Critical Appraisal Assignment
Effect of Splinting and Exercise on Intraneural Edema of the Median Nerve in Carpal Tunnel Syndrome – An MRI Study to Reveal Therapeutic Mechanisms
Student ID: 400042610 Course: PT611
Instructor: Professor Graham
Date: Monday October 5, 2015
PICO QUESTION
The study question developed using the PICO method to aid in the article search was: “In adults with carpal tunnel syndrome (CTS) do gliding exercises (GE) reduce pain and symptomatology in patients compared to night splinting (NS)?” The targeted population was adults with CTS, with comparisons of NS and GE interventions, and an outcome interest of pain and symptoms.
IDENTIFICATION OF A JOURNAL ARTICLE
The article Effect of splinting and …show more content…
Patients were measured three times during the stud: baseline, 10 minutes after treatment, and 1 week after treatment with the primary outcome measure (OM) of Magnetic Resonance Imaging (MRI) measuring median nerve signal intensity and palmar bowing of ligaments. At baseline and after 1 week of treatment, patients were also measured with the secondary OMs of Boston Carpal Tunnel questionnaire (BCCQ), Patient Specific Functional Scale (PSFS), and Visual Analogue (VAS) scales for pain and numbness to detect true changes in symptoms. Patients in the GE group received home exercises from a physiotherapist that were found to be appropriate for CTS in a prerequisite study1 the authors mentioned. Patients completed 10 repetitions of each exercise 10 times per day. Patients in the NS group wore a splint at night for the treatment …show more content…
STRENGTHS AND LIMITATIONS OF OUTCOME MEASURES
The secondary OMs were strong in that each have high validity and reliability while able to detect true change in symptoms. Limitations were found in the primary OM because the use and validity of the MRI method was based on one prerequisite study testing median nerve signal intensity changes in CTS patients without treatment for one week. No psychometric properties were listed so it was unclear if the OM was reliable or valid. Also, this method is not standardized and despite a post-hoc test for reliability, there is still potential interpretation error.
The time points chosen, specifically the 10 minutes and 1 week after treatment marks, limit the article more because no justification was given for clinical relevance. It is hard to understand applying OMs at time points that are not significant in recovery for CTS patients. In addition, the treatment duration was not realistically long enough to determine actual effects of treatments on both OMs. There was no logic provided that results obtained would have clinical or therapeutic significance because the reason for a short duration was the exclusion of the chronic nature of CTS as a confounding variable. However, not only did authors find both groups to be statistically comparable so the confounding variable effects would have been null, they also failed to recognize the reality associated with treatments: the condition is always a variable. Therefore, the article needed further
Effect of Splinting and Exercise on Intraneural Edema of the Median Nerve in Carpal Tunnel Syndrome – An MRI Study to Reveal Therapeutic Mechanisms
Student ID: 400042610 Course: PT611
Instructor: Professor Graham
Date: Monday October 5, 2015
PICO QUESTION
The study question developed using the PICO method to aid in the article search was: “In adults with carpal tunnel syndrome (CTS) do gliding exercises (GE) reduce pain and symptomatology in patients compared to night splinting (NS)?” The targeted population was adults with CTS, with comparisons of NS and GE interventions, and an outcome interest of pain and symptoms.
IDENTIFICATION OF A JOURNAL ARTICLE
The article Effect of splinting and …show more content…
Patients were measured three times during the stud: baseline, 10 minutes after treatment, and 1 week after treatment with the primary outcome measure (OM) of Magnetic Resonance Imaging (MRI) measuring median nerve signal intensity and palmar bowing of ligaments. At baseline and after 1 week of treatment, patients were also measured with the secondary OMs of Boston Carpal Tunnel questionnaire (BCCQ), Patient Specific Functional Scale (PSFS), and Visual Analogue (VAS) scales for pain and numbness to detect true changes in symptoms. Patients in the GE group received home exercises from a physiotherapist that were found to be appropriate for CTS in a prerequisite study1 the authors mentioned. Patients completed 10 repetitions of each exercise 10 times per day. Patients in the NS group wore a splint at night for the treatment …show more content…
STRENGTHS AND LIMITATIONS OF OUTCOME MEASURES
The secondary OMs were strong in that each have high validity and reliability while able to detect true change in symptoms. Limitations were found in the primary OM because the use and validity of the MRI method was based on one prerequisite study testing median nerve signal intensity changes in CTS patients without treatment for one week. No psychometric properties were listed so it was unclear if the OM was reliable or valid. Also, this method is not standardized and despite a post-hoc test for reliability, there is still potential interpretation error.
The time points chosen, specifically the 10 minutes and 1 week after treatment marks, limit the article more because no justification was given for clinical relevance. It is hard to understand applying OMs at time points that are not significant in recovery for CTS patients. In addition, the treatment duration was not realistically long enough to determine actual effects of treatments on both OMs. There was no logic provided that results obtained would have clinical or therapeutic significance because the reason for a short duration was the exclusion of the chronic nature of CTS as a confounding variable. However, not only did authors find both groups to be statistically comparable so the confounding variable effects would have been null, they also failed to recognize the reality associated with treatments: the condition is always a variable. Therefore, the article needed further