Juhi Singh et al., 2024: Commentary on: Preliminary study: efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome
Juhi Singh, Digvijay Sharma, Adarsh Kumar Srivastav
Department of Physiotherapy, School of Health Sciences, Chhatrapati Shahu Ji Maharaj University.
Abstract
No abstract available
PMID: 38860718 DOI: 10.2340/jrm.v56.40610 FREE ARTICLE
Comments 1
The commentary provides an appraisal of the study:
Vongvachvasin P, Phakdepiboon T, Chira-Adisai W, Siriratna P. Efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome: a preliminary study. J Rehabil Med 2024; 56: jrm13411.
that evaluates the effectiveness of focused extracorporeal shockwave therapy (ESWT) for carpal tunnel syndrome (CTS). The authors of the commentary commend the study for its valuable insights but highlight several methodological concerns.
Positive Points
The study showcases the promise of focused shockwave therapy as a non-invasive treatment option for moderate-to-severe CTS. It offers a viable alternative for patients unwilling or unable to undergo surgery, targeting nerve compression and tissue inflammation to improve hand function and alleviate symptoms.
Methodological Concerns
The lack of participant blinding in the study raises concerns about performance bias. Blinding is crucial for reducing bias and ensuring study validity. The study’s inclusion criteria lack specificity compared to the registered trial. Precise criteria are essential for validity and generalizability.
Discrepancies in the reported sample size and calculation method are noted. The commentary questions the reliability of the sample size determination and suggests conducting a post hoc analysis for more robust results.
The study’s calculated effect size of 0.56 suggests moderate clinical significance. However, the commentary calls for further post hoc analysis to understand the results comprehensively.
Recommendations
The commentary emphasizes the need for larger sample sizes and rigorous methodologies in future studies to confirm the findings and improve the understanding of ESWT’s efficacy and safety.
Response of the authors to the critiques
The authors acknowledge the importance of blinding but explain the practical challenges in implementing it, such as the lack of sham ESWT instruments in Thailand. They were unaware of alternative methods at the time.
The authors clarify their sample size calculation, considering constraints like funding and participant availability. They used a clinical superiority formula and aimed for a minimal clinically important difference, resulting in a small sample size.
Conclusion
The authors recognize the study’s limitations, such as the lack of blinding and small sample size. They view the study as preliminary and beneficial in providing initial evidence on ESWT’s potential for CTS.
They agree on the necessity of further studies with larger sample sizes to validate the preliminary findings and enhance the clinical application of ESWT in CTS.
While the study on focused shockwave therapy for CTS is promising, it has methodological limitations, including lack of blinding and small sample size. Both the commentary and the authors acknowledge these issues, highlighting the need for future research to confirm the therapy’s effectiveness and safety in managing CTS
Jens Rassweiler