Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature

Cavalcante, Marcelo Cortês; Moraes, Vinicius Ynoe de; Osés, Guilherme Ladeira; Nakachima, Luis Renato; Belloti, João Carlos

doi:10.1590/1516-3180.2021.1020.R2.10102022

Acessibilidade / Reportar erro

Brasil

Sao Paulo Medical Journal

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Sao Paulo Med. J. 141 (5) • 2023 • https://doi.org/10.1590/1516-3180.2021.1020.R2.10102022 copy

Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Carpal tunnel syndrome (CTS) is a common condition greatly affects patients’ quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions.

OBJECTIVE:

This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS.

DESIGN AND SETTING:

Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil

METHODS:

We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners.

RESULTS:

Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were “low” or “very low”. PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman’s correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA.

CONCLUSION:

Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies.

REGISTRATION NUMBER IN PROSPERO:

CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328)

KEY WORDS (MeSH terms):
Evidence-based medicine; Quality control; Carpal tunnel syndrome

AUTHORS’ KEY WORDS:
Quality; Systematics reviews; PRISMA

Author, Year	Impact factor	Conflict of interest	Country of origin	What comparison?	Number of institutions	Total number of patients	Number of words	Study design	Meta-analysis	Quoted PRISMA?
Alvayay et al.,¹³13. Alvayay CS, Arce-Alvarez A. Revisión sistemática de tratamientos fisioterapéuticos conmejor evidencia para el síndrome del túnel carpiano [Systematic review of physiotherapy treatments with better evidence for the carpal tunnel síndrome]. Rev Soc Esp del Dolor. 2008;15(7):475-80. 2008	Q4	NO	CHILE	Different CTS physiotherapeutic treatments	1	1,415	1,702	RCT, SYSTEMATIC REVIEW	NO	NO
Babaei-Ghazani et al.,¹⁴14. Babaei-Ghazani A, Roomizadeh P, Forogh B, et al. Ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled clinical trials. Arch Phys Med Rehabil. 2018;99(4):766-75. PMID: 28943161. https://doi.org/10.1016/j.apmr.2017.08.484. https://doi.org/https://doi.org/10.1016/... 2017	Q1	NO	IRAN	Corticosteroid injection into the carpal tunnel: guided ultrasound versus guided landmark	3	137	3,502	RCT	YES	NO
Ballestero-perez et al.,¹⁵15. Ballastero-Pérez R, Plaza-Manzano G, Urraca-Gesto A, et al. Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review. J Manipulative Physiol Ther 2017;40(1):50-9. PMID: 27842937; https://doi.org/10.1016/j.jmpt.2016.10.004. https://doi.org/https://doi.org/10.1016/... 2016	Q1	YES	SPAIN	Effectiveness of nerve glide exercises in CTS	5	733	2,420	RCT, CT	NO	YES
Bekhet et al.,¹⁶16. Bekhet AH, Ragab B, Abushouk AI, Elgebaly A, Ali OI. Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis. Lasers Med Sci. 2017;32(6):1439-48. PMID: 28580494; https://doi.org/10.1007/s10103-017-2234-6. https://doi.org/https://doi.org/10.1007/... 2017	Q2	YES	EGYPT	Low frequency laser versus placebo	6	473	2,731	RCT	YES	YES
Burger et al.,¹⁷17. Burger M, Kriel R, Damon A, et al. The effectiveness of low-level laser therapy on pain, self-reported hand function, and grip strength compared to placebo or “sham” treatment for adults with carpal tunnel syndrome: A systematic review. Physiother Theory Pract. 2017;33(3):184-97. PMID: 28272964; https://doi.org/10.1080/09593985.2017.1282999. https://doi.org/https://doi.org/10.1080/... 2017	Q2	YES	SOUTH AFRICA	Low frequency laser versus placebo	5	614	4,897	RCT	NO	NO
Burton et al.,¹⁸18. Burton CL, Chesterton LS, Chen Y, van der Windt DA. Clinical Course and Prognostic Factors in Conservatively Managed Carpal Tunnel Syndrome: A Systematic Review. Arch Phys Med Rehabil. 2016;97(5):836-852.e1. PMID: 26440776; https://doi.org/10.1016/j.apmr.2015.09.013. https://doi.org/https://doi.org/10.1016/... 2016	Q1	YES	UNITED KINGDOM	Clinical course and prognostic factors of conservative treatment CTS	1	2.639	4,490	COHORT	NO	NO
Chapell et al.,¹⁹19. Chapell R, Coates V, Turkelson C. Poor outcome for neural surgery (epineurotomy or neurolysis) for carpal tunnel syndrome compared with carpal tunnel release alone: a meta-analysis of global outcomes. Plast Reconstr Surg. 2003;112(4):983-90; discussion 991-2. PMID: 12973213; https://doi.org/10.1097/01.PRS.0000076222.77125.1F. https://doi.org/https://doi.org/10.1097/... 2003	Q1	YES	UNITED STATES	Neurolysis and epineurotomy versus placebo in surgical treatment	1	390	2,925	RCT	YES	NO
Chen et al.,²⁰20. Chen L, Duan X, Huang X, et al. Effectiveness and safety of endoscopic versus open carpal tunnel decompression. Arch Orthop Trauma Surg. 2014;134(4):585-93. PMID: 24414237; https://doi.org/10.1007/s00402-013-1898-z. https://doi.org/https://doi.org/10.1007/... 2014	Q1	NO	CHINA	Open versus endoscopic release	1	1.395	2,481	RCT	YES	NO
Chen et al.,²¹21. Chen PC, Chuang CH, Tu YK, et al. A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. BMC Musculoskelet Disord. 2015;16:363. Erratum in: BMC Musculoskelet Disord. 2015;16(1):394. PMID: 26585378; https://doi.org/10.1186/s12891-015-0815-8. https://doi.org/https://doi.org/10.1186/... 2015	Q2	YES	TAIWAN	Different local infiltrations of corticosteroids in the carpal tunnel	4	633	4,728	RCT	YES	NO
Choi et al.,²²22. Choi GH, Wieland LS, Lee H, Sim H, Lee MS, Shin BC. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018;12(12):CD011215. PMID: 30521680; https://doi.org/10.1002/14651858.CD011215.pub2. https://doi.org/https://doi.org/10.1002/... 2018	Q1	YES	SOUTH KOREA/UNITED STATES	Acupuncture and related interventions for placebo treatments	2	869	13,354	RCT/QUASI-RCT	YES	YES
Dunn et al.,²³23. Dunn JC, Kusnezov NA, Koehler LR, et al. Outcomes Following Carpal Tunnel Release in Patients Receiving Workers’ Compensation: A Systematic Review. Hand (N Y). 2018;13(2):137-142. PMID: 28387162; https://doi.org/10.1177/1558944717701240. https://doi.org/https://doi.org/10.1177/... 2017	Q2	YES	UNITES STATES	Labor compensation versus no labor compensation in the treatment of CTS	2	4,367	2,006	PROSPECTIVE, RETROSPECTIVE	NO	NO
Franke et al.,²⁴24. Franke TP, Koes BW, Geelen SJG, Huisstede BM. Do Patients with Carpal Tunnel Syndrome Benefit from Low-Level Laser Therapy? A Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil. 2018;99(8):1650-1659.e15. PMID: 28629992; https://doi.org/10.1016/j.apmr.2017.06.002. https://doi.org/https://doi.org/10.1016/... 2017	Q1	YES	NETHERLANDS	Benefits of low frequency laser therapy for CTS	2	1,048	4,923	REVIEWS, RCT	YES	NO
Gerritsen et al.,²⁵25. Gerritsen AA, Uitdehaag BM, van Geldere D, et al. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg. 2001;88(10):1285-95. PMID: 11578281; https://doi.org/10.1046/j.0007-1323.2001.01858.x. https://doi.org/https://doi.org/10.1046/... 2001	Q1	YES	NETHERLANDS	Surgical treatment of CTS	3	1,264	5,021	RCT	NO	NO
Gerritsen et al.,²⁶26. Gerritsen AA, de Krom MC, Struijs MA, et al. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol. 2002;249(3):272-80. PMID: 11993525; https://doi.org/10.1007/s004150200004. https://doi.org/https://doi.org/10.1007/... 2002	Q1	YES	NETHERLANDS	Non-surgical treatment carpal tunnel syndrome	4	639	3,189	RCT	NO	NO
Goodyear-Smith et al.,²⁷27. Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med. 2004;2(3):267-73. PMID: 15209206; https://doi.org/10.1370/afm.21. https://doi.org/https://doi.org/10.1370/... 2004	Q1	YES	NEW ZEALAND	Non-surgical treatment carpal tunnel syndrome	1		2,536	RCT	NO	NO
Hamamoto filho et al.,²⁸28. Hamamoto Filho PT, Leite FV, Ruiz T, Resende LA. A systematic review of anti-inflammatories for mild to moderate carpal tunnel syndrome. J Clin Neuromuscul Dis. 2009;11(1):22-30. PMID: 19730018; https://doi.org/10.1097/CND.0b013e3181ac8364. https://doi.org/https://doi.org/10.1097/... 2009	Q3	YES	BRAZIL	Anti-inflammatory drugs in the treatment of CTS	1	323	3,078	RCT	NO	NO
Hu et al.,²⁹29. Hu K, Zhang T, Xu W. Intraindividual comparison between open and endoscopic release in bilateral carpal tunnel syndrome: a meta-analysis of randomized controlled trials. Brain Behav. 2016;6(3):e00439. PMID: 27099801; https://doi.org/10.1002/brb3.439. https://doi.org/https://doi.org/10.1002/... 2016	Q2	YES	CHINA	Open versus endoscopic release	2	142	3,052	RCT	YES	YES
Huisstede et al.,³⁰30. Huisstede BM, Hoogvliet P, Randsdorp MS, et al. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review. Arch Phys Med Rehabil. 2010;91(7):981-1004. PMID: 20599038; https://doi.org/10.1016/j.apmr.2010.03.022. https://doi.org/https://doi.org/10.1016/... 2010	Q1	YES	NETHERLANDS	Effects of non-surgical treatment on CTS	1	4,596	5,822	SYSTEMATIC REVIEW/RCT	NO	NO
Huisstede et al.,³¹31. Huisstede BM, Randsdorp MS, Coert JH, et al. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic review. Arch Phys Med Rehabil. 2010;91(7):1005-24. PMID: 20599039; https://doi.org/10.1016/j.apmr.2010.03.023. https://doi.org/https://doi.org/10.1016/... 2010	Q1	YES	NETHERLANDS	Effects of surgical treatment on CTS	1	2,957	9,127	SYSTEMATIC REVIEW/RCT	NO	NO
Huisstede et al.,³²32. Huisstede BM, Hoogvliet P, Franke TP, Randsdorp MS, Koes BW. Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil. 2018;99(8):1623-1634.e23. PMID: 28942118; https://doi.org/10.1016/j.apmr.2017.08.482. https://doi.org/https://doi.org/10.1016/... 2017	Q1	YES	NETHERLANDS	Effectiveness of physiotherapy and electrophysical modalities in CTS	2	1,617	5,273	REVIEWS, RCT	NO	NO
Huisstede et al.,³³33. Huisstede BM, van den Brink J, Randsdorp MS, Geelen SJ, Koes BW. Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review. Arch Phys Med Rehabil. 2018;99(8):1660-1680.e21. Erratum in: Arch Phys Med Rehabil. 2020;101(9):1665. PMID: 28577858; https://doi.org/10.1016/j.apmr.2017.04.024. https://doi.org/https://doi.org/10.1016/... 2017	Q1	YES	NETHERLANDS	Comparison between different treatment modalities and post-surgical interventions	2	9,566	7,352	REVIEWS, RCT	NO	NO
Huisstede et al.,³⁴34. Huisstede BM, Randsdorp MS, van den Brink J, et al. Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review. Arch Phys Med Rehabil. 2018;99(8):1609-1622.e10. PMID: 29626428; https://doi.org/10.1016/j.apmr.2018.03.003 https://doi.org/https://doi.org/10.1016/... 2018	Q1	NO	NETHERLANDS	Oral pain medications versus placebo/oral steroids versus splinting/corticosteroid versus placebo	2	1,760	5,171	SYSTEMATIC REVIEW/RCT	NO	NO
Hunt et al.,³⁵35. Hunt KJ, Hung SK, Boddy K, Ernst E. Chiropractic manipulation for carpal tunnel syndrome: a systematic review. Hand Therapy. 2009;14(4):89-94. https://doi.org/10.1258/ht.2009.009023. https://doi.org/https://doi.org/10.1258/... 2009	Q3	YES	UNITED KINGDOM	Chiropractic manipulation CTS	1	91	2,513	RCT	NO	NO
JImenez Del Barrio et al.,³⁶36. Jiménez Del Barrio S, Bueno Gracia E, Hidalgo García C, et al. Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. Neurologia (Engl Ed). 2018;33(9):590-601. PMID: 27461181; https://doi.org/10.1016/j.nrl.2016.05.018. https://doi.org/https://doi.org/10.1016/... 2016	Q2	YES	SPAIN	Effectiveness of non-surgical carpal tunnel syndrome treatment	2	1,818	2,505	“CLINICAL TRIALS”	NO	SIM
Kim et al.,³⁷37. Kim JC, Jung SH, Lee SU, Lee SY. Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98(33):e16870. PMID: 31415424; https://doi.org/10.1097/MD.0000000000016870. https://doi.org/https://doi.org/10.1097/... 2019	Q2	YES	SOUTH KOREA	Shockwave therapy versus non-therapy - CTS	1	281	2,341	RCT	YES	YES
Kim et al.,³⁸38. Kim SD. Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Phys Ther Sci. 2015;27(8):2645-8. PMID: 26357452; https://doi.org/10.1589/jpts.27.2645. https://doi.org/https://doi.org/10.1589/... 2015	Q2	NO	SOUTH KOREA	Effectiveness of nerve and tendon slip exercises in CTS	1	261	1,697	RCT	NO	YES
Klokkari et al.,³⁹39. Klokkari D, Mamais I. Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis. Hong Kong Physiother J. 2018;38(2):91-114. PMID: 30930582; https://doi.org/10.1142/S1013702518500087. https://doi.org/https://doi.org/10.1142/... 2018	Q3	YES	GREECE/CYPRUS	Surgical versus non-surgical treatment	2	1,787	5,194	RCT, CT, PROSPECTIVE, RETROSPECTIVE	YES	YES
Kohanzadeh et al.,⁴⁰40. Kohanzadeh S, Herrera FA, Dobke M. Outcomes of open and endoscopic carpal tunnel release: a meta-analysis. Hand (N Y). 2012;7(3):247-51. PMID: 23997726; https://doi.org/10.1007/s11552-012-9413-5. https://doi.org/https://doi.org/10.1007/... 2012	Q2	YES	UNITED STATES	Open versus endoscopic release	3	4,178	1,846	RCT, RETROSPECTIVE	NO	NO
Lai et al.,⁴¹41. Lai, Sike; Zhang, Kaibo; Li, Jian; Fu, Weili; Harhaus, Leila. Carpal tunnel release with versus without flexor retinaculum reconstruction for carpal tunnel syndrome at short- and long-term follow up—A meta-analysis of randomized controlled trials. Plos One (2019), 14(1), e0211369–. https://doi.org/10.1371/journal.pone.0211369 https://doi.org/https://doi.org/10.1371/... 2019	Q1	YES	CHINA	Surgical treatment with reconstruction versus without retinaculum flexor reconstruction	1	639	2,644	RCT	YES	YES
Li et al.,⁴²42. Li G, Kong L, Kou N, et al. The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98(18):e15372. PMID: 31045782; https://doi.org/10.1097/MD.0000000000015372. https://doi.org/https://doi.org/10.1097/... 2019	Q2	YES	CHINA	Standard incision versus limited incision	2	1,020	2,722	RCT	YES	YES
Li et al,⁴³43. Li ZJ, Wang Y, Zhang HF, et al. Effectiveness of low-level laser on carpal tunnel syndrome: A meta-analysis of previously reported randomized trials. Medicine (Baltimore). 2016;95(31):e4424. PMID: 27495063; https://doi.org/10.1097/MD.0000000000004424. https://doi.org/https://doi.org/10.1097/... 2016	Q2	YES	CHINA/UNITED STATES	Low frequency laser effectiveness in CTS	4	531	2,112	RCT	YES	NO
Lim et al.,⁴⁴44. Lim YH, Chee DY, Girdler S, Lee HC. Median nerve mobilization techniques in the treatment of carpal tunnel syndrome: A systematic review. J Hand Ther. 2017;30(4):397-406. PMID: 28764878; https://doi.org/10.1016/j.jht.2017.06.019. https://doi.org/https://doi.org/10.1016/... 2017	Q1	YES	AUSTRALIA/SINGAPORE	Mobilization of the median nerve in CTS	2	404	2,676	RCT	NO	YES
Malahias,⁴⁵45. Malahias MA, Chytas D, Mavrogenis AF, et al. Platelet-rich plasma injections for carpal tunnel syndrome: a systematic and comprehensive review. Eur J Orthop Surg Traumatol. 2019;29(1):1-8. PMID: 30022241; https://doi.org/10.1007/s00590-018-2278-8. https://doi.org/https://doi.org/10.1007/... 2019	Q2	YES	GREECE/CYPRUS	Platelet rich plasma versus control	2	192	2,636	RCT, CASE CONTROL, PROSPECTIVE CONTROLED TRIAL, CASE CONTROL, CASE REPORT	NO	YES
Marshall et al.,⁴⁶46. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554. PMID: 17443508; https://doi.org/10.1002/14651858.CD001554.pub2. https://doi.org/https://doi.org/10.1002/... 2007	Q1	YES	CANADA	Corticosteroid injection into the carpal tunnel	1	671	7,052	RCT/QUASI-RCT	YES	NO
Medina McKeon et al.,⁴⁷47. Medina McKeon JM, Yancosek KE. Neural gliding techniques for the treatment of carpal tunnel syndrome: a systematic review. J Sport Rehabil. 2008;17(3):324-41 PMID: 18708684; https://doi.org/10.1123/jsr.17.3.324. https://doi.org/https://doi.org/10.1123/... 2008	Q2	NO	UNITED STATES	CTS nerve slip	1	428	4,284	CT	YES	NO
Muller et al.,⁴⁸48. Muller M, Tsui D, Schnurr R, et al. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004;17(2):210-28. PMID: 15162107; https://doi.org/10.1197/j.jht.2004.02.009. https://doi.org/https://doi.org/10.1197/... 2004	Q1	NO	CANADA	Effects of non-surgical treatment on CTS	2	1,280	5,387	RCT UNTILAUTHOR’SOPINION	NO	NO
O’Connor et al.,⁴⁹49. O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;2003(1):CD003219. PMID: 12535461; https://doi.org/10.1002/14651858.CD003219. https://doi.org/https://doi.org/10.1002/... 2003	Q1	YES	CANADA/AUSTRALIA	Non-surgical treatment in CTS (except steroid injection)	3	884	10,131	RCT/QUASI-RCT	YES	NO
O’Connor et al.,⁵⁰50. O’Connor D, Page MJ, Marshall SC, Massy-Westropp N. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;1(1):CD009600. PMID: 22259003; https://doi.org/10.1002/14651858.CD009600. https://doi.org/https://doi.org/10.1002/... 2012	Q1	YES	AUSTRALIA/CANADA	Effects of ergonomic positioning or equipment versus no treatment, placebo, non-surgical treatment	3	105	4,654	RCT/QUASI-RCT	YES	NO
Page et al.,⁵¹51. Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;2012(7):CD010003. PMID: 22786532; https://doi.org/10.1002/14651858.CD010003. https://doi.org/https://doi.org/10.1002/... 2012	Q1	YES	AUSTRALIA	Orthosis versus no treatment, placebo, other non-surgical intervention	2	1,190	14,163	RCT/QUASI-RCT	YES	NO
Page et al.J,⁵²52. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(6):CD009899. PMID: 22696387; https://doi.org/10.1002/14651858.CD009899. https://doi.org/https://doi.org/10.1002/... 2012	Q1	YES	AUSTRALIA	Exercise and mobilization versus placebo, no treatment or non-surgical treatment	2	741	20,024	RCT/QUASI-RCT	NO	NO
Page et al.,⁵³53. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013;2013(3):CD009601. PMID: 23543580; https://doi.org/10.1002/14651858.CD009601.pub2. https://doi.org/https://doi.org/10.1002/... 2013	Q1	YES	AUSTRALIA	Therapeutic ultrasound versus other treatments for CTS	3	443	14,759	RCT	YES	NO
Piazzini et al.,⁵⁴54. Piazzini DB, Aprile I, Ferrara PE, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21(4):299-314. PMID: 17613571; https://doi.org/10.1177/0269215507077294. https://doi.org/https://doi.org/10.1177/... 2007	Q1	NO	ITALY	Non-surgical treatment in CTS	1	1,556	2,569	RCT	NO	NO
Sanati ka et al.,⁵⁵55. Sanati KA, Mansouri M, Macdonald D, et al. Surgical techniques and return to work following carpal tunnel release: a systematic review and meta-analysis. J Occup Rehabil. 2011;21(4):474-81. PMID: 21528400; https://doi.org/10.1007/s10926-011-9310-8. https://doi.org/https://doi.org/10.1007/... 2011	Q1	YES	SCOTLAND/ UNITED KINGDOM/UNITED STATES/IRAN	Standard incision versus limited incision	6	1,512	1,697	RCT	YES	NO
Sayegh et al.,⁵⁶56. Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res. 2015;473(3):1120-32. PMID: 25135849; https://doi.org/10.1007/s11999-014-3835-z. https://doi.org/https://doi.org/10.1007/... 2014	Q1	YES	UNITED STATES	Open versus endoscopic release	1	1,859	3,505	RCT	YES	YES
Scholten et al.,⁵⁷57. Scholten RJ, Mink van der Molen A, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007 Oct 17;2007(4):CD003905. PMID: 17943805; https://doi.org/10.1002/14651858.CD003905.pub3. https://doi.org/https://doi.org/10.1002/... 2007	Q1	YES	NETHERLANDS	Different surgical treatments	1	1,284	4,137	RCT	YES	NO
Shi et al.⁵⁸58. Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res. 2011;6:17. PMID: 21477381; https://doi.org/10.1186/1749-799x-6-17. https://doi.org/https://doi.org/10.1186/... 2011	Q2	YES	CANADA	Surgical treatment versus non-surgical treatment	1	712	2,948	RCT, CT	YES	NO
Shi et al.,⁵⁹59. Shi Q, Bobos P, Lalone EA, Warren L, MacDermid JC. Comparison of the Short-Term and Long-Term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Hand (N Y). 2020;15(1):13-22. PMID: 30015499; https://doi.org/10.1177/1558944718787892. https://doi.org/https://doi.org/10.1177/... 2018	Q2	YES	CANADA	Surgical intervention versus no surgical intervention	4	1,028	2,800	RCT	YES	YES
Sim et al.,⁶⁰60. Sim H, Shin BC, Lee MS, et al. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain. 2011;12(3):307-14. PMID: 21093382; https://doi.org/10.1016/j.jpain.2010.08.006. https://doi.org/https://doi.org/10.1016/... 2011	Q2	YES	SOUTH KOREA/UNITED KINGDOM	Acupuncture versus other non-surgical treatments	4	442	2,245	RCT	YES	NO
Soltani et al.,⁶¹61. Soltani AM, Allan BJ, Best MJ, Mir HS, Panthaki ZJ. A systematic review of the literature on the outcomes of treatment for recurrent and persistent carpal tunnel syndrome. Plast Reconstr Surg. 2013;132(1):114-21. PMID: 23806914; https://doi.org/10.1097/prs.0b013e318290faba. https://doi.org/https://doi.org/10.1097/... 2013	Q1	YES	UNITED STATES	CTS recurrence: open decompression versus flap	1	658	2,990	CASE SERIES: PROSPECTIVE/RETROSPECTIVE	YES	NO
Thoma et al.,⁶²62. Thoma A, Veltri K, Haines T, Duku E. A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression. Plast Reconstr Surg. 20041;113(4):1184-91. PMID: 15083019; https://doi.org/10.1097/01.prs.0000110202.08818.c1. https://doi.org/https://doi.org/10.1097/... 2004	Q1	NO	CANADA	Open versus endoscopic release	1		2,448	RCT	NO	NO
Vasiliadis et al.,⁶³63. Vasiliadis HS, Georgoulas P, Shrier I, Salanti G, Scholten RJ. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014;(1):CD008265. PMID: 24482073; https://doi.org/10.1002/14651858.CD008265.pub2. https://doi.org/https://doi.org/10.1002/... 2014	Q1	YES	GREECE/SWEDEN/CANADA/NETHERLANDS	Endoscopic release versus other surgical intervention in CTS	4	2,586	11,843	RCT/QUASI-RCT	YES	NO
Vasiliadis et al.⁶⁴64. Vasiliadis HS, Nikolakopoulou A, Shrier I, et al. Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis. PLoS One. 2015;10(12):e0143683. https://doi.org/10.1371/journal.pone.0143683. https://doi.org/https://doi.org/10.1371/... 2015	Q1	YES	SWITZERLAND/GREECE/CANADA/UNITED KINGDOM/NETHERLANDS	Open versus endoscopic release	6	2,449	4,754	RCT/QUASI-RCT	YES	YES
Verdugo et al.,²2. Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2002;(2):CD001552. Update in: Cochrane Database Syst Rev. 2003;(3):CD001552. PMID: 12076416; https://doi.org/10.1002/14651858.CD001552. https://doi.org/https://doi.org/10.1002/... 2008	Q1	YES	CHILE	Surgical treatment versus non-surgical treatment	1	198	3,276	RCT/QUASI-RCT	YES	NO
Wade et al.,⁶⁵65. Wade RG, Wormald JC, Figus A. Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery. Cochrane Database Syst Rev. 2018;2(2):CD011757. PMID: 29390170; https://doi.org/10.1002/14651858.CD011757.pub2. https://doi.org/https://doi.org/10.1002/... 2018	Q1	YES	UNITED KINGDOM/ITALY	Absorbable versus non-absorbable suture	4	255	9,703	RCT/QUASI-RCT	YES	YES
Zuo et al.,⁶⁶66. Zuo D, Zhou Z, Wang H, et al. Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2015;10:12. PMID: 25627324; https://doi.org/10.1186/s13018-014-0148-6. https://doi.org/https://doi.org/10.1186/... 2015	Q2	YES	CHINA	Open versus endoscopic release	1	1,253	3,940	RCT	YES	NO

	Average	CI 95%
PRISMA E1	12.67	11.36–13.99
PRISMA E2	14.00	12.94–15.06
PRISMA average	13.34	12.17–14.5
AMSTAR E1	7.17	6.38–7.96
AMSTAR E2	7.21	6.59–7.83
AMSTAR average	7.19	6.51–7.87
Number patients	1326.66	905.74–1747.58
Number words	4872.27	3.867.37–5877.18

	E1		E2		Average E1; E2
“Very low” quality	26	(47%)	17	(31%)	21.5	(39.1%)
“Low” quality	22	(40%)	25	(45.4%)	23.5	(42.7%)
“Moderate” quality	5	(10%)	12	(21.8%)	8.5	(15.5%)
“High” quality	2	(3%)	1	(1.8%)	1.5	(2.7%)

	Number of studies (total = 55)	Average	CI	P value
Impact factor	Q1 (n = 34)	14.16	12.64–15.68	0.095
Meta-analysis	Yes (n = 31)	15.61	14.25–16.97	0.008
Study design	RCT (n = 33)	14.47	12.82–16.12	0.103
Conflict of interest	Conflict (n = 46)	13.95	12.69–15.21	0.155
Country of origin	China (n = 6)	14.67	12.96–16.38	0.268
Quote PRISMA	Yes (n = 17)	14.47	12.19–16.75	0.131

	Number of studies (total = 55)	Average	CI	P value
Impact factor	Q1 (n = 34)	7.55	6.68–8.42	0.372
Meta-analysis	Yes (n = 31)	8.43	7.55–9.31	0.009
Study design	RCT (n = 33)	7.95	6.98–8.92	0.043
Conflict of interest	Conflict (n = 46)	7.57	6.83–8.31	0.173
Country of origin	China (n = 6)	8.21	6.72–9.7	0.16
Quote PRISMA	Yes (n = 17)	7.47	6.04–8.9	0.183

		Low impact(Non Q1)		High impact(Q1)		Total		P value
		n*	%	n*	%	n*	%	P value
Quote PRISMA	Yes	10	47.60%	7	20.60%	17	30.90%	0.035
Conflict of interest	Conflict	18	85.70%	28	82.40%	46	83.60%	0.743
Study design	RCT	18	85.70%	31	91.20%	49	89.10%	0.528
N. Institutions	Multicentric	13	61.90%	20	58.80%	33	60.00%	0.821
Meta-analysis	Yes	12	57.10%	19	55.90%	31	56.40%	0.927
Country of origin	China	4	19.00%	2	5.90%	6	10.90%	0.128

		Chinese studies		Chinese studies		Total		P value
		n*	%	n*	%	n*	%	P value
Quote PRISMA	Yes	3	50%	14	28.60%	17	30.90%	0.284
Conflict of interest	Conflict	5	83.30%	41	83.70%	46	83.60%	0.983
Study design	RCT	6	100%	43	87.80%	49	89.10%	0.364
N. Institutions	Multicentric	3	50%	30	61.20%	33	60.00%	0.596
Meta-analysis	Yes	6	100%	25	51.00%	31	56.40%	0.022

		E1	E2	Average
Spearman	Corr (r)	0.82	0.798	0.829
Spearman	P value	< 0.001	< 0.001	< 0.001
ICC	Corr (r)	0.856	0.839	0.857
ICC	P value	< 0.001	< 0.001	< 0.001

	PRISMA	AMSTAR
Average	-1.33	-0.04
Standard deviation	1.91	1.48
P value	< 0.001	0.856
Regression	< 0.001	0.001

	Kappa	P value
Original*	0.442	< 0.001
Grouped^**	0.641	< 0.001

	PRISMA		AMSTAR
	Coef. (B)	P value	Coef. (B)	P value
Constant	4.89	0.03	3.36	0.016
Impact Q1	2.54	0.01	1.06	0.076
Meta-analysis	4.74	< 0.001	2.53	< 0.001
Multicentric	2.2	0.022	1.69	0.005
Conflict of interest	1.41	0.263	1.16	0.138
Non-Chinese studies	0.17	0.911	-0.45	0.633
Quote PRISMA	1.12	0.275	-0.2	0.747
RCT	1.34	0.353	0.26	0.77
ANOVA	< 0.001		< 0.001
R2	54.40%		49.20%

Associação Paulista de Medicina - APM APM / Publicações Científicas, Av. Brigadeiro Luís Antonio, 278 - 7º and., 01318-901 São Paulo SP - Brazil, Tel.: +55 11 3188-4310 / 3188-4311, Fax: +55 11 3188-4255 - São Paulo - SP - Brazil
E-mail: revistas@apm.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence: Marcelo Cortes Cavalcante R. Borges Lagoa, 786 Vila Clementino — São Paulo (SP) — Brasil CEP 04038-001 Tel. (+55 11) 99859-2210 E-mail: marcelo_cortes88@hotmail.com