- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03582735
Preoperative Neuromobilization Exercises for Individuals With Carpal Tunnel Syndrome
Effects of a Preoperative Neuromobilization Program Offered to Individuals With Carpal Tunnel Syndrome Awaiting Carpal Tunnel Release Surgery: a Pilot Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Carpal Tunnel Syndrome (CTS) is a common disorder characterized by alterations of the median nerve integrity at the carpal tunnel. The syndrome is classically recognized by chief complains of nocturnal or intermittent pain and paresthesia involving the median nerve sensory territory of the hand. In more severe condition, worsening of pain and paresthesia as well as thenar muscle atrophy may be present and lead to disability.
Many conservative treatments for CTS are available. Yet, the current literature only support the use of wrist splints and cortisone infiltration, which have been shown to provide only temporary relief for many individuals. Those with ongoing symptoms or severe conditions are often offered carpal tunnel decompression surgery. However, the costs related to the surgery and the increasing delays on waiting lists warrants the need for better conservative management. A preoperative rehabilitation exercise program based on nerve gliding exercise is advocated by physical therapists to manage physical impairments and functional limitations associated with CTS. These exercises can be implement at low cost in the setting of an home-based program.
The investigators aim to examine the feasibility and the efficacy of a preoperative home rehabilitation program based on nerve gliding exercises completed by individuals with carpal tunnel Syndrome waiting for decompression surgery.
In this trial, individuals awaiting carpal tunnel decompression surgery will be randomly allocated to either complete a preoperative nerve-gliding exercise program (experimental group) or no intervention (control group). Thirty participants confirmed with CTS by their attending hand surgeons and enlisted for carpal tunnel decompression will be recruited for this study conducted at the hospital of the Université de Montréal (CHUM), Montreal, Quebec, Canada. All individuals enrolled in the study will be prioritized on the surgical waiting list to receive their surgery five weeks after initiating the study in order to ensure consistency between different timeframes of the study.
The effects of the nerve-gliding exercise program will be assessed at baseline (T0) using standardized questionnaires, quantitative ultrasound measurements (including static and dynamic evaluations) of the median nerve, pinch grip strength and will be repeated after four weeks (T1; preoperative period) and four weeks following surgery (T2; postoperative period).
Feasibility metrics will be analyzed using descriptive statistics. A significant interaction between the group allocation (experimental vs. control) and time (T0 vs. T1 vs. T2) on the main outcomes will be evaluated using two-way mixed ANOVAs.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Quebec
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Montréal, Quebec, Canada, H2X 0A9
- Centre Hospitalier Universitaire de l'Université de Montréal
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- EMG confirmed diagnosis of carpal tunnel syndrome
- Listed for carpal tunnel decompression
Exclusion Criteria:
- Previous trauma or surgery impairing motion of the upper limb
- Diabetes
- Thyroid disease
- Rheumatoid arthritis
- Recent pregnancy (< 3 months)
- Unable to communicate in English or French
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Nerve gliding exercise
Three series of 15 daily repetition of the rehabilitation exercise targetting nerve excursion
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A 4-week home-based nerve-gliding exercise program (NGEP) including isolated and coupled upper limb and neck movements.
A specific mobilization was elaborated for each week of the program allowing to gradually increase the range of movement and inter-articular coordination.
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No Intervention: Control
No intervention according to current practice.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in different pain-related disabilities and cognitive-behavioral factors involved in the experience of pain measured by the West Haven-Yale Multidimensional Pain inventory (WHYMPI)
Time Frame: Baseline (T0), one month (T1), and two months (T2) following randomization
|
The WHYMPI is comprised of 52 questions organized into subscales quantifying domains including two subscales specific to pain experience (i.e., pain interference (9 items), and pain severity (3 items)).
Each question is rated on a Likert scale ranging from 0 to 6 and a mean score is computed for each subscale.
A higher mean score represents higher disability (e.g., very intense pain or extreme interference).
The French version of the WHYPMI has been adapted and validated and has demonstrated good repeatability (ICC > 0.75) when tested in adults with chronic musculoskeletal pain (Laliberté et al. 2008, Kerns, Turk, and Rudy 1985).
The normalized minimal detectable change (MDC) for the WHYMPI for each of the five WHYMPI subscales range from MDC90%=15.4% (pain interference) to MDC90%=22.8%
(emotional distress) (Bergström et al. 1999).
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Baseline (T0), one month (T1), and two months (T2) following randomization
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Change upper limb functional abilities measured with the Disability of the Arm, Shoulder and Hand (DASH) scale
Time Frame: Baseline (T0), one month (T1), and two months (T2) following randomization
|
The DASH includes 30 questions covering participation and performance of daily activities with the upper limb as well as symptom severity in individuals with musculoskeletal upper limb disorder.
Each question is rated on a Likert scale ranging from 1 to 5, where a higher weighted score (range 0-100) represents substantial functional limitations.
The French version of the DASH has been adapted and validated and has demonstrated excellent repeatability (ICC = 0.91) when tested in adults with chronic musculoskeletal pain (Hudak, Amadio, and Bombardier 1996, Durand et al. 2005).
The normalized MDC was established (MDC90% = 10.7%)
(Greenslade et al. 2004).
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Baseline (T0), one month (T1), and two months (T2) following randomization
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in median nerve cross sectional area at the carpal tunnel inlet measured by quantitative ultrasound imaging
Time Frame: Baseline (T0), one month (T1), and two months (T2) following randomization
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Static images of the median nerve's are acquired in the transverse plane at the level of the carpal tunnel inlet.
The cross-sectional area of the median nerve is defined by semi-automatically outlining the inner border of the epineurium and will be assess offline using custom software.
Median nerve cross-sectional area measurement has good repeatability ( > 0.88) when performed in asymptomatic adults.
The normalized MDC was previously estimated for the cross-sectional area measurement (MDC90% = 6.2%)
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Baseline (T0), one month (T1), and two months (T2) following randomization
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Change in median nerve longitudinal excursion at the distal forearm measured by quantitative ultrasound imaging
Time Frame: Baseline (T0), one month (T1), and two months (T2) following randomization
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Cineloops of the median nerve are acquired during passive extension of the wrist using ultrasound imaging at the distal forearm.
Three region of interest within the epineurium border are manually drawn and will be assess offline custom software.
Median nerve longitudinal excursion has good repeatability ( > 0.84) when performed in a mixed population including asymptomatic individuals and individuals with carpal tunnel syndrome.
The normalized MDC was previously estimated for the longitudinal excursion measurement (MDC90% = 34.1%)
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Baseline (T0), one month (T1), and two months (T2) following randomization
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Change in pinch grip strength
Time Frame: Baseline (T0), 4th week (T1), and four weeks following surgery (T2)
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Assessment of thumb strength (in kilogram) using hand held dynamometer
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Baseline (T0), 4th week (T1), and four weeks following surgery (T2)
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Collaborators and Investigators
Investigators
- Principal Investigator: Dany H Gagnon, PT, PhD, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- DG_NM_15e
- 2015-16-#19 (Other Grant/Funding Number: OPPQ and the Quebec Rehabilitation Research Network)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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