Table.
GRADE evaluation of interventions for carpal tunnel syndrome
| Important outcomes | Symptoms of carpal tunnel syndrome, hand function, time to return to work, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of drug treatments for carpal tunnel syndrome? | |||||||||
| 4 (257) | Symptom severity | Local corticosteroid injection v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for use of an unvalidated outcome scale |
| 2 (97) | Symptom severity | Local corticosteroid injection v systemic corticosteroids | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and use of an unvalidated outcome scale |
| 2 (151) | Symptom severity | Local corticosteroid injection v carpal tunnel release surgery | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for sparse data. Consistency point deducted for conflicting results |
| 1 (50) | Hand function | Local corticosteroid injection v carpal tunnel release surgery | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 3 (90) | Symptom severity | Systemic corticosteroids v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (48) | Symptom severity | Systemic corticosteroids v NSAIDs | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (46) | Symptom severity | Systemic corticosteroids v diuretics | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (40) | Symptom severity | Systemic corticosteroids v splints | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and statistical flaws |
| 1 (40) | Hand function | Systemic corticosteroids v splints | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and statistical flaws |
| 2 (91) | Symptom severity | Diuretics v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and use of an unvalidated outcome scale |
| 1 (42) | Symptom severity | Diuretics v NSAIDs | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (45) | Symptom severity | NSAIDs v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (35) | Symptom severity | Pyridoxine v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and use of an unvalidated outcome scale |
| What are the effects of non-drug treatments for carpal tunnel syndrome? | |||||||||
| 4 (176) | Symptom severity | Nerve/tendon gliding exercise plus splint v splint alone | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for differences in intervention type and duration |
| 1 (176) | Hand function | Nerve/tendon gliding exercise plus splint v splint alone | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for differences in intervention type and duration |
| 1 (45) | Symptom severity | Therapeutic ultrasound v placebo | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, use of an unvalidated outcome scale, and statistical flaws |
| 1 (83) | Symptom severity | Wrist splint v no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 2 (198) | Symptom severity | Wrist splints v carpal tunnel surgery | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and methodological flaws |
| 1 (24) | Symptom severity | Full-time use of splint v nocturnal use alone | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and poor compliance with treatment |
| 1 (61) | Symptom severity | Neutral splint v cock-up splint | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and statistical flaws. Directness point deducted for use of co-interventions |
| What are the effects of surgical treatments for carpal tunnel syndrome? | |||||||||
| At least 13 RCTs (at least 1457 people) | Symptom severity | Endoscopic v open surgery | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for heterogeneity among studies |
| At least 6 RCTs ( at least 608 people) | Hand function | Endoscopic v open surgery | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for heterogeneity among studies |
| At least 15 RCTs (at least 1645 people) | Time to return to work | Endoscopic v open surgery | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for heterogeneity among studies |
| 3 (148) | Symptom severity | Internal neurolysis plus open carpal tunnel release v open carpal tunnel release alone | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for uncertainty about interventions |
| What are the effects of postoperative treatments for carpal tunnel syndrome? | |||||||||
| 1 (47) | Symptom improvement | Wrist splints after surgery v no movement restriction | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and poor follow-up. Directness point deducted for uncertain outcome measure |
| 1 (74) | Hand function | Wrist splints after surgery v no movement restriction | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (50) | Return to work | Wrist splints after surgery v no movement restriction | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
Type of evidence: 4 = RCT; 2 = Observational; 1 = Non-analytical/expert opinion. Consistency: similarity of results across studies. Directness: generalisability of population or outcomes. Effect size: based on relative risk or odds ratio.