Before going straight to surgery for carpal tunnel syndrome, consider manual physical therapy, including desnensitization maneuvers. This treatment has been found to be equally effective but less costly than surgery for women with carpal tunnel syndrome. ~ Dr. Broussard
Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial
Published: Journal of Orthopaedic & Sports Physical Therapy, 2018 Volume:49 Issue:2 Pages:55–63 DOI: 10.2519/jospt.2019.8483
Background
Carpal tunnel syndrome (CTS) results in substantial societal costs and can be treated either by nonsurgical or surgical approaches.
Objective
To evaluate differences in cost-effectiveness of manual physical therapy versus surgery in women with CTS.
Methods
In this randomized clinical trial, 120 women with a clinical and an electromyographic diagnosis of CTS were randomized through concealed allocation to either manual physical therapy or surgery. Interventions consisted of 3 sessions of manual physical therapy, including desensitization maneuvers of the central nervous system, or decompression/release of the carpal tunnel. Societal costs and health-related quality of life (estimated by the European Quality of Life-5 Dimensions [EQ-5D] scale) over 1 year were used to generate incremental cost per quality-adjusted life year ratios for each treatment.
Results
The analysis was possible for 118 patients (98%). Incremental quality-adjusted life years showed greater cost-effectiveness in favor of manual physical therapy (difference, 0.135; 95% confidence interval: 0.134, 0.136). Manual therapy was significantly less costly than surgery (mean difference in cost per patient, €2576; P<.001). Patients in the surgical group received a greater number of other treatments and made more visits to medical doctors than those receiving manual physical therapy (P = .02). Absenteeism from paid work was significantly higher in the surgery group (P<.001). The major contributors to societal costs were the treatment protocol (surgery versus manual therapy mean difference, €106 980) and absenteeism from paid work (surgery versus manual physical therapy mean difference, €42 224).
Conclusion
Manual physical therapy, including desensitization maneuvers of the central nervous system, has been found to be equally effective but less costly (ie, more cost-effective) than surgery for women with CTS. From a cost-benefit perspective, the proposed CTS manual physical therapy intervention can be considered.
Level of Evidence
Economic and decision analyses, level 1b. J Orthop Sports Phys Ther 2019;49(2):55–63. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8483