Abstract
Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel
syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys
Med Rehabil 2000;81:424-9. Objective: To compare the effects of night-only to full-time splint wear instructions on symptoms,
function, and impairment in carpal tunnel syndrome (CTS). Design: Randomized clinical trial with 6-week follow-up. Setting: Veterans Administration Medical Center, outpatient clinic. Subjects: Outpatients with untreated CTS were consecutively recruited from our electrodiagnostics
lab. Twenty-one patients (30 hands) were enrolled, and 17 patients (24 hands) completed
the study. Interventions: Thermoplastic, custom-molded, neutral wrist splints with subjects receiving either
full-time or night-only wear instructions. Outcome Measures: Symptoms and functional deficits were measured by Levine's self-administered questionnaire,
and physiologic impairment was measured by median nerve sensory and motor distal latency.
Compliance and Crossover: Almost all (92%) of the combined sample reported frequent splint use, but their adherence
to specific wearing instructions was limited. A majority (73%) of the full-time group
reported splint wear less than one half of waking hours, and some (23%) of the night-only
group reported occasional daytime wear. Despite this tendency for treatment crossover,
the two treatment groups differed in daytime wear as intended (χ2 analysis, p =.004). Results: The combined sample improved in three of four outcome measures: sensory distal latency
(mean =.28msec, standard deviation [SD] =.37, p =.004), symptom severity (mean =.64, SD =.46, p =.0001), and functional deficits (mean =.49, SD =.51, p =.0001). Severity of CTS was a factor only in sensory distal latency improvement
(more improvement in severe CTS). Subjects receiving full-time wear instructions showed
superior distal latency improvement, both motor (.35 vs −.07msec, p =.04) and sensory (.46 vs.13msec, p =.05) when compared with subjects receiving night-only wear instructions. Conclusions: This study provides added scientific evidence to support the efficacy of neutral
wrist splints in CTS and suggests that physiologic improvement is best with full-time
splint wear instructions. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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Article info
Publication history
Accepted:
July 28,
1999
Received in revised form:
July 28,
1999
Received:
March 22,
1999
Footnotes
☆No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
☆☆Reprint requests to William C. Walker, MD, 12807 Fox Meadow Drive, Richmond VA, 23233.
★Supplier
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© 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
