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Editor's Choice | This Week in BMJ | Press releases
BMJ No 7133 Volume 316 Papers - Abstracts Saturday 7 March 1998
Ultrasound treatment for treating the carpal tunnel syndrome:
randomised "sham" controlled trial
Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trialGerold R Ebenbichler, Karl L Resch, Peter Nicolakis, Günther F Wiesinger, Frank Uhl, Abdel-Halim Ghanem, Veronika Fialka
AbstractObjective: To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome. Design: Randomised, double blind, "sham" controlled trial with assessments at baseline, after 2 weeks' and 7 weeks' treatment, and at a follow up assessment 6 months later (8 months after baseline evaluation). Setting: Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna. Subjects: 45 patients with mild to moderate bilateral carpal tunnel syndrome as verified by electroneurography. Intervention: 20 sessions of ultrasound (active) treatment (1 MHz, 1.0 W/cm2, pulsed mode 1:4, 15 minutes per session) applied to the area over the carpal tunnel of one wrist, and indistinguishable sham ultrasound treatment applied to the other. The first 10 treatments were performed daily (5 sessions/week); 10 further treatments were twice weekly for 5 weeks. Main outcome measures: Score of subjective symptom ratings assessed by visual analogue scale; electroneurographic measures (for example, motor distal latency and sensory antidromic nerve conduction velocity). Results: Improvement was significantly more pronounced in actively treated than in sham treated wrists for both subjective symptoms (P<0.001, paired t test) and electroneurographic variables (motor distal latency P<0.001, paired t test; sensory antidromic nerve conduction velocity P<0.001, paired t test). Effects were sustained at 6 months' follow up. Conclusion: Results suggest there are satisfying short to medium term effects due to ultrasound treatment in patients with mild to moderate idiopathic carpal tunnel syndrome. Findings need to be confirmed, and ultrasound treatment will have to be compared with standard conservative and invasive treatment options. Department of Physical Medicine and
Rehabilitation, Department of
Complementary Medicine, Department of Neurology,
Correspondence to: Dr Ebenbichler
Design: Stratified random sample representative of
the general population aged 18 and over and living in the community.
Setting: United Kingdom.
Subjects: 3,395 people resident in the United Kingdom.
Main outcome measures: Average values for mobility,
self care, usual activities, pain or discomfort, and anxiety or
depression.
Results: One in three respondents reported problems
with pain or discomfort. There were differences in the perception of
health according to the respondent's age, social class, education,
housing tenure, economic position, and smoking behaviour.
Conclusions: The EQ-5D questionnaire is a
practical way of measuring the health of a population and of detecting
differences in subgroups of the population.
Centre for Health Economics,
Correspondence to: Dr Kind pk1@york.ac.uk
Design: Cross sectional ecological study based on
rates of use of eight cardiovascular drug groups by outpatients. A
population based cohort study including users of drugs to control
hypertension.
Subjects: The ecological study included 152 of
Sweden's 284 municipalities. The cohort study included all inhabitants
of one Swedish municipality who during 1988 or 1989 had purchased
cardiovascular agents from pharmacies within the municipality. Six
hundred and seventeen subjects (18.2%) were classified as users of
calcium channel blockers and 2780 (81.8%) as non-users.
Main outcome measures: Partial correlations (least
squares method) between rates of use of cardiovascular drugs and age
standardised mortality from suicide in Swedish municipalities. Hazard
ratios for risk of suicide with adjustments for difference in age and
sex in users of calcium channel blockers compared with users of other
hypertensive drugs.
Results: Among the Swedish municipalities the use of
each cardiovascular drug group except angiotensin converting enzyme
inhibitors correlated significantly and positively with suicide rates.
After adjustment for the use of other cardiovascular drug groups, as a
substitute for the prevalence of cardiovascular morbidity, only the
correlation with calcium channel blockers remained significant
(r=0.29, P<0.001). In the cohort study, five users and
four non-users of calcium channel blockers committed suicide during the
follow up until the end of 1994. The absolute risk associated with use
of calcium channel blockers was 1.1 suicides per 1000 person years. The
relative risk, adjusted for differences in age and sex, among users
versus non-users was 5.4 (95% confidence interval 1.4 to 20.5).
Conclusions: Use of calcium channel blockers may
increase the risk of suicide.
Swedish Network for Pharmaco-
epidemiology,
Correspondence to: Dr Lindberg
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