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RESEARCH PRODUCT

Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis.

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OBJECTIVE To determine the effects of the cognitive and mental health factors on the outcomes following carpal tunnel release (CTR). DATA SOURCES Embase, Pubmed/MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to August 14, 2021. STUDY SELECTION Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia and self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least three months post-CTR. DATA EXTRACTION Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis. DATA SYNTHESIS A total of fifteen studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes following CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n = 531, r = 0.347, 95% CI = 0.205 to 0.475, p = <0.0001), function (n = 386, r = 0.307, 95% CI = 0.132 to 0.464, p = 0.0008), and pain (n = 344, r = 0.431, 95% CI = 0.286 to 0.558, p = <0.0001). In general, the risk of bias in the included studies was low. CONCLUSIONS This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor post-surgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.