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Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions
Walker WC, Metzler M, Cifu DX, Swartz Z
Archives of Physical Medicine and Rehabilitation 2000 Apr;81(4):424-429
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: No; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To compare the effects of night-only to full-time splint wear instructions on symptoms, function, and impairment in carpal tunnel syndrome (CTS). DESIGN: Randomized clinical trial with 6-week follow-up. SETTING: Veterans Administration Medical Center, outpatient clinic. SUBJECTS: Outpatients with untreated CTS were consecutively recruited from our electrodiagnostics lab. Twenty-one patients (30 hands) were enrolled, and 17 patients (24 hands) completed the study. INTERVENTIONS: Thermoplastic, custom-molded, neutral wrist splints with subjects receiving either full-time or night-only wear instructions. OUTCOME MEASURES: Symptoms and functional deficits were measured by Levine's self-administered questionnaire, and physiologic impairment was measured by median nerve sensory and motor distal latency. Compliance and Crossover: Almost all (92%) of the combined sample reported frequent splint use, but their adherence to specific wearing instructions was limited. A majority (73%) of the full-time group reported splint wear less than one half of waking hours, and some (23%) of the night-only group reported occasional daytime wear. Despite this tendency for treatment crossover, the two treatment groups differed in daytime wear as intended (Chi2 analysis, p = 0.004). RESULTS: The combined sample improved in three of four outcome measures: sensory distal latency (mean 0.28msec, standard deviation (SD) 0.37, p = 0.004), symptom severity (mean 0.64, SD 0.46, p = 0.0001), and functional deficits (mean 0.49, SD 0.51, p = 0.0001). Severity of CTS was a factor only in sensory distal latency improvement (more improvement in severe CTS). Subjects receiving full-time wear instructions showed superior distal latency improvement, both motor (0.35 versus -0.07msec, p = 0.04) and sensory (0.46 versus 0.13msec, p = 0.05) when compared with subjects receiving night-only wear instructions. CONCLUSIONS: This study provides added scientific evidence to support the efficacy of neutral wrist splints in CTS and suggests that physiologic improvement is best with full-time splint wear instructions.

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