The effects of virtual reality-mediated tendon and nerve gliding exercises in the conservative management of carpal tunnel syndrome: a double-blind randomized placebo controlled trial

Abstract

Background: Carpal tunnel syndrome (CTS) is a common condition resulting from compression of the median nerve at the wrist. First-line treatment typically involves conservative management, which commonly includes splinting and gliding exercises. Emerging evidence suggests the potential benefits of using virtual reality (VR) in rehabilitation.

Aim: This study aimed to assess the effects of VR-mediated tendon and nerve gliding exercises on the conservative treatment of CTS, compared to video-assisted (sham virtual) and home-based gliding exercises.

Design: This study was a prospective, double-blind, randomized, placebo controlled interventional trial.

Setting: The study was conducted in the Department of Physical Medicine and Rehabilitation at a university hospital.

Population: The study included patients with mild to moderate CTS.

Methods: The study included a total of 54 hands from 33 patients. The participants were randomly allocated into three groups: the VR-mediated group (VG), the sham VR-mediated group (SG), and the control (home-based) group (CG). Both intervention groups engaged in gliding exercises utilizing a Leap Motion Controller-based VR system and instructional videos, under the supervision of a physical therapist. The VR system was activated for the VG and deactivated for the SG. Exercises were performed twice weekly for eight weeks. The CG received a brochure describing the gliding exercises. Primary outcomes were symptom severity measured by the Numerical Rating Scale (NRS) and the Boston Carpal Tunnel Questionnaire (BCTQ), along with nerve conduction studies. Secondary outcomes included muscle strength (hand grip, key pinch), sensory measures (static two-point discrimination, vibration), and quality of life.

Results: Both the VG and SG showed significant improvements in NRS and BCTQ scores compared to the CG in within-group comparisons. Nighttime symptoms improved significantly in the VG compared to the CG in between-group analyses. Electrophysiological findings showed no significant changes.

Conclusions: An eight-week VR-mediated exercise program may enhance tendon and nerve gliding exercise effectiveness, particularly for nighttime symptoms in CTS patients.

Clinical rehabilitation impact: In the future, challenging exercises requiring time and supervision could be effectively performed through VR, offering an alternative to traditional methods.

Figure 1

—CONSORT flow diagram of the study. CTS: carpal tunnel syndrome; NRS: Numeric Rating Scale; BCTQ: Boston Carpal Tunnel Questionnaire; SSS: Symptom Severity Scale; FSS: Functional Status Scale; 2-PD: two-point discrimination; SF-36: Short Form-36; PCS: physical component summary; MCS: mental component summary; NCS: nerve conduction studies.

Figure 2

—Example of a supervised exercise session using virtual reality, which includes tendon and nerve gliding exercises. The virtual hand image is displayed on the left side of the screen, while instructional videos are shown on the right side.