Carpal Tunnel Syndrome (CTS)NCT07302282
The Effectiveness of Pain Neuroscience Education for Patients With Carpal Tunnel Syndrome
A study testing Exercise and Pain neuroscience education in people with Carpal Tunnel Syndrome (CTS), run by Karamanoğlu Mehmetbey University at 1 site in Turkey (Türkiye).
Trial summary
The goal of this clinical trial is to investigate the effects of Pain Neuroscience Education applied in the treatment of mild and moderate carpal tunnel syndrome (CTS). The main question it aims to answer is: Does PNE have a therapeutic effect on carpal tunnel syndrome in clinical and ultrasonographic terms?… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Carpal Tunnel Syndrome (CTS)
- What is being tested?
- Exercise and Pain neuroscience education
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 48 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 29 Dec 2025to 31 Jul 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Being 18 years of age or older
- Having a diagnosis of mild or moderate CTS confirmed by ENMG
- Having complaints of pain and numbness in the first three fingers of the hand for at least 3 months
Who cannot join
- Presence of severe CTS findings on electrophysiological examination
- Presence of metabolic diseases such as uncontrolled diabetes and hypothyroidism
- Presence of inflammatory rheumatic disease (e.g., rheumatoid arthritis)
- Presence of other neuromuscular diseases affecting the hand and wrist (Polyneuropathy, Cervical radiculopathy, peripheral nerve damage, Brachial plexus damage, other entrapment neuropathies, etc.)
- History of hand and wrist trauma
- History of neck and wrist surgery
Show all 11Show fewer
- History of steroid injection into the carpal tunnel within the last 3 months
- History of physical therapy application to wrist within the last 3 months
- Deformity preventing the use of a splint on the wrist
- Previous participation in a program for the psychological management of chronic pain
- Cognitive dysfunction preventing cooperation with tests
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Karaman Training and Research Hospital
Karaman, Karaman, 70200
About this study
Official title: The Effectiveness of Pain Neuroscience Education for Patients With Mild to Moderate Carpal Tunnel Syndrome
The goal of this clinical trial is to investigate the effects of Pain Neuroscience Education applied in the treatment of mild and moderate carpal tunnel syndrome (CTS).
The main question it aims to answer is: Does PNE have a therapeutic effect on carpal tunnel syndrome in clinical and ultrasonographic terms? Researchers will compare whether PNE creates a synergistic effect alongside home based exercise programs and splint application in mild to moderate CTS, and will objectively demonstrate potential benefits such as relief from pain and numbness.
Read the detailed description
Carpal Tunnel Syndrome (CTS) is a common compressive neuropathy of the median nerve that presents with symptoms of numbness and tingling in the median nerve distribution of the hand. If symptoms are not treated early, they become chronic. Factors affecting the severity of chronic pain include; biological, psychological and social/environmental etc.
Pain neuroscience education is a treatment strategy that aims to teach patients about the effects of their beliefs and behaviors on the formation of their pain experiences. This education focuses on the role of the central nervous system in pain by raising awareness about the neurobiology and neurophysiology of pain. It focuses on remodelling the behavioral approach to pain perception rather than anatomical damage. This approach aims to reduce patients' fear and catastrophizing by helping them better understand pain. Various metaphors, examples, and visuals are used during PNE to help patients understand pain mechanisms. PNE is thought to have an impact not only on pain but also on disability, functionality, and quality of life. PNE has been documented to have a positive effect not only on pain but also on other important factors such as disability, functionality, and quality of life.
A clinical study has shown that adding PNE to a telerehabilitation program has some positive effects, such as a reduction in symptom severity in patients with carpal tunnel syndrome. However, the number of studies in the literature on the efficacy of PNE in carpal tunnel syndrome is limited to a single study and is based on subjective methods such as patient statements. Unlike the previous study, this study will use objective and innovative assessment methods such as ultrasonography, quantitative sensory test and examination to evaluate symptoms and function.
The evaluation methods used in the study will enable a more in-depth and reliable analysis of symptom management and recovery processes, thereby facilitating the collection of more accurate and reliable data. As there are no similar studies using objective evaluation methods, the methodological contributions of this study will be highly valuable. By offering an innovative approach to pain management and rehabilitation through conservative treatment, it will make significant contributions to both scientific literature and clinical practice.
- Conditions
- Carpal Tunnel Syndrome (CTS)
- Being tested
- Exercise, Pain neuroscience education
- Keywords
- Median Neuropathy, Mononeuropathies, Nerve Compression Syndromes, Education, Exercise, Pain neuroscience education, Carpal tunnel syndrome, Median nerve gliding exercise
- Medical subject headings
- Carpal Tunnel Syndrome, Median Neuropathy, Mononeuropathies, Nerve Compression Syndromes, Motor Activity
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
ExerciseOther
Also called Median nerve gliding exercises, Self-stretching of carpal ligament
Stretching the transverse carpal ligament helps correct imbalance and provides more space for the median nerve, supporting nerve mobility. Stretching also balances flexor and extensor muscles, reduces tension, and supports overall hand health.
Nerve gliding exercises, similar to stretching, aim to restore nerve mobility and reduce symptoms.
Pain neuroscience educationBehavioural
PNE is an educational intervention aiming to alter a patient's beliefs and cognitions regarding their pain experience. The main contents addressed in the educational session were: neurophysiological aspects of pain, biopsychosocial aspects of pain, concept of peripheral and central sensitization, using audio-visual support, examples and metaphors for a better understanding by the patient, as reported in previous studies.
| Study group | Role | What they receive |
|---|---|---|
| Group 1 (home based exercise program) | Active comparator | Group 1 will receive training on median nerve gliding exercises and self-stretching exercises for the carpal ligament. Patients will be asked to perform 3 sets of median nerve gliding exercises, each consisting of 10 repetitions, and self-stretching exercises for the carpal ligament 3 times a day for 30 seconds as part of home program. Receives: Other: Exercise |
| Group 2 (home based exercise program and pain neuroscience education) | Experimental | Group 2 will receive exercise and pain neuroscience education. The exercise will be taught as a home program, similar to the other group. Pain neuroscience training will be provided twice a week for a total of 6 sessions by a trained physical therapist. Receives: Other: Exercise; Behavioral: Pain neuroscience education |
What is being measured
The primary outcome is the main question the study is designed to answer.
Boston Carpal Tunnel Questionnaire - Symptom Severity Scale
Symptom Severity Scale is an 11-item questionnaire used to assess symptom severity in individuals with CTS. Each item is scored from 1 to 5. Scores range from 1 (no symptoms) to 5 (worst symptoms). The patient's symptom severity score is the average score of 11 items.
Measured: Baseline, in the 3rd week and in the 6th week
Boston Carpal Tunnel Questionnaire - Functional Status Scale
Functional Status Scale is an 8-item questionnaire used to assess the functional status of patients with CTS. Each item is scored from 1 to 5. Scores range from 1 (no functional deficit) to 5 (worst possible function). The patient's functional status score is the average of all 8 items.
Measured: Baseline, in the 3rd week and in the 6th week
Numerical Rating Scale
Patients rate the current pain intensity from 0 ("no pain") to 10 ("worst possible pain").
Measured: Baseline, in the 3rd week and in the 6th week
6-item carpal tunnel syndrome symptom scale (CTS-6)
6 items are evaluated out of a total of 26 points. If the patient's total score is above 5, the probability of carpal tunnel syndrome is 25%, while if it is above 12, the probability reaches 80%.
Measured: Baseline, in the 3rd week and in the 6th week
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)
It consists of a total of 7 items. The scale is scored between 0 and 24, with a score of 12 or higher suggesting neuropathic pain.
Measured: Baseline, in the 3rd week and in the 6th week
Secondary outcomes (6)
Ultrasound median nerve cross-sectional area
The cross-sectional area of the median nerve is significantly higher in CTS patients compared to the normal population. Ultrasound, which is used to evaluate the median nerve and determine the underlying etiology, is also used to monitor the effectiveness of the treatment. The cross-sectional area measurement of the median nerve will be recorded in mm².
Measured: Baseline, in the 3rd week and in the 6th week
Semmes-Weinstein Monofilament Test
It is used to assess light touch sensation. The assessment is performed using 5 separate monofilaments. The numerical value in the test kits represents the logarithm of 10 times the force required to bend the monofilament, expressed in milligrams. The numerical values are 2.83 (normal light touch sensation), 3.61 (decreased light touch), 4.31 (decreased protective sensation), 4.56 (loss of protective sensation), and 6.65 (loss of deep pressure sensation). The test is performed by applying the monofilament to the tip of the index finger at a 90-degree angle to the skin for 1.5 seconds, repeated three times. The patient must perceive at least one of the monofilament applications as normal. Failure to perceive the 2.83 threshold value is significant for carpal tunnel syndrome.
Measured: Baseline, in the 3rd week and in the 6th week
Two-Point Discrimination Test (2PD)
It is used to assess cortical tactile sensation. The test is applied to the lateral part of the volar surface of the index finger tip. During the test, patients are asked to close their eyes and indicate whether they feel a single or double point. To prevent incorrect sensory perception, pressure exceeding 1 mm is not applied to the skin. The distance between the two points is increased by 1 mm at a time, starting from 1 mm, until the patient feels two distinct points. In the evaluation, a measurement value perceived as two points is considered normal if it is below 6 mm. The minimum distance between two points that can be distinguished by an individual will be tested three times at 1-minute intervals, and the average value will be recorded in centimeters.
Measured: Baseline, in the 3rd week and in the 6th week
Quantitative sensory evaluation
Starting at 32 °C, the Cold Detection Threshold is cooled at a rate of 1 °C per second, and the patient presses the button when they first feel the cold. For the Heat Detection Threshold, the temperature is heated at a rate of 1 °C per second, and the patient presses the button when they first feel the heat. For the cold pain threshold, it is cooled at a rate of 1 °C per second, and the patient presses the button when they feel cold pain. For the hot pain threshold, it is heated at a rate of 1 °C per second, and the patient presses the button when they feel hot pain. Each measurement is taken 3 times, and the average value is recorded in degrees Celsius.
Measured: Baseline, in the 3rd week and in the 6th week
Hand grip strength measurement
The Baseline® hydraulic hand dynamometer-90 kg (Fabrication Enterprises, White Plains, New York 10602, USA) will be used for hand grip strength measurements. According to the test procedure, three measurements will be taken for hand grip and finger grip strength, with one-minute intervals between each measurement, and the average peak force value will be recorded in kilograms.
Measured: Baseline, in the 3rd week and in the 6th week
Finger pinch strength measurement
The Baseline® hydraulic pinchmeter (Fabrication Enterprises, USA) will be used for pinch force measurements. According to the test procedure, three measurements will be taken for hand grip and finger grip strength, with one-minute intervals between each measurement, and the average peak force value will be recorded in kilograms.
Measured: Baseline, in the 3rd week and in the 6th week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Dec 2025
- Study start29 Dec 2025
- Primary completion31 Jul 2026
- Study completion31 Jul 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Carpal Tunnel Syndrome (CTS)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- After being diagnosed with mild to moderate CTS based on electrophysiological findings, patients will be randomly assigned to two groups. One group (Group 1) will receive home based exercise program, while the other group (Group 2) will receive home based exercise program and pain neuroscience education.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 48 participants (actual)
Sponsor and investigators
- Lead sponsor
- Karamanoğlu Mehmetbey University
- Sponsor type
- University, hospital or other
- Collaborators
- Karaman Training and Research Hospital
- Responsible party
- Principal investigator, MAHMUT TALHA SUSAM, Karamanoğlu Mehmetbey University
- Investigators
- Mahmut Talha Susam, MD, Study chair, Karamanoglu Mehmetbey University Physical Medicine and RehabilitationMahmut Talha Susam, MD, Principal investigator, Karamanoglu Mehmetbey University Physical Medicine and RehabilitationAynur Başaran, Prof.MD, Principal investigator, Karamanoglu Mehmetbey University Physical Medicine and RehabilitationSüleyman Gül, PhD, Principal investigator, Karamanoglu Mehmetbey University Physical Medicine and RehabilitationElif Dilara Durmaz, Pt, Principal investigator, Karaman Training and Research Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07302282
- Sponsor's protocol ID
- 25-2025/12
- Status last verified
- Dec 2025
- First submitted
- 28 Nov 2025
- Last updated
- 5 Aug 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 5 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effectiveness of Pain Neuroscience Education for Patients With Mild to Moderate Carpal Tunnel Syndrome
- ClinicalTrials.gov ID
- NCT07302282
- Acronym / sponsor ID
- 25-2025/12
- Conditions
- Carpal Tunnel Syndrome (CTS)
- Keywords
- Median Neuropathy, Mononeuropathies, Nerve Compression Syndromes, Education, Exercise, Pain neuroscience education, Carpal tunnel syndrome, Median nerve gliding exercise
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 48 participants (actual)
- Lead sponsor
- Karamanoğlu Mehmetbey UniversityUniversity, hospital or other
- Collaborators
- Karaman Training and Research Hospital
- Study start
- 29 Dec 2025 (actual)
- Primary completion
- 31 Jul 2026 (actual)
- Study completion
- 31 Jul 2026 (actual)
- First posted
- 24 Dec 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to investigate the effects of Pain Neuroscience Education applied in the treatment of mild and moderate carpal tunnel syndrome (CTS).
The main question it aims to answer is: Does PNE have a therapeutic effect on carpal tunnel syndrome in clinical and ultrasonographic terms? Researchers will compare whether PNE creates a synergistic effect alongside home based exercise programs and splint application in mild to moderate CTS, and will objectively demonstrate potential benefits such as relief from pain and numbness.
Detailed description
Carpal Tunnel Syndrome (CTS) is a common compressive neuropathy of the median nerve that presents with symptoms of numbness and tingling in the median nerve distribution of the hand. If symptoms are not treated early, they become chronic. Factors affecting the severity of chronic pain include; biological, psychological and social/environmental etc.
Pain neuroscience education is a treatment strategy that aims to teach patients about the effects of their beliefs and behaviors on the formation of their pain experiences. This education focuses on the role of the central nervous system in pain by raising awareness about the neurobiology and neurophysiology of pain. It focuses on remodelling the behavioral approach to pain perception rather than anatomical damage. This approach aims to reduce patients' fear and catastrophizing by helping them better understand pain. Various metaphors, examples, and visuals are used during PNE to help patients understand pain mechanisms. PNE is thought to have an impact not only on pain but also on disability, functionality, and quality of life. PNE has been documented to have a positive effect not only on pain but also on other important factors such as disability, functionality, and quality of life.
A clinical study has shown that adding PNE to a telerehabilitation program has some positive effects, such as a reduction in symptom severity in patients with carpal tunnel syndrome. However, the number of studies in the literature on the efficacy of PNE in carpal tunnel syndrome is limited to a single study and is based on subjective methods such as patient statements. Unlike the previous study, this study will use objective and innovative assessment methods such as ultrasonography, quantitative sensory test and examination to evaluate symptoms and function.
The evaluation methods used in the study will enable a more in-depth and reliable analysis of symptom management and recovery processes, thereby facilitating the collection of more accurate and reliable data. As there are no similar studies using objective evaluation methods, the methodological contributions of this study will be highly valuable. By offering an innovative approach to pain management and rehabilitation through conservative treatment, it will make significant contributions to both scientific literature and clinical practice.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- After being diagnosed with mild to moderate CTS based on electrophysiological findings, patients will be randomly assigned to two groups. One group (Group 1) will receive home based exercise program, while the other group (Group 2) will receive home based exercise program and pain neuroscience education.
| Arm | Type | Receives |
|---|---|---|
| Group 1 (home based exercise program) | Active comparator | Other: ExerciseGroup 1 will receive training on median nerve gliding exercises and self-stretching exercises for the carpal ligament. Patients will be asked to perform 3 sets of median nerve gliding exercises, each consisting of 10 repetitions, and self-stretching exercises for the carpal ligament 3 times a day for 30 seconds as part of home program. |
| Group 2 (home based exercise program and pain neuroscience education) | Experimental | Other: Exercise, Behavioral: Pain neuroscience educationGroup 2 will receive exercise and pain neuroscience education. The exercise will be taught as a home program, similar to the other group. Pain neuroscience training will be provided twice a week for a total of 6 sessions by a trained physical therapist. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Being 18 years of age or older
- Having a diagnosis of mild or moderate CTS confirmed by ENMG
- Having complaints of pain and numbness in the first three fingers of the hand for at least 3 months
Key exclusion criteria (11 listed)
- Presence of severe CTS findings on electrophysiological examination
- Presence of metabolic diseases such as uncontrolled diabetes and hypothyroidism
- Presence of inflammatory rheumatic disease (e.g., rheumatoid arthritis)
- Presence of other neuromuscular diseases affecting the hand and wrist (Polyneuropathy, Cervical radiculopathy, peripheral nerve damage, Brachial plexus damage, other entrapment neuropathies, etc.)
- History of hand and wrist trauma
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| ExerciseAlso: Median nerve gliding exercises, Self-stretching of carpal ligamentStretching the transverse carpal ligament helps correct imbalance and provides more space for the median nerve, supporting nerve mobility. Stretching also balances flexor and extensor muscles, reduces tension, and supports overall hand health. Nerve gliding exercises, similar to stretching, aim to restore nerve mobility and reduce symptoms. | Other | Group 1 (home based exercise program), Group 2 (home based exercise program and pain neuroscience education) |
| Pain neuroscience educationPNE is an educational intervention aiming to alter a patient's beliefs and cognitions regarding their pain experience. The main contents addressed in the educational session were: neurophysiological aspects of pain, biopsychosocial aspects of pain, concept of peripheral and central sensitization, using audio-visual support, examples and metaphors for a better understanding by the patient, as reported in previous studies. | Behavioural | Group 2 (home based exercise program and pain neuroscience education) |
Primary outcome
Boston Carpal Tunnel Questionnaire - Symptom Severity Scale
Time frame: Baseline, in the 3rd week and in the 6th week
Symptom Severity Scale is an 11-item questionnaire used to assess symptom severity in individuals with CTS. Each item is scored from 1 to 5. Scores range from 1 (no symptoms) to 5 (worst symptoms). The patient's symptom severity score is the average score of 11 items.
Boston Carpal Tunnel Questionnaire - Functional Status Scale
Time frame: Baseline, in the 3rd week and in the 6th week
Functional Status Scale is an 8-item questionnaire used to assess the functional status of patients with CTS. Each item is scored from 1 to 5. Scores range from 1 (no functional deficit) to 5 (worst possible function). The patient's functional status score is the average of all 8 items.
Numerical Rating Scale
Time frame: Baseline, in the 3rd week and in the 6th week
Patients rate the current pain intensity from 0 ("no pain") to 10 ("worst possible pain").
6-item carpal tunnel syndrome symptom scale (CTS-6)
Time frame: Baseline, in the 3rd week and in the 6th week
6 items are evaluated out of a total of 26 points. If the patient's total score is above 5, the probability of carpal tunnel syndrome is 25%, while if it is above 12, the probability reaches 80%.
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)
Time frame: Baseline, in the 3rd week and in the 6th week
It consists of a total of 7 items. The scale is scored between 0 and 24, with a score of 12 or higher suggesting neuropathic pain.
6 secondary outcomes
Ultrasound median nerve cross-sectional area
Time frame: Baseline, in the 3rd week and in the 6th week
Semmes-Weinstein Monofilament Test
Time frame: Baseline, in the 3rd week and in the 6th week
Two-Point Discrimination Test (2PD)
Time frame: Baseline, in the 3rd week and in the 6th week
Quantitative sensory evaluation
Time frame: Baseline, in the 3rd week and in the 6th week
Hand grip strength measurement
Time frame: Baseline, in the 3rd week and in the 6th week
Finger pinch strength measurement
Time frame: Baseline, in the 3rd week and in the 6th week
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Aug 2026.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mahmut Talha Susam, MD study chair
Karamanoglu Mehmetbey University Physical Medicine and Rehabilitation
Mahmut Talha Susam, MD principal investigator
Karamanoglu Mehmetbey University Physical Medicine and Rehabilitation
Aynur Başaran, Prof.MD principal investigator
Karamanoglu Mehmetbey University Physical Medicine and Rehabilitation
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Exercise and Pain neuroscience education in people with Carpal Tunnel Syndrome (CTS), run by Karamanoğlu Mehmetbey University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 5 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Boston Carpal Tunnel Questionnaire - Symptom Severity Scale (time frame: Baseline, in the 3rd week and in the 6th week). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Aug 2026.