Burton, CL ORCID: https://orcid.org/0000-0003-4688-3075, Rathod-Mistry, T ORCID: https://orcid.org/0000-0002-6369-4746, Blackburn, SJ ORCID: https://orcid.org/0000-0002-2629-3126, Blagojevic-Bucknall, M ORCID: https://orcid.org/0000-0001-7230-7771, Chesterton, L ORCID: https://orcid.org/0000-0002-1639-4441, Davenport, G ORCID: https://orcid.org/0000-0001-8181-7060, Dziedzic, KS ORCID: https://orcid.org/0000-0002-1168-8993, Higginbottom, A, Jowett, S ORCID: https://orcid.org/0000-0001-8936-3745, Myers, H ORCID: https://orcid.org/0000-0002-4004-6615, Oppong, R ORCID: https://orcid.org/0000-0002-0815-4616, 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/0000-0002-8954-7082 (2022) The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial. Rheumatology.

[img] Text
Rheumatology_Instincts_accepted version.docx - Accepted Version

Download (241kB)

Abstract

Objectives
This follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate carpal tunnel syndrome (CTS) on symptoms, resource use, and carpal tunnel surgery, over 24 months.

Methods
Adults with mild-to-moderate CTS were randomised 1:1 to a local corticosteroid injection or a night splint worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery, and healthcare utilisation. A cost-utility analysis was conducted.

Results
116 participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly (mean difference £68o59 (95% CI: -120·84, 291·24)) with fewer quality-adjusted life-years (QALYs) than NS over 24 months (mean difference -0·022 (95% CI: (-0·093, 0·045)).

Conclusion
Over 24 months, surgical intervention rates were low in both groups, but less frequent in the NS group. Whilst there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS.

Item Type: Article
Additional Information: © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, [br]distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Uncontrolled Keywords: carpal tunnel syndrome; clinical trial; primary care
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RM Therapeutics. Pharmacology
R Medicine > RM Therapeutics. Pharmacology > Physical medicine. Physical therapy. Including massage, exercise, occupational therapy, hydrotherapy, phototherapy, radiotherapy, thermotherapy, electrotherapy
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 11 Apr 2022 11:58
Last Modified: 09 Jun 2022 13:38
URI: https://eprints.keele.ac.uk/id/eprint/10824

Actions (login required)

View Item View Item