Chesterton, L ORCID: https://orcid.org/0000-0002-1639-4441, Bucknall, M, Burton, CL ORCID: https://orcid.org/0000-0003-4688-3075, Dziedzic, KS ORCID: https://orcid.org/0000-0002-1168-8993, Davenport, G ORCID: https://orcid.org/0000-0001-8181-7060, Jowett, S, Myers, H, Oppong, R, Rathod-Mistry, T ORCID: https://orcid.org/0000-0002-6369-4746, van der Windt, DA ORCID: https://orcid.org/0000-0002-7248-6703, Hay, EM ORCID: https://orcid.org/0000-0002-9545-4296 and Roddy, E ORCID: https://orcid.org/0000-0001-8699-0735 (2018) The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. The Lancet, 392 (10156). 1423 - 1433.

[img]
Preview
Text
E Roddy - The clinical and cost-effectiveness....pdf - Published Version
Available under License Creative Commons Attribution.

Download (467kB) | Preview

Abstract

Background
To our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.

Methods
We did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452.

Findings
Between April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference −0·32; 95% CI −0·48 to −0·16; p=0·0001). No adverse events were reported.

Interpretation
A single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.

Item Type: Article
Additional Information: © 2018 The Author(s). Published by Elsevier Ltd.
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 24 Oct 2018 12:01
Last Modified: 05 Mar 2019 15:55
URI: http://eprints.keele.ac.uk/id/eprint/5455

Actions (login required)

View Item View Item