Rehabilitation using plastic building-block toys was associated with early recovery following carpal tunnel release: a prospective comparative observational pilot study

BACKGROUND: Carpal tunnel syndrome (CTS) frequently requires surgical release, but optimal postoperative rehabilitation strategies remain poorly standardized. Innovative, task-oriented approaches may improve functional recovery and patient engagement. This study aimed to determine whether a structured rehabilitation program using plastic building-block toys improves outcomes after carpal tunnel release (CTR). Specifically, we asked: (1) does this program enhance sensory recovery, (2) does it improve patient-reported functional outcomes, and (3) are these effects observable early after surgery? HYPOTHESIS: We hypothesized that the BRICKS rehabilitation program would result in superior sensory and functional recovery compared with non-formal therapy. PATIENTS AND METHODS: This single-centre prospective study included adult patients with severe CTS (grade 4-6) undergoing CTR between 2022 and 2025. Postoperatively, patients received either non-formal therapy (NFT group) or a structured home-based rehabilitation program using plastic building-block toys (BRICKS group). The primary endpoint was the comparison of sensory discrimination (Weber test) at 3 months postoperatively. Secondary endpoints included comparison of Boston Carpal Tunnel Questionnaire Symptom Severity Scale [BCTQ-SS] and Functional Form [BCTQ-FF] results at 3 months postoperatively as well as as all outcome measurements obtained at 1 month postoperatively. A total of 40 patients were included (20 per group). RESULTS: Both groups showed significant improvements in Weber test, BCTQ-SS, and BCTQ-FF scores between preoperative and postoperative assessments (1 and 3 months). At 1 month, the Weber test was significantly lower in the BRICKS group compared with the NFT group (3.4 ± 1.0 vs 4.5 ± 1.2), with no between-group differences in BCTQ scores. At 3 months, the BRICKS group demonstrated significantly better outcomes for all endpoints, with lower Weber test values (2.8 ± 0.6 vs 4.1 ± 1.2), BCTQ-SS scores (13.3 ± 1.8 vs 16.6 ± 3.0), and BCTQ-FF scores (9.5 ± 1.7 vs 12.0 ± 3.3) compared with the NFT group. DISCUSSION: A structured, task-oriented rehabilitation program using building-block activities improved sensory discrimination and functional outcomes following CTR, with effects becoming significant at 3 months. These findings support the integration of engaging, home-based rehabilitation strategies to enhance postoperative recovery in severe CTS, in line with growing evidence favoring active, task-specific rehabilitation approaches. LEVEL OF EVIDENCE: III; Therapeutic.