FINCROSS: Effect of Night-time and Full-time Splinting for Carpal Tunnel Syndrome

Sponsor

Tampere University Hospital (Other)

Overall Status

Recruiting

CT.gov ID

NCT05637294

Collaborator

Terveystalo (Other)

110

Enrollment

Locations

Arms

Anticipated Duration (Months)

27.5

Patients Per Site

0.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Carpal tunnel syndrome is a common compression neuropathy of upper extremities. Its usual symptoms are pain, numbness and tingling of fingers, which tend to be worse at night. Splinting the wrist with an external orthosis is usually a first-line treatment provided to most people with mild to moderate disease.

The FINCROSS trial (randomized cross-over trial) aims to assess the effect of night-time and full-time splinting in comparison with no-treatment. It also aims to identify possible subgroups of people who would benefit from splinting, as well as assess if positive response to splinting is associated with subsequent lower need of surgery.

The trial will recruit 110 people with previously untreated carpal tunnel syndrome in Finland. Each participant will undergo all three treatment periods in a randomised order: 1) splinting at night-time for six weeks, 2) splinting both day and night for six weeks; and 3) be assessed under a six weeks long control period of no-treatment.

Each treatment period will be separated with a three-week washout period. Therefore, the whole treatment sequence for each participant lasts 24 weeks after randomization. The participant will be followed-up to 1 year after the randomisation.

Additionally, the participants will get instructions for self-administered stretching exercises to perform throughout the study. All participants will be asked to avoid any intervention administered or supervised by medical personnel (such as structured supervised exercises, manual therapy, steroid injections, surgery, etc.).

Condition or Disease	Intervention/Treatment	Phase
Carpal Tunnel Syndrome	Device: splinting	N/A

Study Design

Study Type:

Interventional

Anticipated Enrollment :

110 participants

Allocation:

Randomized

Intervention Model:

Crossover Assignment

Intervention Model Description:

Multicentre, three-treatment, three-period, randomised, crossover superiority trial (3 x 6 crossover design)Multicentre, three-treatment, three-period, randomised, crossover superiority trial (3 x 6 crossover design)

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Effect of Night-time and Full-time Splinting for Carpal Tunnel Syndrome: a Multi-center, Three-period, Randomized Cross-over Superiority Trial (FINCROSS - Finnish Crossover Trial for Carpal Tunnel Syndrome)

Anticipated Study Start Date :

Dec 1, 2022

Anticipated Primary Completion Date :

Dec 1, 2025

Anticipated Study Completion Date :

Dec 1, 2025

Arms and Interventions

Arm	Intervention/Treatment
Other: Sequence of three treatment periods in the following order: ABC Splinting at night while sleeping for 6 weeks (period A), then no treatment for 6 weeks (period B), then splinting at day and night for 6 weeks (period C). Each treatment period will be separated by 3-week washout period.	Device: splinting neutral-positioned wrist orthosis
Other: Sequence of three treatment periods in the following order: ACB Splinting at night while sleeping for 6 weeks (period A), then splinting at day and night for 6 weeks (period C), then no treatment for 6 weeks (period B). Each treatment period will be separated by 3-week washout period.	Device: splinting neutral-positioned wrist orthosis
Other: Sequence of three treatment periods in the following order: BAC No treatment for 6 weeks (period B), then splinting at night while sleeping for 6 weeks (period A), then splinting at day and night for 6 weeks (period C). Each treatment period will be separated by 3-week washout period.	Device: splinting neutral-positioned wrist orthosis
Other: Sequence of three treatment periods in the following order: BCA No treatment for 6 weeks (period B), then splinting at day and night for 6 weeks (period C), then splinting at night while sleeping for 6 weeks (period A). Each treatment period will be separated by 3-week washout period.	Device: splinting neutral-positioned wrist orthosis
Other: Sequence of three treatment periods in the following order: CAB Splinting at day and night for 6 weeks (period C), then splinting at night while sleeping for 6 weeks (period A), then no treatment for 6 weeks (period B). Each treatment period will be separated by 3-week washout period.	Device: splinting neutral-positioned wrist orthosis
Other: Sequence of three interventions/treatments in the following order: CBA Splinting at day and night for 6 weeks (period C), then no treatment for 6 weeks (period B), then splinting at night while sleeping for 6 weeks (period A). Each treatment period will be separated by 3-week washout period.	Device: splinting neutral-positioned wrist orthosis

Outcome Measures

Primary Outcome Measures

Change of The 6-item CTS Symptoms Scale scores between baseline and 6 weeks [6 weeks, i.e. end of each treatment period]
6-item CTS Symptoms Scale is a 6-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse symptoms. The study will use a Finnish version of The 6-item CTS Symptoms Scale.

Secondary Outcome Measures

Change of The 6-item CTS Symptoms Scale scores between baseline and 3 weeks [3 weeks, i.e. middle of each treatment period]
6-item CTS Symptoms Scale is a 6-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse symptoms. The study will use a Finnish version of The 6-item CTS Symptoms Scale.
Change of The 6-item CTS Symptoms Scale scores between baseline and 1 year [1 year]
6-item CTS Symptoms Scale is a 6-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse symptoms. The study will use a Finnish version of The 6-item CTS Symptoms Scale.
Change of The Boston Carpal Tunnel Questionnaire Symptom Severity Scale scores (BCTQ SSS) between baseline and 6 weeks of each treatment period [6 weeks, i.e. end of each treatment period]
BCTQ SSS is an 11-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse symptoms. The study will use a Finnish version of the BCTQ SSS.
Change of The Boston Carpal Tunnel Questionnaire Symptom Severity Scale scores (BCTQ SSS) between baseline and 1 year [1 year]
BCTQ SSS is an 11-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse symptoms. The study will use a Finnish version of the BCTQ SSS.
Change of The Boston Carpal Tunnel Questionnaire Functional Status Scale (BCTQ FSS) between baseline and 6 weeks of each treatment period [6 weeks, i.e. end of each treatment period]
BCTQ FSS is an 8-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse function. The study will use a Finnish version of the BCTQ FSS.
Change of The Boston Carpal Tunnel Questionnaire Functional Status Scale (BCTQ FSS) between baseline and 1 year [1 year]
BCTQ FSS is an 8-item questionnaire, with score from 1 to 5 to each of the item, higher score indicating worse function. The study will use a Finnish version of the BCTQ FSS.
Change of The Boston Carpal Tunnel Questionnaire (BCTQ) Total between baseline and 6 weeks [6 weeks, i.e. end of each treatment period]
BCTQ Total consists of BCTQ SSS and BCTQ FSS, with score from 1 to 5 to each of the item, higher score indicating worse function.
Change of The Boston Carpal Tunnel Questionnaire (BCTQ) Total between baseline and 1 year [1 year]
BCTQ Total consists of BCTQ SSS and BCTQ FSS, with score from 1 to 5 to each of the item, higher score indicating worse function.
Overall improvement as measured by 7-point Likert Scale [6 weeks, i.e. end of each treatment period]
7-point Likert Scale assesses the improvement of hand symptoms with 7 possible scores: much better, better, somewhat better, no changes, somewhat worse, worse, much worse.
Overall improvement as measured by 7-point Likert Scale [1 year]
7-point Likert Scale assesses the improvement of hand symptoms with 7 possible scores: much better, better, somewhat better, no changes, somewhat worse, worse, much worse.
Change of The EuroQol 5-dimension (EQ-5D-5L) Health Status and Quality-of-life Measure score between baseline and 6 weeks of each treatment period [6 weeks, i.e. end of each treatment period]
Finnish version of EQ-5D-5L will be used.
Change of The EuroQol 5-dimension (EQ-5D-5L) Health Status and Quality-of-life Measure score between baseline and 1 year [1 year]
Finnish version of EQ-5D-5L will be used.
Adverse effects [up to 1 year]
Assessed by participant self-reported adverse events.
Need for surgery [up to 1 year]
Assessed by participant self-reported information of referral to or executed surgery.
Escape treatments (e.g., corticosteroid injection or any other treatment supervised by medical personnel) [up to 1 year]
Assessed by participant self-reported information of undergoing or having undergone the escape treatment.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Clinically and electro-diagnostically confirmed carpal tunnel syndrome (CTS) of any severity level (diagnostic criteria: numbness, pain or paraesthesia in the median nerve distribution area of wrist and fingers; electrodiagnostic findings consistent with CTS: delayed motor or sensory latency, decreased conduction velocity, reduced amplitude of sensory nerve action potential),
Symptom duration of CTS for at least 3 weeks,
Treatment naive CTS,
Aged 18 years or older,
Able to complete self-report questionnaires electronically,
Able to understand Finnish,
Willing to join the study and follow the study protocol instructions,
Sign informed consent.

Exclusion Criteria:

Cervical radiculopathy,
Other neurological condition affecting the function of the hand such as Multiple Sclerosis, previous nerve injury,
Active Rheumatoid arthritis or any other active inflammatory joint disease affecting the hand,
Thenar muscle atrophy,
Hypothyroidism,
Known allergy to any of the splint materials (self-reported by patient),
Any other known reason that could prevent from participation for the study time.

Contacts and Locations

Locations

	Site	City	Country
1	Terveystalo Kamppi	Helsinki	Finland
2	Terveystalo Jyväskylä	Jyväskylä	Finland
3	Tampere University Hospital	Tampere	Finland
4	Terveystalo Tampere	Tampere	Finland