The effect of education, diacutaneous fibrolysis, and self-mobilization on sleep quality in patients with carpal tunnel syndrome waiting for surgery: A randomized controlled trial.

Background: Carpal tunnel syndrome (CTS) patients experience a wide range of sleep complaints. However, little evidence exists on how conservative treatment can improve sleep quality in these patients.

Purpose: To determine the effectiveness of a multimodal physiotherapy approach based on sleep symptoms and quality in patients suffering from CTS included in a surgery waiting list.

Study design: A randomized controlled trial.

Methods: CTS patients included in surgical waiting list of Spanish Public Health System were recruited. Patients were randomized into an education, diacutaneous fibrolysis, and self-mobilization treatment over 3 weeks (n = 20) or a control group (n = 22). Nocturnal symptoms, Medical Outcome Study Sleep Scale, Boston Carpal Tunnel Questionnaire, and sensitivity of the hand were assessed after treatment, at 3- and 6-months follow-up. A general linear model of repeated measures was performed.

Results: Nocturnal symptoms (p < 0.1; d = 1.0-1.5) and Boston Carpal Tunnel Questionnaire (p = 0.01; d = 1.0-1.1) were improved in favor of intervention group at each follow-up. Also, sensitivity of the first three fingers showed better results for intervention group at 3- (p = 0.021; d = 0.5) and 6-months (p = 0.036; d = 0.8) follow-up. Five of the eight items in the Medical Outcome Study Sleep Scale reported significant differences at 6-month against the control group (p < 0.1). There was a significant increase in the amount of sleep in the intervention group (p = 0.006; d = 0.7). Finally, physical activity and splint influenced the results of nocturnal symptoms and awaken short of breath and headache.

Conclusions: Education, diacutaneous fibrolysis, and self-mobilization may improve night-time symptoms and sleep quality in CTS patients awaiting surgery. Patients included were mainly severe, had associated comorbidities, and under-represented patients in conservative treatment studies.