None listed
Conditions
Brief summary
Carpal Tunnel Syndrome (CTS) is the most common condition affecting the upper limb and is associated with significant socioeconomic and quality of life costs. CTS is either treated conservatively (provision of wrists splints and exercises) or with surgery. However, long public health orthopedic waiting lists often mean symptoms have progressed beyond the point of conservative management being an option. The aim of this project is to implement a therapy based, screening and early intervention clinic for patients with CTS, to determine its effect on waiting lists, benefits to Hospital based health services and patient satisfaction and clinical outcomes. The participant group will be those who have been referred to Orthopedic depts of participating hospitals by their General Practitioner for management of CTS. The method will involve a standard care group who will receive the currently implemented management (i.e. staying on the orthopedic department waitlist for review), and the enhanced care group who will receive early intervention and conservative management. The standard care group will receive treatment at the conclusion of the study, which will still be sooner than they would otherwise normally receive it.
Interventions
All participants will attend a clinical assessment with a member of the hand therapy unit team who has undergone management of CTS competency training, and assessor training.
This will involve an initial assessment and completion of outcome measures. .
At this time, eligible participants will be randomly allocated (concealed allocation) to either 'standard care' or the 'enhanced care' group.
Enhanced care:
Participants will attend a group one off education class that will cover general in
All participants will attend a clinical assessment with a member of the hand therapy unit team who has undergone management of CTS competency training, and assessor training. This will involve an initial assessment and completion of outcome measures. . At this time, eligible participants will be randomly allocated (concealed allocation) to either 'standard care' or the 'enhanced care' group. Enhanced care: Participants will attend a group one off education class that will cover general information on CTS, education regarding posture and activity modification, provision of wrist splints for night-time use, active range of motion exercises and neural glides for the median nerve. This class will run for approx 30mins. Participants will follow this conservative, home-based intervention programme for 6 weeks, at which time they will attend a follow-up consultation with a therapist. At this appointment, outcome measures will be collected by a trained assessor who has been blinded to group allocation. Based on specific criteria (response to conservative management, clinically relevant change in symptoms based on the Boston CTS Questionnaire and other outcome measures including patients preference) , the therapist will provide this information to the orthopaedic surgeon during a case conference to assist with determining the need for surgery, further monitoring or investigations. At 6 months post commencing conservative management, a final assessment will be completed using the previous outcome measures. If the patient has had a reduction in symptoms (as determined by outcome measures), and does not wish to be considered for surgery, than the patient may be discharged into the care of their GP (with a standardised letter) following a case consultation with the orthopaedic surgeon. If the participant is deemed to have failed conservative management, then they will be reviewed by the orthopaedic surgeon to determine the need for surgery.
Sponsors
QEII Jubilee Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria: A diagnosis of idiopathic Carpal Tunnel Syndrome confirmed by a nerve conduction study. 3 months or less since referral to the QEII Hospital from their GP. Symptoms for greater than 2 months A diagnosis of CTS as determined a nerve conduction study 18-85 years of age
Exclusion criteria
Exclusion Criteria: Diabetes Patients with severe CTS symptoms as determined by patient outcome measures, nerve conduction resultsand wasting of the thenar eminence. Pregnancy related CTS Inflammatory disease (such as rheumatoid arthritis, lupus) Wrist and carpal osteoarthritis Traumatic onset of CTS from a fracture or injury Pending litigation or WorkCover claim Other neuropathy of the upper limb.
Outcome results
None listed