The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis

Abstract

ABSTRACT Purpose To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). Methods Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. Results Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = −2.36, 95% CI −4.31 to −0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = −1.27 95% CI −1.60 to −0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. Conclusion Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.