Treatment Efficacy of OMT for Carpal Tunnel Syndrome - Full Text View

Purpose

This study investigated whether an eight-week regimen of osteopathic manipulative treatment would have immediate and lasting positive effects on the symptoms, functional limitation and physiologic impairment associated with Carpal Tunnel Syndrome.

Condition	Intervention	Phase
Carpal Tunnel Syndrome	Procedure: Osteopathic Manipulative Treatment Procedure: Placebo Sub-Therapeutic Ultrasound	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Participant, Care Provider, Outcomes Assessor Primary Purpose: Treatment
Official Title:	Treatment Efficacy of OMT for Carpal Tunnel Syndrome

Resource links provided by NLM:

MedlinePlus related topics: Carpal Tunnel Syndrome

Genetic and Rare Diseases Information Center resources: Charcot-Marie-Tooth Disease Hereditary Neuropathy With Liability to Pressure Palsy Roussy Levy Syndrome

U.S. FDA Resources

Further study details as provided by University of North Texas Health Science Center:

Primary Outcome Measures:

Changes in the Median motor and sensory distal latencies.
Improvement in the patients'self-reported symptoms and functionality scores.

Secondary Outcome Measures:

Strength measured with one grip and three pinch strength tests.
Changes in sensation as measured by Current Perceptual Threshold.
Changes in the transverse and anterior/posterior interior diameters and cross-sectional areas of the carpal tunnel.
Carpal tunnel edema.


Enrollment:	138
Study Start Date:	October 2006
Study Completion Date:	October 2009
Primary Completion Date:	October 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Osteopathic Manipulative Treatment A protocol of specific osteopathic manipulative techniques was applied.	Procedure: Osteopathic Manipulative Treatment A protocol of specific Osteopathic manipulative techniques was used.
Placebo Comparator: Placebo ultrasound Sub-therapeutic ultrasound was applied.	Procedure: Placebo Sub-Therapeutic Ultrasound Sub-therapeutic ultrasound was applied in a standardized method.
No Intervention: Standard Medical care Subjects did not receive either study treatment, but continued to receive standard medical care.

Detailed Description:

The incidence of Carpal Tunnel Syndrome (CTS) in adults in the U.S. ranges from 15-20% depending on the study, and costs over one billion dollars annually in medical care. Surgery for CTS accounts for much of these costs with up to one third of these patients experiencing re-occurrence of symptoms post-operatively.

The overall goal for this proposed exploratory clinical trial was to evaluate the efficacy of a conservative, manual medicine treatment as an adjunctive therapy to standard care for CTS. This pilot study utilized a prospective, randomized, placebo-controlled clinical trial methodology to examine whether an eight week treatment regimen of osteopathic manipulative treatment (OMT) when used adjunctively to standard therapy would have immediate and lasting positive effects on the symptoms, functional limitations, and physiologic impairment associated with CTS.

Male and female subjects between the ages of 20 and 65 who meet electro-physiologic and symptom/functional inclusion criteria were randomly assigned to one of three study groups, all of which will continue standard medical care with their treating physician/provider; (i) OMT plus standard medical care; (ii) placebo (sub-therapeutic ultrasound) plus standard medical care; and (iii) standard medical care only (no-treat).

Outcome measures were: 1. Median and Ulnar motor and sensory nerve conduction amplitudes and distal latencies, 2. Symptoms and Functional status, 3. Strength, 4. Sensation, 5. Interior dimensions of the carpal tunnel, and 6. Quantification (signal intensity by MRI) of water (edema) in the Median nerve and carpal tunnel. Placebo potency and blinding success will be evaluated. A preliminary investigation demonstrated our ability to recruit subjects and measure these outcomes. Power analysis based upon a decrease in the mean median motor nerve distal latency of 30% identified a minimum number of 42 subjects per treatment group.

It was expected that a significantly greater number of subjects in the OMT adjunctive treatment group would achieve the effective change in nerve latency compared to the other two treatment groups. It was also expected that the OMT adjunctive treatment group would have greater improvement of all physiological and clinical outcome measures than the other two groups.

Eligibility


Ages Eligible for Study:	21 Years to 65 Years (Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Men and women with a self-reported medical diagnosis of unilateral or bilateral CTS, between the ages of 21 and 65 and all races and ethnic groups.
Median motor nerve distal latency greater than 4.2 ms
A difference between ipsilateral Median and Ulnar motor nerve distal latency greater than 1.5 ms.
Median nerve sensory nerve distal latency greater than 2.2 ms
A difference between Median and Ulnar sensory nerve peak distal latency greater than 0.2 ms

Exclusion Criteria:

severe CTS that has progressed to muscle atrophy
pregnancy
previous wrist surgery on the wrist to be studied
systemic disease or condition including but not limited to diabetes mellitus, thyroid disorders, rheumatoid disorders, Paget's bone disease, gout, myxedema, multiple myeloma, acromegaly, hepatic disease, dialysis patients, or other diseases or conditions in which peripheral neuropathies are common.
secondary cause of CTS such as a ganglion cyst, mass, or an accessory muscle shown by an MRI exam of the wrist.

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00394043

Sponsors and Collaborators

University of North Texas Health Science Center

Osteopathic Research Center

Investigators


Principal Investigator:	Scott T Stoll, D.O., Ph.D.	Osteopathic Research Center University of North Texas Health Science Center

More Information


ClinicalTrials.gov Identifier:	NCT00394043 History of Changes
Other Study ID Numbers:	1R21AT002303-01A2 ( U.S. NIH Grant/Contract )
Study First Received:	October 27, 2006
Last Updated:	March 14, 2017

Keywords provided by University of North Texas Health Science Center:


Carpal Tunnel Sydrome Osteopathic Manipulative Treatment Osteopathic Manipulative Medicine Physical Medicine

Additional relevant MeSH terms:


Carpal Tunnel Syndrome Syndrome Disease Pathologic Processes Median Neuropathy Mononeuropathies Peripheral Nervous System Diseases	Neuromuscular Diseases Nervous System Diseases Nerve Compression Syndromes Cumulative Trauma Disorders Sprains and Strains Wounds and Injuries

ClinicalTrials.gov processed this record on July 21, 2017