Effects of cognitive and mental health factors on the outcomes following carpal tunnel release: A systematic review and meta-analysis

Arch Phys Med Rehabil. 2021 Nov 30:S0003-9993(21)01602-6. doi: 10.1016/j.apmr.2021.10.026. Online ahead of print.


OBJECTIVE: To determine the effects of the cognitive and mental health factors on the outcomes following carpal tunnel release (CTR).

DATA SOURCES: Embase, Pubmed/MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to August 14, 2021.

STUDY SELECTION: Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia and self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least three months post-CTR.

DATA EXTRACTION: Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis.

DATA SYNTHESIS: A total of fifteen studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes following CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n = 531, r = 0.347, 95% CI = 0.205 to 0.475, p = <0.0001), function (n = 386, r = 0.307, 95% CI = 0.132 to 0.464, p = 0.0008), and pain (n = 344, r = 0.431, 95% CI = 0.286 to 0.558, p = <0.0001). In general, the risk of bias in the included studies was low.

CONCLUSIONS: This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor post-surgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.

PMID:34861234 | DOI:10.1016/j.apmr.2021.10.026

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