Article

OBJECTIVE: To summarize the available evidence regarding the course of symptoms
and prognostic factors in patients with diagnosed carpal tunnel syndrome (CTS)
who are treated conservatively. DATA SOURCES: Computerized databases, reference
checking, and experts in the field were used to identify studies for inclusion in
the review. STUDY SELECTION: Multiple reviewers were used to identify studies
which included adults (aged >/=18y) diagnosed with CTS in either a clinical
setting or population setting. The study must have observed the course of CTS
over at least a 6-week period in patients receiving no treatment or usual care
that included conservative (nonsurgical) treatments. The design was of a
longitudinal cohort study with either prospective or retrospective data
collection. There were no language restrictions, and none of the research
identified was only reported in abstract form. DATA EXTRACTION: Methodological
bias was assessed using the Quality in Prognosis Studies tool. A high risk of
bias (predominantly relating to study attrition, confounding, and/or statistical
analysis and reporting) was judged to be present in 8 studies. Designs showed
wide variability with respect to characteristics of the included population,
definition of CTS, assessment of prognostic factors, types of interventions
provided, and types of outcome measures applied. This prevented pooled estimates
from being produced. DATA SYNTHESIS: A negative outcome at 3 years' follow-up of
conservatively treated participants ranged from 23% to 89%. Four included studies
observed the rate of surgical intervention after initial conservative management
and found this to be 57% to 66%. Evidence regarding factors predicting the
negative outcome of no treatment or conservative treatment was graded, taking
into account the number of studies evaluating the factor, the methodological
quality of these studies, and the consistency of the available evidence. There
was 100% agreement in at least 3 cohorts with a medium or high risk of bias that
symptom duration, a positive Phalen's test, and thenar wasting were associated
with a negative outcome of conservative management; however, not all results were
statistically significant, and hence the overall judgment remained inconclusive.
CONCLUSIONS: Results of this review should be treated with caution because of the
heterogeneity of studies and the risks of bias identified. However, the course of
CTS appears variable, and poor prognosis may be predicted by a longer symptom
duration, a positive Phalen's test, and thenar wasting.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS