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Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial.

Publication ,  Journal Article
Liew, BXW; de-la-Llave-Rincón, AI; Scutari, M; Arias-Buría, JL; Cook, CE; Cleland, J; Fernández-de-Las-Peñas, C
Published in: Phys Ther
April 1, 2022

OBJECTIVE: The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS). METHODS: Data from a randomized clinical trial (n = 104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity. RESULTS: Manual physical therapy improved function in women with CTS (between-groups difference: 0.09; 95% CI = 0.07 to 0.11). The Bayesian network showed that early improvements (at 1 month) in function and symptom severity led to long-term (at 12 months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI = 0.11 to 0.17 point) poorer function at 12 months than those with mild CTS and 0.12-point (95% CI = 0.09 to 0.15 point) poorer function at 12 months than those with severe CTS. CONCLUSION: Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects. IMPACT: Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS.

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Published In

Phys Ther

DOI

EISSN

1538-6724

Publication Date

April 1, 2022

Volume

102

Issue

4

Location

United States

Related Subject Headings

  • Rehabilitation
  • Pain Measurement
  • Pain
  • Musculoskeletal Manipulations
  • Humans
  • Female
  • Carpal Tunnel Syndrome
  • Bayes Theorem
  • 4201 Allied health and rehabilitation science
  • 1106 Human Movement and Sports Sciences
 

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Liew, B. X. W., de-la-Llave-Rincón, A. I., Scutari, M., Arias-Buría, J. L., Cook, C. E., Cleland, J., & Fernández-de-Las-Peñas, C. (2022). Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial. Phys Ther, 102(4). https://doi.org/10.1093/ptj/pzac015
Liew, Bernard X. W., Ana I. de-la-Llave-Rincón, Marco Scutari, José L. Arias-Buría, Chad E. Cook, Joshua Cleland, and César Fernández-de-Las-Peñas. “Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial.Phys Ther 102, no. 4 (April 1, 2022). https://doi.org/10.1093/ptj/pzac015.
Liew BXW, de-la-Llave-Rincón AI, Scutari M, Arias-Buría JL, Cook CE, Cleland J, Fernández-de-Las-Peñas C. Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial. Phys Ther. 2022 Apr 1;102(4).
Journal cover image

Published In

Phys Ther

DOI

EISSN

1538-6724

Publication Date

April 1, 2022

Volume

102

Issue

4

Location

United States

Related Subject Headings

  • Rehabilitation
  • Pain Measurement
  • Pain
  • Musculoskeletal Manipulations
  • Humans
  • Female
  • Carpal Tunnel Syndrome
  • Bayes Theorem
  • 4201 Allied health and rehabilitation science
  • 1106 Human Movement and Sports Sciences