Supervised Versus Home Therapy

Routine post-operative therapy after carpal tunnel release was examined in 6 high and moderate quality studies. From these, two moderate quality studies (Hochberg 2001 and Jerosch-Herold 2012) addressed interventions not relevant to current core practices of postoperative rehabilitation. Two high quality studies (Fagan 2004, Pomerance 2007) and two moderate quality studies (Alves 2011, and Provinciali 2000) addressed the need for supervised therapy in addition to a home program in the early postoperative period, the early use of laser, or the role of sensory reeducation in the later stages of recovery.

One moderate quality study (Alves 2011) evaluated the use of laser administered to the carpal tunnel in 10 daily consecutive sessions at a 3J dosage and found no difference in pain/symptom reoccurrence in comparison to placebo.
 
One high quality study (Pomerance 2007) and one moderate quality study (Provinciali 2000) compared in-clinic or therapist supervised exercise programs in addition to a home program to a home program alone. The studies were somewhat limited by an incomplete description of who delivered home programs, exercise/education content and dosage, and treatment progression. Pomerance (2007) compared a two week program directed by a therapist combined with a home program alone and found no additional benefit in terms of grip or pinch strength in comparison to the home program alone. Provinciali (2000) compared one hour sessions over 10 consecutive days of in-clinic physiotherapy comprising a multimodal program with a home program that was progressed in terms of strength/endurance. No benefit was found in outcome when measured by a CTS-specific patient reported instrument.