The use of telerehabilitation to deliver an exercise program combined with pain education was studied in carpal tunnel syndrome
It was compared against exercise therapy alone
No differences were observed in the primary endpoint at week 6
Pain education is everywhere, and that is a good thing. It has been shown to reduce levels of anxiety and distress in various musculoskeletal conditions. When you inform (or educate, what is in a name) your patient well, you already have an advantage despite the type of treatment you opt for. More and more evidence points to the relevance of self-management. As such, physiotherapy is turning away from “treating” patients and moving on to guide someone through a certain pathology. In this aspect, I chose to review this RCT as it combined both. The application of pain education and exercise for carpal tunnel syndrome delivered through telerehabilitation.
In this RCT, pain education and exercise for carpal tunnel syndrome were compared against exercise only. Both interventions were delivered through telerehabilitation.
Participants were between the ages of 18 and 60 years and had moderate to severe carpal tunnel syndrome. This definition was established according to the clinical practice guidelines of the Academy of Orthopaedic Physical Therapy and the Academy of Hand and Upper Extremities Physical Therapy. We covered this practice guideline on our YouTube channel, which you can watch here. Further, their symptoms were present for at least 3 months and could have been unilateral or bilateral in presence.
The included participants were randomized on a 1:1 allocation ratio to receive exercise only compared to pain education and exercise for carpal tunnel syndrome. Both groups received the exercise therapy program through telerehabilitation. Three telerehabilitation sessions were supervised by physiotherapists every 15 days.
In the exercise group participants performed aerobic exercise, digital flexor tendon gliding, neurodynamic home exercises, and self-stretching.
These exercises were performed three times per week for 6 weeks, with a 48-hour interval between each session. Each exercise session lasted approximately 30 min. In total, 15 self-managed and 3 supervised sessions were held.
In the group receiving pain education and exercise for carpal tunnel syndrome, participants received 3 additional sessions of pain neuroscience education. The table hereunder depicts the detailed program for both groups.
Pain intensity was the primary outcome of interest and this was measured using the NPRS at 6 weeks and 12 weeks. Other outcome measures included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia-11, Boston Carpal Tunnel Questionnaire (BCTQ), Hospital Anxiety and Depression Scale (HADS), EuroQol5-dimensions (EQ-5D), and the Patient Global Impression of Change Scale (PGICS).
The analysis of the baseline characteristics revealed no significant differences between the groups at the start of the study.
The study wanted to know whether pain education combined with exercise was better than exercise alone. So they tried to rate the between-group effects.
The paper stated that there was no interaction effect or main effect for group, but a main effect for time was observed. Further, they state: “Significant and clinically relevant differences in NPRS were observed at week 6 in the PNE + exercise group (MD: 2.0 points, 95% CI: -3.8 to −0.2). The exercise group showed no improvement at any time point”.
Pain education and exercise for carpal tunnel syndrome were not more effective than exercise alone for reducing pain intensity. Although mentioned and highlighted, this reflects the interpretation of a within-group improvement where the study wanted to compare between-group effects. The study indicated that adherence to the program was high and that participants were satisfied with the way of receiving telerehabilitation. Combining pain education and exercise may be useful for reducing kinesiophobia, but this was a secondary outcome and should be further tested.
Núñez-Cortés R, Cruz-Montecinos C, Torreblanca-Vargas S, Tapia C, Gutiérrez-Jiménez M, Torres-Gangas P, Calatayud J, Pérez-Alenda S. Effectiveness of adding pain neuroscience education to telerehabilitation in patients with carpal tunnel syndrome: A randomized controlled trial. Musculoskelet Sci Pract. 2023 Jul 28;67:102835. doi: 10.1016/j.msksp.2023.102835. Epub ahead of print. PMID: 37572618.
Bland JM, Altman DG. Comparisons against baseline within randomised groups are often used and can be highly misleading. Trials. 2011 Dec 22;12:264. doi: 10.1186/1745-6215-12-264. PMID: 22192231; PMCID: PMC3286439.
Watch this FREE video lecture on Nutrition & Central Sensitisation by Europe’s #1 chronic pain researcher Jo Nijs. Which food patients should avoid will probably surprise you!