Biopsychosocial factors in carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity, causing disability, reducing quality of life and limiting daily activities and work capacity. The purpose of this thesis was to evaluate the role of psychological and social factors on physical and mental health outcomes in patients with CTS during the pre- and post-operative periods, and to determine the efficacy of adding a biopsychosocial approach to telerehabilitation in patients with CTS awaiting surgery. Study I: We conducted a systematic review and meta-analysis by systematically searching Embase, Pubmed/MEDLINE, Web of Science, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to 14 August 202. Two independent reviewers extracted data and assessed risk of bias. Random-effects models were used for meta-analysis. A total of fifteen studies involving 2599 patients were included. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes following surgery. Depressive symptoms, anxiety symptoms, catastrophic thinking and self-efficacy were important indicators of poor post-operative outcome. Study II: A cross-sectional study was conducted. Data were collected on the following social determinants of health: employment status, educational level and income. Physical activity level was defined in terms of compliance with WHO recommendations. A high level of physical activity was associated with a 12.41 mm decrease in pain intensity (β=-12.41, 95% CI: -23.87 to -0.95) and a 3.29 points decrease in depressive symptoms (β=-3.29, 95%CI: -5.52 to -1.06). In addition, being employed was associated with a 2.30 points decrease in anxiety symptoms (β=-2.30; 95%CI: -4.41 to -0.19) and a high educational level was associated with a 7.71 points decrease in catastrophizing (β=-7.71; 95%CI: -14.06 to -1.36). Study III: A single-blind randomised controlled trial was conducted. Twenty-five patients with CTS were allocated to either Pain Neuroscience Education (PNE) plus exercise or exercise alone. The PNE was conducted through an interactive video conference with visual support. The exercise program included aerobic exercise, digital flexor tendon gliding, neurodynamic exercises and stretching. A significant intergroup x time point interaction with a large effect size was observed for kinesiophobia (F=6.67, p=0.005, ηp2=0.225) and symptom severity (F=4.82, p=0.013, ηp2=0.173). In conclusión, preoperative assessment of psychosocial variables could help identify patients at risk of poor surgical outcomes and provide timely treatment. Additionally, these results highlight the benefits of incorporating a biopsychosocial approach into telerehabilitation interventions in patients with CTS.