Outcome study of a conservative treatment program for carpal tunnel syndrome

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Outcome study of a conservative treatment program for carpal tunnel syndrome

 

Author: Chan, Kit-yuk Rebecca
Title: Outcome study of a conservative treatment program for carpal tunnel syndrome
Degree: M.Sc.
Year: 1998
Subject: Carpal tunnel syndrome -- Treatment -- Evaluation
Outcome assessment (Medical care)
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xiii, 136 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1446575
URI: http://theses.lib.polyu.edu.hk/handle/200/1261
Abstract: The main purpose of this study is to explore the treatment efficacy of a conservative occupational therapy (OT) program for carpal tunnel syndrome (CTS). Traditional conservative treatment for carpal tunnel syndrome includes splintage and steroid injection. However, high relapse rates have been reported following the use of these methods. Carpal tunnel syndrome is viewed as a result of median nerve compression at wrist level and very often related to repetitive and forceful hand use in daily occupation. Without identifying risk factors and changing the habit of using hand and upper limb in awkward positions, the problems cannot be resolved. As occupational therapy utilises purposeful activities and training programs to facilitate recovery, a comprehensive program was adopted in this study based on treatment for repetitive strain injuries. Besides splintage, the program also included education, detailed job analysis and training on proper hand use in daily occupation. To study the treatment efficacy of this new program, a quasi-experimental design was performed. Repeated measures design was used to study the changes in symptom severity, functional status, grip strength and sensory recovery before treatment, at 4 weeks and 8 weeks post treatment, and also one month post discharge as follow up. Without control groups, double baselines were used to eliminate maturation effect. These patients did not receive any steroid injection. Patients with muscle wasting were also excluded because immediate surgical intervention would be advised instead of using conservative treatment. Eighteen patients with twenty-eight wrists diagnosed as CTS were recruited into a 2 month rehabilitation program and the patients returned for follow up one month after discharge. The age, sex, duration of onset and types of occupation were documented. The outcome measurements included a self-administered questionnaire of symptom severity and function status developed by Levine et al in 1993. As most subjects were Chinese, the questionnaire was translated into Chinese. Three experts were invited to assess the content validity after backward translation was done. Test- retest reliability on other measurement tool studies were also conducted before the main study. The main scores for symptom severity, functional status grip strength, and the Monofilament & Phalen test were compared using ANOVA. For statistical procedure, ANOVA of repeated measure were applied on the mean of the scores on individual outcome measurements. The results supported the hypothesis that there were significant changes among the four assessment occasions before treatment, at 4 weeks and 8 weeks post treatment and one month after discharge. However, it was noted that two patients with severe numbness and high work stress or physical demand were least responsive to this treatment method. The outcome measurements during the four assessment occasions fluctuated for these two cases. It was concluded that the conservative program made positive changes in symptom severity and function status for the subjects in this study. It also improved grip strength and sensory recovery for this group of carpal tunnel syndrome patients. Further studies might be useful to clarify factors that may impact on treatment efficacy of conservative treatment programmes. The study also provided insights for improving treatment accountability by comparing different treatment protocols developed for identical patient groups in the future.

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