{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T22:03:21Z","timestamp":1787090601313,"version":"build-2736575974"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T00:00:00Z","timestamp":1645488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from a randomized clinical trial (n\u2009=\u2009104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Manual physical therapy improved function in women with CTS (between-groups difference:\u00a00.09; 95% CI\u2009=\u20090.07 to 0.11). The Bayesian network showed that early improvements (at 1\u00a0month) in function and symptom severity led to long-term (at 12\u00a0months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI\u2009=\u20090.11 to 0.17 point) poorer function at 12\u00a0months than those with mild CTS and 0.12-point (95% CI\u2009=\u20090.09 to 0.15 point) poorer function at 12\u00a0months than those with severe CTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy\/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzac015","type":"journal-article","created":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T12:08:13Z","timestamp":1645099693000},"source":"Crossref","is-referenced-by-count":4,"title":["Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial"],"prefix":"10.1093","volume":"102","author":[{"given":"Bernard X W","family":"Liew","sequence":"first","affiliation":[{"name":"School of Sport , Rehabilitation and Exercise Sciences, , Colchester, United Kingdom"},{"name":"University of Essex , Rehabilitation and Exercise Sciences, , Colchester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana I","family":"de-la-Llave-Rinc\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy , Occupational Therapy, Rehabilitation and Physical Medicine, , Alcorc\u00f3n, Spain"},{"name":"Universidad Rey Juan Carlos , Occupational Therapy, Rehabilitation and Physical Medicine, , Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Scutari","sequence":"additional","affiliation":[{"name":"Istituto Dalle Molle di Studi Sull\u2019Intelligenza Artificiale (IDSIA) , Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L","family":"Arias-Bur\u00eda","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy , Occupational Therapy, Rehabilitation and Physical Medicine, , Alcorc\u00f3n, Spain"},{"name":"Universidad Rey Juan Carlos , Occupational Therapy, Rehabilitation and Physical Medicine, , Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad E","family":"Cook","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program, Duke University , Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Cleland","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program , Department of Public Health and Community Medicine, , Boston, Massachusetts, USA"},{"name":"Tufts University School of Medicine , Department of Public Health and Community Medicine, , Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar","family":"Fern\u00e1ndez-de-las-Pe\u00f1as","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy , Occupational Therapy, Rehabilitation and Physical Medicine, , Alcorc\u00f3n, Spain"},{"name":"Universidad Rey Juan Carlos , Occupational Therapy, Rehabilitation and Physical Medicine, , Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,2,22]]},"reference":[{"key":"2023011809035974900_ref1","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1016\/j.apmr.2014.06.022","article-title":"Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline: results from the European HANDGUIDE study","volume":"95","author":"Huisstede","year":"2014","journal-title":"Arch Phys Med 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