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Meta-Analysis
. 2022 Feb;46(2):301-312.
doi: 10.1007/s00264-021-05272-2. Epub 2021 Dec 3.

The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis

Sandra Jiménez-Del-Barrio  1 , Aida Cadellans-Arróniz  2 , Luis Ceballos-Laita  3 , Elena Estébanez-de-Miguel  4 , Carles López-de-Celis  2   5 , Elena Bueno-Gracia  2   4 , Albert Pérez-Bellmunt  2
Affiliations
Meta-Analysis

The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis

Sandra Jiménez-Del-Barrio et al. Int Orthop. 2022 Feb.

Abstract

Aim of the study: Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies.

Method: MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies.

Results: Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of - 2.13 with 95% confidence interval (CI) (- 2.39, - 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of - 1.67 with 95% CI (- 1.92, - 1.43) on symptoms severity, and a SMD of - 0.89 with 95% CI (- 1.08, - 0.70) on functional status. Nerve conduction studies showed a SMD of - 0.19 with 95% CI (- 0.40, - 0.02) on motor conduction and a SMD of - 1.15 with 95% CI (- 1.36, - 0.93) on sensory conduction.

Conclusions: This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.

Keywords: Carpal tunnel syndrome; Manual therapy; Median nerve; Meta-analysis; Neuropathies.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Forest plot of comparison. Manual therapy vs control group. Outcome: pain
Fig. 3
Fig. 3
Forest plot of comparison. Manual therapy vs control group. Outcome: symptom severity scale (BCTS-Q)
Fig. 4
Fig. 4
Forest plot of comparison. Manual therapy vs control group. Outcome: functional status scale (BCTS-Q)
Fig. 5
Fig. 5
Forest plot of comparison. Manual therapy vs control group. Outcome: nerve motor conduction
Fig. 6
Fig. 6
Forest plot of comparison: manual therapy vs control group. Outcome: nerve sensory conduction
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