Liew, BXWde-la-Llave-Rincón, AIScutari, MArias-Buría, José LCleland, JFernández-de-Las-Peñas, C2023-12-262023-12-2620223. Liew BXW, de-la-Llave-Rincón AI, Scutari M, Arias-Buría José L, Cook CE, Cleland J, Fernández-de-Las-Peñas C. Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial. Phys Ther 2022;102(4):pzac0150031-9023https://hdl.handle.net/10115/27895Objective: The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS). Methods: Data from a randomized clinical trial (n = 104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity. Results: Manual physical therapy improved function in women with CTS (between-groups difference: 0.09; 95% CI = 0.07 to 0.11). The Bayesian network showed that early improvements (at 1 month) in function and symptom severity led to long-term (at 12 months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI = 0.11 to 0.17 point) poorer function at 12 months than those with mild CTS and 0.12-point (95% CI = 0.09 to 0.15 point) poorer function at 12 months than those with severe CTS. Conclusion: Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects. Impact: Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS. Trial registration: ClinicalTrials.gov NCT01789645.engBayesian NetworksCarpal Tunnel SyndromeMachine LearningManual Therapyinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/embargoedAccess