The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial

Claire Burton; Trishna Rathod-Mistry; Steven Blackburn; Milica Blagojevic-Bucknall; Linda S. Chesterton; Graham Davenport; Krysia Dziedzic; Adele  Higginbottom; Sue Jowett; Helen Myers; Raymond Oppong; Danielle van der Windt; Elaine Hay; Edward Roddy

doi:10.1093/rheumatology/keac219

The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial

Claire Burton^*, Trishna Rathod-Mistry, Steven Blackburn, Milica Blagojevic-Bucknall, Linda S. Chesterton, Graham Davenport, Krysia Dziedzic, Adele Higginbottom , Sue Jowett, Helen Myers, Raymond Oppong, Danielle van der Windt, Elaine Hay, Edward Roddy

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Article number	keac219
Number of pages	9
Journal	Rheumatology
Volume	62
Issue number	2
Early online date	8 Apr 2022
DOIs	https://doi.org/10.1093/rheumatology/keac219
Publication status	Published - Feb 2023

Keywords

Carpal tunnel syndrome
clinical trial
primary care

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Burton, C., Rathod-Mistry, T., Blackburn, S., Blagojevic-Bucknall, M., Chesterton, L. S., Davenport, G., Dziedzic, K., Higginbottom , A., Jowett, S., Myers, H., Oppong, R., van der Windt, D., Hay, E., & Roddy, E. (2023). The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial. Rheumatology, 62(2), Article keac219. https://doi.org/10.1093/rheumatology/keac219

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title = "The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial",

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.",

keywords = "Carpal tunnel syndrome, clinical trial, primary care",

author = "Claire Burton and Trishna Rathod-Mistry and Steven Blackburn and Milica Blagojevic-Bucknall and Chesterton, {Linda S.} and Graham Davenport and Krysia Dziedzic and Adele Higginbottom and Sue Jowett and Helen Myers and Raymond Oppong and {van der Windt}, Danielle and Elaine Hay and Edward Roddy",

year = "2023",

month = feb,

doi = "10.1093/rheumatology/keac219",

language = "English",

volume = "62",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "2",

}

Burton, C, Rathod-Mistry, T, Blackburn, S, Blagojevic-Bucknall, M, Chesterton, LS, Davenport, G, Dziedzic, K, Higginbottom , A, Jowett, S, Myers, H, Oppong, R, van der Windt, D, Hay, E & Roddy, E 2023, 'The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial', Rheumatology, vol. 62, no. 2, keac219. https://doi.org/10.1093/rheumatology/keac219

TY - JOUR

T1 - The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome

T2 - 24-month follow-up of a randomised trial

AU - Burton, Claire

AU - Rathod-Mistry, Trishna

AU - Blackburn, Steven

AU - Blagojevic-Bucknall, Milica

AU - Chesterton, Linda S.

AU - Davenport, Graham

AU - Dziedzic, Krysia

AU - Higginbottom , Adele

AU - Jowett, Sue

AU - Myers, Helen

AU - Oppong, Raymond

AU - van der Windt, Danielle

AU - Hay, Elaine

AU - Roddy, Edward

PY - 2023/2

Y1 - 2023/2

N2 - 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.

AB - 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.

KW - Carpal tunnel syndrome

KW - clinical trial

KW - primary care

U2 - 10.1093/rheumatology/keac219

DO - 10.1093/rheumatology/keac219

M3 - Article

SN - 1462-0324

VL - 62

JO - Rheumatology

JF - Rheumatology

IS - 2

M1 - keac219

ER -

The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomised trial

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