Graded Motor Imagery in Carpal Tunnel Syndrome
Is There an Advantage to Incorporating a Central Nervous System-targeted Intervention Within an Exercise Program for Individuals Diagnosed With Carpal Tunnel Syndrome? A Randomized Controlled Trial
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Nelze použít
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Zeynep Yıldız Kızkın
- Telefonní číslo: +905346945085
- E-mail: pt.zeynepyildiz@gmail.com
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- mild to moderate unilateral CTS based on the Bland classification of electrodiagnostic testing ;
- positive Phalen or Tinel tests;
- symptoms such as paresthesia and pain associated with CTS that last longer than 3 months;
- patients aged 30-60 years (when CTS becomes more prevalent);
- patients who achieved a minimum score of 24 on the Mini-Mental State Examination (MMSE).
Exclusion Criteria:
- bilateral CTS;
- history of prior CTS surgery;
- clinical indicators of cervical radiculopathy or polyneuropathy;
- pregnancy or cognitive impairment;
- the presence of orthopedic, neurological, or functional problems on the unaffected side that could affect hand function (e.g., history of trauma or surgery, peripheral nerve injury, tendinopathy, tenosynovitis, trigger finger, arthritis, sequelae of a fracture, etc.);
- receipt of any conservative treatment for CTS within the last month.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Singl
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
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Experimentální: Graded Motor Imagery
Each patient in the Graded Motor Imagery group will receive a treatment protocol consisting of Graded Motor Imagery, progressive neurodynamic exercises, and nighttime resting splints.
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GMI includes three stages. GMI program will span over 6 weeks. The first 2 weeks will focus on lateralization, followed by 2 weeks of motor imagery, and the final 2 weeks will involve mirror therapy. Lateralization: Patients will be asked to differentiate whether the hands shown in the Recognise™ Hand application belongs to the right or left side of their body. Motor Imagery: Patients will be instructed to imagine slowly and smoothly moving their affected extremities to the posture depicted in the photos in the Recognise™ Hand application and then returning to the starting position. Mirror Therapy: Using a mirror measuring 300 x 300 x 300 mm³ placed between the upper extremities, patients will be instructed to progressively move only their unaffected extremity, then their affected extremity, and finally both extremities.
The progressive neurodynamic exercises involved holding each position for 5 seconds.
Each session included two sets of 10 repetitions (2×10).
The treatment lasted for 30-minute sessions, conducted twice weekly over a total of 6 weeks.
The night splint was fitted with a wrist splint that keeps the wrist in a neutral position, permits finger flexion, maintains the wrist within a 0°-5° extension range, and ends just distal to the distal palmar crease.
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Aktivní komparátor: Progressive Neurodynamic Exercises
Each patient in the progressive neurodynamic exercises group will receive a treatment protocol consisting of progressive neurodynamic exercises and nighttime resting splints.
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The progressive neurodynamic exercises involved holding each position for 5 seconds.
Each session included two sets of 10 repetitions (2×10).
The treatment lasted for 30-minute sessions, conducted twice weekly over a total of 6 weeks.
The night splint was fitted with a wrist splint that keeps the wrist in a neutral position, permits finger flexion, maintains the wrist within a 0°-5° extension range, and ends just distal to the distal palmar crease.
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Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
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Disabilities of the Arm, Shoulder, and Hand (DASH)
Časové okno: Baseline
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DASH is a 30-item self-report tool assessing upper-extremity disability and symptoms, including daily activities, pain, numbness, joint stiffness, weakness, sleep issues, and psychological effects.
Examples include turning a doorknob, changing a light bulb, and cutting food.
Scores range from 0 to 100; higher scores indicate more severe symptoms and impairment.
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Baseline
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Disabilities of the Arm, Shoulder, and Hand (DASH)
Časové okno: After the 6-week intervention
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DASH is a 30-item self-report tool assessing upper-extremity disability and symptoms, including daily activities, pain, numbness, joint stiffness, weakness, sleep issues, and psychological effects.
Examples include turning a doorknob, changing a light bulb, and cutting food.
Scores range from 0 to 100; higher scores indicate more severe symptoms and impairment.
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After the 6-week intervention
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Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Mini vyšetření duševního stavu
Časové okno: Základní linie
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Mini-Mental State Examination (MMSE) bude sloužit k posouzení kognitivního stavu pacientů.
Skládá se z 11 otázek a hodnotí se na stupnici 30 bodů.
Skóre mezi 24-30 je považováno za normální, 18-23 označuje mírnou kognitivní poruchu a skóre 17 nebo nižší ukazuje na těžkou demenci.
MMSE hodnotí orientaci, paměť, pozornost, výpočet, vybavování, jazyk, motorické funkce, vnímání a zrakově prostorové schopnosti.
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Základní linie
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Mini Mental State Examination
Časové okno: After the 6-week intervention
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The Mini-Mental State Examination (MMSE) will be used to assess the cognitive status of patients.
It consists of 11 questions and is evaluated on a scale of 30 points.
A score between 24-30 is considered normal, 18-23 indicates mild cognitive impairment, and a score of 17 or below is indicative of severe dementia.
The MMSE assesses orientation, memory, attention, calculation, recall, language, motor function, perception, and visuospatial abilities.
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After the 6-week intervention
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Boston Carpal Tunnel Syndrome Questionnaire (BCTQ)
Časové okno: Baseline
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A patient-reported assessment uses a 5-point Likert scale with two subscales: the 11-item Symptom Severity Scale (CTSQ-S) for symptom intensity like numbness and pain, and the 8-item Functional Status Scale (CTSQ-F) for ADL ability such as writing and dressing.
Higher scores mean more severe symptoms and impairment.
The BCTQ shows high reliability, validity, and sensitivity to clinical changes.
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Baseline
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Boston Carpal Tunnel Syndrome Questionnaire (BCTQ)
Časové okno: After the 6-week intervention
|
A patient-reported assessment uses a 5-point Likert scale with two subscales: the 11-item Symptom Severity Scale (CTSQ-S) for symptom intensity like numbness and pain, and the 8-item Functional Status Scale (CTSQ-F) for ADL ability such as writing and dressing.
Higher scores mean more severe symptoms and impairment.
The BCTQ shows high reliability, validity, and sensitivity to clinical changes.
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After the 6-week intervention
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The Semmes-Weinstein Monofilament Test
Časové okno: Baseline
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The assessment used a monofilament test (0.49-0.96), known for high sensitivity in diagnosing CTS.
Sensory thresholds were checked at the radial tips of the thumbs, index, middle, and ring fingers.
The monofilament was applied perpendicularly to the dorsal finger pads with eyes closed and the wrist in a neutral position.
Pressure was applied for 1 to 1.5 seconds until slight bending of the filament.
Lower readings indicate better sensory function; higher readings suggest worse light touch perception.
A gauge of 2.83 grams is the normal threshold, while 3.22 grams or higher indicates moderate-to-severe sensory impairment in CTS.
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Baseline
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The Semmes-Weinstein Monofilament Test
Časové okno: After the 6-week intervention
|
The assessment used a monofilament test (0.49-0.96), known for high sensitivity in diagnosing CTS.
Sensory thresholds were checked at the radial tips of the thumbs, index, middle, and ring fingers.
The monofilament was applied perpendicularly to the dorsal finger pads with eyes closed and the wrist in a neutral position.
Pressure was applied for 1 to 1.5 seconds until slight bending of the filament.
Lower readings indicate better sensory function; higher readings suggest worse light touch perception.
A gauge of 2.83 grams is the normal threshold, while 3.22 grams or higher indicates moderate-to-severe sensory impairment in CTS.
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After the 6-week intervention
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Purdue Pegboard Test
Časové okno: Baseline
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The Purdue Pegboard consists of 50 holes in two columns, with pins, washers, and sleeves in four recesses at the top.
Patients sat in front of the apparatus and performed four tests: the dominant hand, non-dominant hand, two-hand, and assembly test.
For the hand tests, they inserted pins into holes with their hands for 30 seconds each; the two-hand test used both hands.
In the assembly test, they placed materials in order: pin → washer → collars → washer within 60 seconds.
Each test was repeated three times, and scores were averaged.
This test assesses fine motor skills, coordination, finger dexterity, hand-eye coordination, and small object manipulation; lower scores indicate poorer hand skills.
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Baseline
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Purdue Pegboard Test
Časové okno: After the 6-week intervention
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The Purdue Pegboard consists of 50 holes in two columns, with pins, washers, and sleeves in four recesses at the top.
Patients sat in front of the apparatus and performed four tests: the dominant hand, non-dominant hand, two-hand, and assembly test.
For the hand tests, they inserted pins into holes with their hands for 30 seconds each; the two-hand test used both hands.
In the assembly test, they placed materials in order: pin → washer → collars → washer within 60 seconds.
Each test was repeated three times, and scores were averaged.
This test assesses fine motor skills, coordination, finger dexterity, hand-eye coordination, and small object manipulation; lower scores indicate poorer hand skills.
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After the 6-week intervention
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The Two-Point Discrimination Test
Časové okno: Baseline
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The two-point discrimination threshold was evaluated using an esthesiometer applied to the pulp of the thumb, index, and middle fingers.
During the evaluation, participants' eyes remained closed, and light stimuli, consisting of either one or two points, were randomly presented along the longitudinal axis of the fingers.
The procedure began at a distance of 5 mm, with 10 trials conducted at each specified interval.
If the participant failed to achieve at least seven correct responses, the distance was increased by 1 mm, and the test was repeated.
The discrimination threshold was defined as the smallest distance at which at least seven out of ten responses were correct.
Testing was discontinued at a maximum distance of 15 mm, with values below 6 mm considered within normal limits.
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Baseline
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The Two-Point Discrimination Test
Časové okno: After the 6-week intervention
|
The two-point discrimination threshold was evaluated using an esthesiometer applied to the pulp of the thumb, index, and middle fingers.
During the evaluation, participants' eyes remained closed, and light stimuli, consisting of either one or two points, were randomly presented along the longitudinal axis of the fingers.
The procedure began at a distance of 5 mm, with 10 trials conducted at each specified interval.
If the participant failed to achieve at least seven correct responses, the distance was increased by 1 mm, and the test was repeated.
The discrimination threshold was defined as the smallest distance at which at least seven out of ten responses were correct.
Testing was discontinued at a maximum distance of 15 mm, with values below 6 mm considered within normal limits.
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After the 6-week intervention
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Grip Strength
Časové okno: Baseline
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Grip strength was measured using a hand dynamometer.
The participant sat comfortably with shoulder abducted, elbow at 90°, and forearm neutral.
The wrist was between 0° and 30° extension.
Each hand was tested three times with one-minute rests, and the average was recorded.
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Baseline
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Grip Strength
Časové okno: After the 6-week intervention
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Grip strength was measured using a hand dynamometer.
The participant sat comfortably with shoulder abducted, elbow at 90°, and forearm neutral.
The wrist was between 0° and 30° extension.
Each hand was tested three times with one-minute rests, and the average was recorded.
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After the 6-week intervention
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Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Zeynep Yıldız Kızkın, Artvin Coruh University
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
Další identifikační čísla studie
Další identifikační čísla studie
- Graded Motor Imagery in CTS
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