center. Patients who fulfill the trial’s eligibility criteria will be invited to participate. A total of 112 patients who provide informed consent will be randomly assigned to treatment with either a rigid wrist splint or a soft bandage to be used initially for 6 weeks at night and, if possible, during the day. The splints and bandages will be fitted with a temperature-monitoring device to measure the total time during which they have actually been worn. The trial participants will complete a questionnaire that includes the 6-item CTS symptoms scale (CTS-6); the 11-item disabilities of the arm, shoulder, and hand (QuickDASH) scale; and the EuroQol 5-dimension (EQ-5D) health status and quality-of-life measure at baseline and at 6, 12, 24, and 52 weeks after treatment start. The participants will undergo physical examination and nerve conduction testing at baseline and at 52 weeks. The trial’s primary outcomes are the change in the CTS-6 score from baseline to 12 weeks and the rate of carpal tunnel release surgery at 52 weeks.

Discussion

This is the first placebo-controlled randomized trial with electronic monitoring of actual splint use and will provide evidence regarding the efficacy of wrist splinting in patients with CTS.

Trial registration

ISRCTN Registry, ISRCTN81836603. Registered on May 5, 2018.
Appendix
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Literature
1.
go back to reference Atroshi I, Gummesson C, Johnsson R, Sprinchorn A. Symptoms, disability, and quality of life in patients with carpal tunnel syndrome. J Hand Surg Am. 1999;24:398–404.CrossRef Atroshi I, Gummesson C, Johnsson R, Sprinchorn A. Symptoms, disability, and quality of life in patients with carpal tunnel syndrome. J Hand Surg Am. 1999;24:398–404.CrossRef
2.
go back to reference Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282:153–8.CrossRef Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282:153–8.CrossRef
3.
go back to reference Huisstede BM, Friden J, Coert JH, Hoogvliet P. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline-results from the European HANDGUIDE Study. Arch Phys Med Rehabil. 2014;95:2253–63.CrossRef Huisstede BM, Friden J, Coert JH, Hoogvliet P. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline-results from the European HANDGUIDE Study. Arch Phys Med Rehabil. 2014;95:2253–63.CrossRef
4.
go back to reference Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil. 2000;81:424–9.CrossRef Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil. 2000;81:424–9.CrossRef
5.
go back to reference Gerritsen AA, De Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288:1245–51.CrossRef Gerritsen AA, De Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288:1245–51.CrossRef
6.
go back to reference Nobuta S, Sato K, Nakagawa T, Hatori M, Itoi E. Effects of wrist splinting for Carpal Tunnel syndrome and motor nerve conduction measurements. Ups J Med Sci. 2008;113:181–92.CrossRef Nobuta S, Sato K, Nakagawa T, Hatori M, Itoi E. Effects of wrist splinting for Carpal Tunnel syndrome and motor nerve conduction measurements. Ups J Med Sci. 2008;113:181–92.CrossRef
7.
go back to reference Huisstede BM, Hoogvliet P, Franke TP, Randsdorp MS, Koes BW. Carpal tunnel syndrome: effectiveness of physical therapy and electrophysical modalities. An updated systematic review of randomized controlled trials. Arch Phys Med Rehabil. 2018;99:1623–34.CrossRef Huisstede BM, Hoogvliet P, Franke TP, Randsdorp MS, Koes BW. Carpal tunnel syndrome: effectiveness of physical therapy and electrophysical modalities. An updated systematic review of randomized controlled trials. Arch Phys Med Rehabil. 2018;99:1623–34.CrossRef
8.
go back to reference Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(7):CD010003. Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(7):CD010003.
9.
go back to reference Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009;374:1074–81.CrossRef Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009;374:1074–81.CrossRef
10.
go back to reference Atroshi I, Gummesson C. Non-surgical treatment in carpal tunnel syndrome. Lancet. 2009;374:1042–4.CrossRef Atroshi I, Gummesson C. Non-surgical treatment in carpal tunnel syndrome. Lancet. 2009;374:1042–4.CrossRef
11.
go back to reference Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome: a study of carpal canal pressures. J Bone Joint Surg. 1981;63A:380–3.CrossRef Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome: a study of carpal canal pressures. J Bone Joint Surg. 1981;63A:380–3.CrossRef
12.
go back to reference Huisstede BM, Randsdorp MS, van den Brink J, Franke TPC, Koes BW, Hoogvliet P. Effectiveness of oral pain medication and corticosteroid injections for carpal tunnel syndrome: a systematic review. Arch Phys Med Rehabil. 2018;99:1609–22.CrossRef Huisstede BM, Randsdorp MS, van den Brink J, Franke TPC, Koes BW, Hoogvliet P. Effectiveness of oral pain medication and corticosteroid injections for carpal tunnel syndrome: a systematic review. Arch Phys Med Rehabil. 2018;99:1609–22.CrossRef
13.
go back to reference Werner RA, Franzblau A, Gell N. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005;86:1–7.CrossRef Werner RA, Franzblau A, Gell N. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005;86:1–7.CrossRef
14.
go back to reference Korthals-de Bos IB, Gerritsen AA, van Tulder MW, Rutten-van Mölken MP, Adèr HJ, de Vet HC, et al. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial. BMC Musculoskelet Disord. 2006;7:86.CrossRef Korthals-de Bos IB, Gerritsen AA, van Tulder MW, Rutten-van Mölken MP, Adèr HJ, de Vet HC, et al. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial. BMC Musculoskelet Disord. 2006;7:86.CrossRef
15.
go back to reference Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, Liang MH. A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. J Rheumatol. 1990;17:1495–8.PubMed Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, Liang MH. A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. J Rheumatol. 1990;17:1495–8.PubMed
17.
go back to reference Atroshi I, Lyren PE, Gummesson C. The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res. 2009;18:347–58.CrossRef Atroshi I, Lyren PE, Gummesson C. The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res. 2009;18:347–58.CrossRef
18.
go back to reference Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.CrossRef Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.CrossRef
19.
go back to reference Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.CrossRef Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.CrossRef
20.
go back to reference Atroshi I, Lyren PE, Ornstein E, Gummesson C. The six-item CTS symptoms scale and palmar pain scale in carpal tunnel syndrome. J Hand Surg Am. 2011;36:788–94.CrossRef Atroshi I, Lyren PE, Ornstein E, Gummesson C. The six-item CTS symptoms scale and palmar pain scale in carpal tunnel syndrome. J Hand Surg Am. 2011;36:788–94.CrossRef
21.
go back to reference Tolonen U, Kallio M, Ryhanen J, Raatikainen T, Honkala V, Lesonen V. A handheld nerve conduction measuring device in carpal tunnel syndrome. Acta Neurol Scand. 2007;115:390–7.CrossRef Tolonen U, Kallio M, Ryhanen J, Raatikainen T, Honkala V, Lesonen V. A handheld nerve conduction measuring device in carpal tunnel syndrome. Acta Neurol Scand. 2007;115:390–7.CrossRef
22.
go back to reference Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44:597–607.CrossRef Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44:597–607.CrossRef
23.
go back to reference Uhl J, Benigni J, Chahim M, Cornu-Thenard A. Use of compression stockings in chronic venous disease: validation of a new device to assess patient compliance. J Vasc Surg Venous Lymphat Disord. 2015;3:131.CrossRef Uhl J, Benigni J, Chahim M, Cornu-Thenard A. Use of compression stockings in chronic venous disease: validation of a new device to assess patient compliance. J Vasc Surg Venous Lymphat Disord. 2015;3:131.CrossRef
24.
go back to reference Uhl JF, Benigni JP, Chahim M, Frederic D. Prospective randomized controlled study of patient compliance in using a compression stocking: importance of recommendations of the practitioner as a factor for better compliance. Phlebology. 2018;33:36–43.CrossRef Uhl JF, Benigni JP, Chahim M, Frederic D. Prospective randomized controlled study of patient compliance in using a compression stocking: importance of recommendations of the practitioner as a factor for better compliance. Phlebology. 2018;33:36–43.CrossRef
25.
go back to reference McNutt L-A, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. 2003;157:940–3.CrossRef McNutt L-A, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. 2003;157:940–3.CrossRef
26.
go back to reference Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.CrossRef Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.CrossRef
27.
go back to reference Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med. 2011;171:943–4.CrossRef Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med. 2011;171:943–4.CrossRef
28.
go back to reference De Angelis MV, Pierfelice F, Di Giovanni P, Staniscia T, Uncini A. Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled study. Acta Neurol Scand. 2009;119:68–74.CrossRef De Angelis MV, Pierfelice F, Di Giovanni P, Staniscia T, Uncini A. Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled study. Acta Neurol Scand. 2009;119:68–74.CrossRef
29.
go back to reference So H, Chung VCH, Cheng JCK, Yip RML. Local steroid injection versus wrist splinting for carpal tunnel syndrome: a randomized clinical trial. Int J Rheum Dis. 2018;21:102–7.CrossRef So H, Chung VCH, Cheng JCK, Yip RML. Local steroid injection versus wrist splinting for carpal tunnel syndrome: a randomized clinical trial. Int J Rheum Dis. 2018;21:102–7.CrossRef
30.
go back to reference Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, et al. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, single-blind controlled trial. Sci Rep. 2017;7:94.CrossRef Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, et al. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, single-blind controlled trial. Sci Rep. 2017;7:94.CrossRef
31.
go back to reference Chung VC, Ho RS, Liu S, MKC C, Leung AWN, Yip BHK, et al. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial. CMAJ. 2016;188:867–75.CrossRef Chung VC, Ho RS, Liu S, MKC C, Leung AWN, Yip BHK, et al. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial. CMAJ. 2016;188:867–75.CrossRef
32.
go back to reference Chen LC, Ho CW, Sun CH, Lee JT, Li TY, Shih FM, et al. Ultrasound-guided pulsed radiofrequency for carpal tunnel syndrome: a single-blinded randomized controlled study. PLoS One. 2015;10:e0129918.CrossRef Chen LC, Ho CW, Sun CH, Lee JT, Li TY, Shih FM, et al. Ultrasound-guided pulsed radiofrequency for carpal tunnel syndrome: a single-blinded randomized controlled study. PLoS One. 2015;10:e0129918.CrossRef
33.
go back to reference Atroshi I, Hofer M, Larsson GU, Ranstam J. Extended follow-up of a randomized clinical trial of open vs endoscopic release surgery for carpal tunnel syndrome. JAMA. 2015;314:1399–401.CrossRef Atroshi I, Hofer M, Larsson GU, Ranstam J. Extended follow-up of a randomized clinical trial of open vs endoscopic release surgery for carpal tunnel syndrome. JAMA. 2015;314:1399–401.CrossRef
34.
go back to reference Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473–6.CrossRef Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473–6.CrossRef
35.
go back to reference Atroshi I, Zhou C, Joud A, Petersson IF, Englund M. Sickness absence from work among persons with new physician-diagnosed carpal tunnel syndrome: a population-based matched-cohort study. PLoS One. 2015;10:e0119795.CrossRef Atroshi I, Zhou C, Joud A, Petersson IF, Englund M. Sickness absence from work among persons with new physician-diagnosed carpal tunnel syndrome: a population-based matched-cohort study. PLoS One. 2015;10:e0119795.CrossRef
36.
go back to reference Chesterton LS, Blagojevic-Bucknall M, Burton C, Dziedzic KS, Davenport G, Jowett SM, et al. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet. 2018;392:1423–33.CrossRef Chesterton LS, Blagojevic-Bucknall M, Burton C, Dziedzic KS, Davenport G, Jowett SM, et al. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet. 2018;392:1423–33.CrossRef
Metadata
Title
Treatment of carpal tunnel syndrome with wrist splinting: study protocol for a randomized placebo-controlled trial
Authors
Isam Atroshi
Kamelia Tadjerbashi
Steven J. McCabe
Jonas Ranstam
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3635-6

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