***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare the effects of a neutral wrist and metacarpophalangeal ( MCP ) splint with a wrist cock-up splint , with and without exercises , for the treatment of carpal tunnel syndrome ( CTS ) . DESIGN A 2x2x3 r and omized factorial design with 3 main factors : splint ( neutral wrist and MCP and wrist cock-up ) , exercise ( exercises , no exercise ) , and time ( baseline , 4wk , 8wk ) . SETTING Subjects were evaluated in an outpatient h and therapy clinic . PARTICIPANTS Sixty-one subjects with mild to moderate CTS ; 51 subjects completed the study . INTERVENTIONS There were 4 groups : the neutral wrist and MCP group and the neutral wrist and MCP-exercise group received fabricated customized splints that supported the wrist and MCP joints ; the wrist cock-up group and the wrist cock-up-exercise group received wrist cock-up splints . The neutral wrist and MCP-exercise and wrist cock-up-exercise groups also received tendon and nerve gliding exercises and were instructed to perform exercises 3 times a day . All subjects were instructed to wear the assigned splint every night for 4 weeks . MAIN OUTCOME MEASURES We used the CTS Symptom Severity Scale ( SSS ) and the Functional Status Scale ( FSS ) to assess CTS symptoms and functional status . RESULTS Analysis of variance showed a significant main effect for splint and time on the SSS ( P<.001 , P=.014 ) and FSS ( P<.001 , P=.029 ) , respectively . There were no interaction effects . CONCLUSIONS Our results vali date the use of wrist splints for the treatment of CTS , and suggest that a splint that supports the wrist and MCP joints in neutral may be more effective than a wrist cock-up splint OBJECTIVE To compare the effects of night-only to full-time splint wear instructions on symptoms , function , and  impairment  in carpal tunnel syndrome ( CTS ) . DESIGN R and omized clinical trial with 6-week follow-up . SETTING Veterans Administration Medical Center , outpatient clinic . SUBJECTS Out patients with untreated CTS were consecutively recruited from our electrodiagnostics lab . Twenty-one patients ( 30 h and s ) were enrolled , and 17 patients ( 24 h and s ) completed the study . INTERVENTIONS Thermoplastic , custom-molded , neutral wrist splints with subjects receiving either full-time or night-only wear instructions . OUTCOME MEASURES Symptoms and functional deficits were measured by Levine 's self-administered question naire , and physiologic impairment was measured by median nerve sensory and motor distal latency . COMPLIANCE AND CROSSOVER : Almost all ( 92 % ) of the combined sample reported frequent splint use , but their adherence to specific wearing instructions was limited . A majority ( 73 % ) of the full-time group reported splint wear less than one half of waking hours , and some ( 23 % ) of the night-only group reported occasional daytime wear . Despite this tendency for treatment crossover , the two treatment groups differed in daytime wear as intended ( chi2 analysis , p = .004 ) . RESULTS The combined sample improved in three of four outcome measures : sensory distal latency ( mean = .28msec , st and ard deviation [ SD ] = .37 , p = .004 ) , symptom severity ( mean = .64 , SD = .46 , p = .0001 ) , and functional deficits ( mean = .49 , SD = .51 , p = .0001 ) . Severity of CTS was a factor only in sensory distal latency improvement ( more improvement in severe CTS ) . Subjects receiving full-time wear instructions showed superior distal latency improvement , both motor ( .35 vs -.07msec , p = .04 ) and sensory ( .46 vs . 13msec , p = .05 ) when compared with subjects receiving night-only wear instructions . CONCLUSIONS This study provides added scientific evidence to support the efficacy of neutral wrist splints in CTS and suggests that physiologic improvement is best with full-time splint wear instructions Carpal tunnel syndrome is the most common peripheral entrapment neuropathy . There is little literature available that addresses the management of this condition , which may partly explain why physiotherapy is often overlooked as a treatment approach in its management . This study investigated the effects of two manual therapy techniques in the treatment of patients experiencing carpal tunnel syndrome . An experimental different subject design compared three groups of subjects in three different conditions  ( two treatment interventions  and one control group )  . Each group consisted of seven patients . The objectives of the study were : ( 1 ) to investigate differences between treated and untreated groups ; ( 2 ) to investigate differences in the effectiveness of treatment I ( median nerve mobilization ) compared with treatment II ( carpal bone mobilization ) . Measurements were taken applying several measurement tools , including active range of wrist movement ( ROM flexion and extension ) , upper limb tension test with a median nerve bias ( ULTT2a ) , three different scales to evaluate pain perception and function , and lastly numbers of patients continuing to surgery in each group were compared . In visual terms a clear trend was demonstrated between subjects who received treatment compared to those who were not treated , in particular the descriptive analysis of results for ULTT2a and numbers of patients continuing to surgery . When analysed statistically , less could be concluded . Only scores on a Pain Relief Scale ( P<0.01 ) demonstrated highly significant differences between the three groups when analyzed using Kruskal-Wallis Test . In exploring the results of the two intervention groups , no statistically significant difference in effectiveness of treatment was demonstrated between carpal bone mobilization and median nerve mobilization While developments continue in the surgical management of carpal tunnel syndrome , little emphasis has been placed on the evaluation of a comprehensive non-surgical treatment . In this study , 197 patients ( 240 h and s ) presenting for treatment of carpal tunnel syndrome were divided into two groups . Patients in both groups were treated by st and ard conservative methods , and those in one group were also treated with a program of nerve and tendon gliding exercises . Of those who did not perform the nerve and tendon gliding exercises , 71.2 % underwent surgery compared with only 43.0 % of patients who did perform them . Patients in the experimental group who did not undergo surgery were interviewed at an average follow-up time of 23 months ( range , 14 - 38 months ) . Of these 53 patients , 47 ( 89 % ) responded to this detailed interview . Of the 47 who responded , 70.2 % reported good or excellent results , 19.2 % remained symptomatic , and 10.6 % were non-compliant . Thus , a significant number of patients who would otherwise have undergone surgery for failure of traditional conservative treatment were spared the surgical morbidity of a carpal tunnel release ( p = 0.0001 ) We developed a h and brace and studied its efficacy and tolerability in patients with carpal tunnel syndrome ( CTS ) . We r and omized 83 subjects into a treated group , which wore the h and brace at night for 4 weeks , and a control group , which received no treatment . The primary efficacy measure was change in the Boston Carpal Tunnel Question naire ( BCTQ ) score . Secondary measures were Subjects ' Global Impression of Change Question naire ( SGICQ ) , median distal motor latency , sensory conduction velocity and amplitude , and neurophysiological class of severity . The treated group showed a reduction in BCTQ symptomatic score ( from 2.75 to 1.54 at 4 weeks ; P < 0.001 ) and functional score ( from 1.89 to 1.48 ; P < 0.001 ) . There were no significant changes in the control subjects . SGICQ documented improvement in all treated subjects ( P = 0.006 ) . No significant difference was found in electrophysiological measurements , but overall neurophysiological classification shifted to less severe classes in the treated group ( P < 0.05 ) . Thus , the study demonstrates that this h and brace is highly efficient in relieving symptoms and functional loss in CTS We conducted a prospect i ve study to evaluate the effect of a new non-surgical protocol for treating carpal tunnel syndrome ( CTS ) . It incorporates the Carpal Tunnel Decompression Exercise Program ( Exercise Program ) into conventional non-surgical treatment .  Twenty-eight patients ( 33 h and s ) met the inclusion criteria and were followed for 18 months . The outcome measurement tools used were the Symptom Severity Scale ( SSS ) and the Functional Status Scale ( FSS ) . The outcome tools were administered at admission and repeated at 1 , 2 , and 18 months after admission to the treatment program . Using the adjunct treatment , 80 % of the h and s in the mild category and 71 % in the moderate category were successfully treated without surgery . All patients in the severe category required surgery . The average success rate of our adjunct non-surgical treatment protocol was 67 % , a substantial improvement over the 18 % to 34 % success rate reported nationally for conventional treatment methods . Furthermore , improvement in the outcome of carpal tunnel syndrome by the adjunct non-surgical treatment can result in significant savings in human suffering , medical cost , lost work time , and socioeconomic distress The assessment of a measure of chronic pain , should be reliable , valid and sensitive to change . Our study evaluated the reliability of 3 pain scales , visual analogue scale ( VAS ) , numerical rating scale ( NRS ) and verbal rating scale ( VRS )  in literate and illiterate patients with rheumatoid arthritis ( RA ) . Patients with RA attending an outpatient rheumatology clinic were interviewed and asked to score their pain levels on the 3 pain scales . The scales were presented in r and om order , twice , before and just after a regular medical consultation . Ninety-one patients were studied ( 25 illiterate and 66 literate ) . The Pearson product moment correlation between first and second assessment was 0.937 for VAS , 0.963 for NRS and 0.901 for VRS in the literate patient group and 0.712 for VAS , 0.947 for NRS and 0.820 for VRS in the illiterate patient group . These results indicate that the NRS has the higher reliability in both groups of patients Abstract One way to ensure adequate sensitivity for analgesic trials is to test the intervention on patients who have established pain of moderate to severe intensity . The usual criterion is at least moderate pain on a categorical pain intensity scale . When visual analogue scales ( VAS ) are the only pain measure in trials we need to know what point on a VAS represents moderate pain , so that these trials can be included in meta‐ analysis when baseline pain of at least moderate intensity is an inclusion criterion . To investigate this we used individual patient data from 1080 patients from r and omised controlled trials of various analgesics .  Baseline pain was measured using a 4‐point categorical pain intensity scale and a pain intensity VAS under identical conditions . The distribution of the VAS scores was examined for 736 patients reporting moderate pain and for 344 reporting severe pain .  The VAS scores corresponding to moderate or severe pain were also examined by gender . Baseline VAS scores recorded by patients reporting moderate pain were significantly different from those of patients reporting severe pain . Of the patients reporting moderate pain 85 % scored over 30 mm on the corresponding VAS , with a mean score of 49 mm . For those reporting severe pain 85 % scored over 54 mm with a mean score of 75 mm . There was no difference between the corresponding VAS scores of men and women . Our results indicate that if a patient records a baseline VAS score in excess of 30 mm they would probably have recorded at least moderate pain on a 4‐point categorical scale Akalin E , El Ö , Peker Ö , Şenocak Ö , Tamci Ş , Gülbahar S , Çakmur R , Öncel S : Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises . Am J Phys Med Rehabil 2002;81:108–113 . Objective To assess the effect of nerve and tendon gliding exercises in carpal tunnel syndrome . Design The study was a prospect i ve , r and omized , before- and -after treatment trial . A total of 28 patients with the diagnosis of carpal tunnel syndrome in 36 h and s were r and omly assigned to two groups . A custom made neutral volar wrist splint was given to group 1 and group 2 . The patients were instructed to wear the splints all night and during the day as much as possible for 4 wk . The patients in group 2 were also instructed to perform series of nerve and tendon gliding exercises in addition to the splint treatment . Patients were evaluated with clinical parameters , a functional status scale , and a symptom severity scale . Results At the end of treatment , statistically significant improvement was obtained in all parameters in both groups . The improvement in group 2 was slightly greater , but the difference between the groups was not significant , except for the lateral pinch strength value . Patient satisfaction was investigated during the follow-up period , ranging from 5 to 11 mo , with a mean of 8 mo . A total of 72 % of the patients in group 1 and 93 % of the patients in group 2 reported good or excellent results . The difference between the two groups was not statistically significant . Conclusion Although the results in group 2 were better than group 1 , the difference was not statistically significant . Further investigations are required to establish the role of nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome 
    Output:
    
For all variables , none were consistently favorable toward  neural gliding  over alternative treatment .
However , comparisons across studies revealed a possible trend toward improved outcomes with the use neural gliding .
CONCLUSIONS The efficacy of neural gliding is not clear .