"Outcome measures in Iranian studies of carpal tunnel syndrome surgery: a systematic review"

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent peripheral nerve compression neuropathy. Its annual global incidence is approximately 2.3%, while prevalence estimates in Iran are around 17%. Surgery is typically recommended when conservative treatment fails or motor weakness is present. Despite numerous Iranian studies on CTS surgery, outcome assessment methods remain inconsistent. This systematic review aimed to evaluate the tools and methodologies used in Iranian research to report postoperative outcomes. METHODS: Major databases were searched (1996–2025) for Iranian CTS surgery studies (≥ 3-week follow-up). We extracted study design, sample size, follow-up duration, surgical technique, and outcome measures. Outcome reporting was summarized using descriptive statistics (frequencies and percentages) and grouped into Patient-Reported Outcome Measures (PROMs), physical examination findings (e.g., grip strength), and electrodiagnostic parameters for structured comparison. RESULTS: Twenty-two studies met the inclusion criteria. The Boston Carpal Tunnel Questionnaire was used in 45.5% of studies, pain was assessed with the Visual Analog Scale in 59.1%, and grip and pinch strength were evaluated in 40.9% and 13.6%, respectively. Electrodiagnostic testing was performed preoperatively in 81.8% of studies, but only 18% assessed postoperative changes. Reporting of return to work, scar length, and surgical technique was inconsistent. CONCLUSIONS: Iranian CTS research shows substantial variability in study design and outcome assessment. Although the volume of research is increasing, the methodological quality remains suboptimal, with a high prevalence of risk of bias in RCTs and poor quality in observational studies. The limited use of standardized instruments and inconsistent reporting may reduce comparability and clinical relevance.