Article type
Year
Abstract
Background: To assess the outcome measures being used in published RCTs regarding the treatment of carpal tunnel syndrome (CTS) and the presentation of the results. On the basis of the findings the possibility of combining the results of the individual studies will be considered.
Methods: Twenty-eight RCTs regarding the treatment of CTS were examined. Ten focused on conservative therapy: ultrasound treatment (2), (local) steroid injections (3), vitamin B6 (2), oral medications (diuretics, oral steroids) (3). Various types of surgery were compared in the other trials: endoscopic versus open carpal tunnel release (OCTR) (11), OCTR with a short or long incision (2), OCTR with or without internal neurolysis (3) and OCTR with or without epineurotomy (2).
Results: In general the conservative trials only used outcome measures based on the symptoms of CTS. Unfortunately almost none of these outcomes were the same. Among those were specific descriptions of symptoms (e.g. pain or paresthesias), but also more general expressions had been used (e.g. night discomfort or just 'symptoms'). Sometimes the symptoms were combined into a 'global symptom score' or the 'general improvement in symptoms' had to be indicated by the patients. In the majority of the cases data presentation had been done adequately (e.g. means with standard deviations, or numbers of patients). In addition to outcome measures based on CTS symptoms, all the surgical studies had used at least one of the following outcome measures: strength (grip, pinch, manual thenar muscle), sensibility (two-point discrimination, Semmes Weinstein monofilaments) and time to return to work/ADL. The presentation of the results, however, generally was poor. For example, strength had been presented as mean values (usually without sd), (mean percent of) change from preoperative values, distribution of patients over different categories of strength and time to return to preoperative values. Often these results were presented in graphs only (without confidence intervals), resulting in inaccuracy when abstracting the data. Poor presentation of results applied also to sensibility measures. With regard to time to return to work/ADL, only the mean or median number of days had been presented in most cases.
Conclusions: The results of the studies regarding the conservative treatment of CTS cannot easily be combined due to the different outcome measures that have been used. Although often similar outcomes had been used in the surgical trials, the variability in the presentation of study results impedes combining the data of the individual studies. To enable a quantitative summary of the results of individual studies both the use and presentation of outcome measures have to be similar.
Methods: Twenty-eight RCTs regarding the treatment of CTS were examined. Ten focused on conservative therapy: ultrasound treatment (2), (local) steroid injections (3), vitamin B6 (2), oral medications (diuretics, oral steroids) (3). Various types of surgery were compared in the other trials: endoscopic versus open carpal tunnel release (OCTR) (11), OCTR with a short or long incision (2), OCTR with or without internal neurolysis (3) and OCTR with or without epineurotomy (2).
Results: In general the conservative trials only used outcome measures based on the symptoms of CTS. Unfortunately almost none of these outcomes were the same. Among those were specific descriptions of symptoms (e.g. pain or paresthesias), but also more general expressions had been used (e.g. night discomfort or just 'symptoms'). Sometimes the symptoms were combined into a 'global symptom score' or the 'general improvement in symptoms' had to be indicated by the patients. In the majority of the cases data presentation had been done adequately (e.g. means with standard deviations, or numbers of patients). In addition to outcome measures based on CTS symptoms, all the surgical studies had used at least one of the following outcome measures: strength (grip, pinch, manual thenar muscle), sensibility (two-point discrimination, Semmes Weinstein monofilaments) and time to return to work/ADL. The presentation of the results, however, generally was poor. For example, strength had been presented as mean values (usually without sd), (mean percent of) change from preoperative values, distribution of patients over different categories of strength and time to return to preoperative values. Often these results were presented in graphs only (without confidence intervals), resulting in inaccuracy when abstracting the data. Poor presentation of results applied also to sensibility measures. With regard to time to return to work/ADL, only the mean or median number of days had been presented in most cases.
Conclusions: The results of the studies regarding the conservative treatment of CTS cannot easily be combined due to the different outcome measures that have been used. Although often similar outcomes had been used in the surgical trials, the variability in the presentation of study results impedes combining the data of the individual studies. To enable a quantitative summary of the results of individual studies both the use and presentation of outcome measures have to be similar.