Immobilization
Strong evidence supports that the use of immobilization (brace/splint/orthosis) should improve patient reported outcomes.

Rationale
There are two high quality studies (Hall 2013 and Manente 2001) that directly compare the use of brace/splint to no use of brace/splint to treat carpal tunnel syndrome.  Hall 2013 compared 8 weeks of full-time splinting versus no splinting. The authors showed statistically significant improvement in pain and function (Boston Questionnaire for assessment of carpal tunnel symptom functional status scale, Boston Questionnaire for assessment of carpal tunnel symptom severity, AS, phalens, grip strength, Purdue Pegboard Test score, Semmes Weinstein monofilaments).  The authors describe statistically significant differences when comparing percent change in these factors from pre to post treatment.  There were some baseline/pretreatment differences between the groups, such that it calls into question whether these factors were actually statistically different after treatment.  Manente 2001 compared four weeks of night bracing to no intervention.  The treated group showed a reduction in the Boston Carpal Tunnel Questionnaire symptomatic score (from 2.75 to 1.54 at 4 weeks; p<0.001) and functional score (from 1.89 to 1.48 at 4 weeks; p<0.001). Subjects’ Global Impression of Change Questionnaire documented improvement in the braced group at 4 weeks (p=0.006). Subjects’ Global Impression of Change Questionnaire documented improvement in the braced group at 4 weeks (p=0.006).
 

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