Working in hand disease research: Max Stewart

Max Stewart, a Clinical Research Training Fellow from the Furniss Group in the University of Oxford, is the Chief Investigator on the PROSpeCT trial. PROSpeCT aims to help people recover better after surgery for carpal tunnel syndrome, a hand disease which leads to pain, tingling and numbness in the hand. The University of Oxford study plans to recruit 60 people from the Nuffield Orthopaedic Centre, Oxford.

What is this research study about?

We are studying a new treatment for a disease called carpal tunnel syndrome. Carpal tunnel syndrome is a hand disease, in which a nerve at the wrist is squashed. The resulting nerve damage leads to pain, tingling, numbness and eventually weakness in the hand. Currently, the gold standard treatment is an operation to take pressure off the nerve and let it heal. Carpal tunnel syndrome is very common - we do more than 50,000 carpal tunnel operations every year in England. Most people do very well after the surgery, but we know that one in five don't get much improvement.

PROSPECT is a study of a new treatment which might help people recover better after surgery for carpal tunnel syndrome. There is evidence that using small pulses of electricity to stimulate the nerve before surgery can speed up nerve healing. The electricity is thought to supercharge the nerve’s natural healing abilities, so it can bounce back quicker after the operation. 

We are giving this electrical stimulation treatment to people who are scheduled for carpal tunnel surgery, around one week before their operation. We will then follow them up for 6 months to see if the electrical stimulation improved their recovery.

We hope that the results of this study could help not just people with carpal tunnel syndrome, but also those with other nerve injuries for which we do not currently have effective treatments.

What does taking part involve?

We are recruiting people who have been seen by a hand surgeon and scheduled for a carpal tunnel operation. People come to two appointments before their surgery, and then two appointments after surgery. 

At the first appointment, we test the overall health of people's hands. We test the strength, dexterity and feeling in the hand and fingers. We also do some electrical tests and an MRI scan of the wrist, which give us a better idea of what's happening to the damaged nerve.

The second appointment is done around one week before surgery. At this appointment we give people the electrical stimulation treatment. PROSPECT is a ‘randomised, placebo-controlled’ study. This means we randomly split people into two groups. One group gets the real electrical stimulation treatment, while the other gets a placebo treatment. The placebo treatment feels like the real electrical stimulation treatment, but doesn't actually do anything to the nerve. By comparing these two groups, we can account for how people’s expectations about the new treatment could affect their recovery.

Both the stimulation and placebo group then go on to have their operation as normal, around a week later. The operation is done under local anaesthetic, takes about 20 minutes and people go home the same day. We then bring people back for follow-up appointments at three months after surgery, and again six months after surgery. We repeat the tests of hand health to see how the nerve is healing. By comparing the electrical stimulation and placebo groups, we hope to spot any difference that the stimulation has made to recovery.

What motivates you to work in research?

In my opinion, our job as doctors is to solve problems. That said, it's important to recognise that there are problems we can’t solve. While some problems will probably be unsolvable forever, some problems are just unsolvable for now. Research is how we make those problems solvable. Nerve injury is one such problem. We haven't made much progress in treating nerve injuries for about 40 years - most people with severe nerve damage don’t do very well. However, we understand so much more about nerves than we once did. Many different lines of science are now coming together to help us overcome this problem. I believe that we are on the brink of new treatments which could transform the lives of these patients over the coming decades. Making that difference is going to require input from a huge number of people from a wide variety of backgrounds: surgeons, physiotherapists, biologists, materials scientists and geneticists to name just a few. I work in research because I want to be a part of that effort.

What would you say to people about considering whether to take part in research?

I would thank people for considering it. Ultimately, taking part in a research study is an act of generosity. There are almost no research studies where we know that taking part will definitely benefit you. If we already knew something worked, we wouldn’t be doing the study. We rely on people giving up their time, travelling to hospital and going through study appointments, all in the hope that what we learn might benefit other patients in future. Without these acts of generosity, we couldn't improve medicine. For instance, electrical stimulation hasn't been studied before in the UK and we don't know if it offers any benefit over just having surgery. I explain this to anyone who wants to join PROSpeCT. They almost always say something like ‘If it could help someone else, I'll do it’. I think we should be proud of that attitude.