POS1454 NEUROPLASTICITY STIMULATION-BASED REHABILITATION IMPROVES PAIN AND HAND FUNCTIONALITY IN PATIENTS DIAGNOSED WITH CARPAL TUNNEL SYNDROME: A PILOT STUDY

Abstract

BackgroundCarpal tunnel syndrome (CTS) is the most commonly diagnosed entrapment neuropathy, characterized by sensory and motor disorders. Physiotherapy interventions based on neuroplasticity stimulation, such as mirror therapy (MT) and cross-education (CE) have been demonstrated effective in pain and impaired function. In those therapies, mirror neurons that are activated when observing an action are considered the possible underlying neural mechanism, creating organized new pathways between two cerebral hemispheres and enabling brain plasticity. However, MT and CE effects have not been widely studied on unilateral CTS.ObjectivesTo analyze the effectiveness of MT and CE rehabilitation protocols in a sample of patients with CTS on pain intensity and functionality.MethodsA randomized-controlled trial was conducted. Subjects diagnosed with unilateral CTS were enrolled in this study. MT group (MTG) (N=9) performed a rehabilitation protocol consisting of six-weeks of MT training, five days/week. The healthy hand was trained in front of a mirror placed in the middle of the body, while the affected hand was hidden and quiet on the opposite side. CE group (CEG) (N=10) intervention was designed to perform the same training protocol, but without a mirror. Thus, the difference between interventions was the use of the mirror. Training consisted of mobility, strength and functional exercises. Minimum, maximum and average perceived pain were assessed through Visual analog scale (VAS), and upper limb function through Quick-DASH, before and after the intervention. Regarding statistical analyses, a two-factor mixed multivariate analysis of variance (MANOVA) was carried out with a between-subjects factor “treatment group” (MTG and CEG) and a within-subject factor “time measuremets” (pre and post-intervention) for all variables. (Clinical trial Id: NCT05115396).ResultsNineteen participants (4 men and 15 women) between 30 and 60 years were included in the study. There were no statistically significant differences between groups at the beginning of the study. After treatment, there was a significant decrease in maximum pain (p<0.05), minimum pain (p<0.05) and average pain (p<0.05) of the affected hand in both groups, being larger the experienced changes of the MTG compared to that of the CEG (Table 1). Regarding hand functionality, both groups significantly improved compared with baseline (p<0.01). This study suggests that activation of mirror neurons either by MT or CE, is effective on hand pain and functionality in people with unilateral CTS.Table 1.Pre and post-intervention results on pain and functionality.GroupNPre-treatmentPost-treatmentVAS maximumMTG94.22 (2.64)2.11 (2.26)*CEG104.70 (2.87)2.80 (2.15)*VAS minimumMTG92.22 (2.22)0.33 (0.50)*CEG102.50 (2.64)0.90 (1.10)*VAS meanMTG93.22 (2.44)1.56 (1.59)*CEG103.80 (2.82)2.20 (1.75)*Quick-DASHMTG934.35 (21.36)23.74 (21.71)**CEG1031.14 (26.48)19.77 (19.87)**Data are shown as mean (SD). MTG: Mirror Therapy Group; CEG: Cross-education Group; VAS: Visual Analog Scale; *: p-value <0.05 between pre and post-intervention; **p-value <0.01 between pre and post-intervention.ConclusionNeuroplasticity stimulation-based rehabilitation, using a MT protocol or a CE protocol, improves pain and functionality in patients with unilateral CTS.