Pilot and feasibility Randomised Controlled Trial (RCT) – Evaluation of Technology-Enhanced, Group-based (TEG) model of care following Carpal Tunnel Release (CTR) surgery.

The research design is a single-centre, two-arm parallel group, independent assessor-blinded, pilot RCT. Participants will be randomised to receive either the TEG model of care (arm 1) or usual model of care (arm 2). Both models of care are led by the treating hand therapist. The TEG hand therapy model (arm 1) involves: 1. An initial appointment within 10-14 days post-CTR surgery in an in-person, group format comprising up to four patients for 30 minutes to one hour. During this appointment, sutures are removed for each patient and education is provided as a group regarding carpal tunnel surgery, post-operation recovery and the hand therapy program involved. During suture removal, infection control measures will include the use of separate tables, social distancing, separate wound care packs, aseptic non-touch technique (ANTT) and handwashing between each patient. Range of motion (active tendon gliding, thumb and wrist) exercises and median nerve sliding exercises are prescribed as a group three times a day to encourage early movement after surgery and reduce scar adherence. Scar management including scar massage with non-slip matting 3 times a day, and silicone sheeting worn at night is commenced as a group. 2. A home therapy program is prescribed using the mobile telephone /computer-based app, PhysiTrack App, and will comprise of interactive videos, reminders and prompts to increase self-monitoring to the home program. The home program will include the exercises that were prescribed in the initial appointment (eg. range of motion exercises 3 times a day, scar massage 3 times a day), and the patient will be instructed to complete this program for 12 weeks post-operation. The patient will be assisted in the set-up of the app and a demonstration of how to use the app will be provided. A written log designed to prompt completion of the home program each day is provided at the first appointment (and will also be used to monitor adherence to the home program, in addition to the app). 3. A review appointment is scheduled at six weeks post-operation in a one-to-one format via a telehealth or telephone (depending on patients’ preference) 30-minute appointment. Progress is reviewed regarding pain, oedema, scar healing, range of motion and functional use. Strengthening is commenced using theraputty exercises 2 times a day.