The Polish version of the Boston Carpal Tunnel Questionnaire: Associations between patient-rated outcome measures and nerve conduction studies

A "Clear" Carpal Tunnel Syndrome Diagnosis on Ultrasound Examination Does Not Predict Improved Outcomes When Compared With a "Borderline" Diagnosis

BACKGROUND

Nerve conduction studies (NCS) and ultrasound (US) remain imperfect compared with clinical diagnosis and/or diagnostic tools such as carpal tunnel syndrome-6 (CTS-6) for diagnosis of carpal tunne syndrome (CTS). One potential reason for the discrepancy between clinical diagnosis and testing is "borderline" case inclusion. This study aims to compare clinical outcomes after carpal tunnel release (CTR) between "borderline" and "clear" patients with CTS determined by NCS and US.

METHODS

This was a retrospective review of patients who underwent CTR. We collected NCS and US measurements of the median nerve cross-sectional area (MNCSA) at the carpal tunnel inlet, and the Boston Carpal Tunnel Questionnaire (BCTQ) scores comprised of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). Ultrasound measurements defined patients as having "borderline" (MNCSA < 13 mm2) or "clear" (MNCSA ≥ 13 mm2) CTS.

RESULTS

The study included 94 unilateral patients with CTS. "Borderline" CTS was diagnosed in 58 patients (62%), and "clear" CTS was diagnosed in 36 patients (38%). No significant differences in BCTQ scores were found between groups. At greater than 6-month follow-up, the mean FSS was 1.44 and 1.45 for clear and borderline groups, respectively (P = .97) and the mean SSS was 1.47 and 1.51, respectively (P = .84). However, a significant difference between groups when comparing distal motor latency (DML) and distal sensory latency (DSL) existed. The mean DSL was 3.71 and 4.44 for the clear and borderline groups, respectively (P = .02). The mean DML was 4.59 and 5.36 (P = .048).

CONCLUSION

Categorizing CTS diagnosis into "borderline" and "clear" based on preoperative US and NCS testing did not correlate with BCTQ changes after CTR. It remains unclear whether the BCTQ is a valid postoperative assessment tool, despite its frequent use in literature.

Validation of the Polish versions of the Lower Limb Task Questionnaire, Lower Limb Functional Index, and Lower Limb Functional Index-10

BACKGROUND

Physicians who treat patients with lower limb diseases should pay attention not only to the patients' clinical condition but also to their individual needs and expectations. For this purpose, many different questionnaires can be employed. This study aimed to validate the Lower Limb Task Questionnaire (LLTQ), Lower Limb Functional Index (LLFI), and Lower Limb Functional Index-10 (LLFI-10) for their use in Polish conditions and to perform a mutual comparison and analysis of differences in subjective assessments by patients who undergo hip or knee arthroplasty.

METHODS

The LLTQ, LLFI, and LLFI-10 were translated into Polish. A total of 103 patients who qualified for hip or knee arthroplasty at a University Hospital in from 2019 to 2021 were included in this study. The patients were asked to complete the Polish versions of the LLTQ, LLFI, LLFI-10, Lower Extremity Functional Scale (LEFS), and Short Form-36 four times - twice before and twice after their surgeries.

RESULTS

The Polish versions of the LLTQ, LLFI, and LLFI-10 had good psychometric properties. One year after surgery, the Cohen's standard response mean revealed high improvement of limb functionality and thus quality of life among all patients. We observed better treatment outcomes among patients who had hip osteoarthritis.

CONCLUSIONS

The questionnaires were validated and can be used both in everyday health practice and in further research in Poland.

Field testing and psychometric properties of Thai version of the Boston carpal tunnel questionnaire

Introduction

The Boston Carpal Tunnel Questionnaire (BCTQ) is a widely recommended patient-reported outcome measure to evaluate symptoms and functions in carpal tunnel syndrome (CTS) patients. We aimed to evaluate the translation and cross-cultural adaptation of the Thai version of the BCTQ (Thai BCTQ) and to investigate the psychometric properties including internal consistency, test-retest reliability, construct validity and responsiveness.

Methods

The Thai BCTQ was field tested with 15 healthy volunteers and 15 CTS patients to evaluate the item-objective congruence of each item. Following that, one hundred and twenty-four CTS patients were included for psychometric evaluation in this study. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was examined using the intraclass correlation coefficient (ICC). To evaluate construct validity, Spearman's rank correlation of the symptom severity scale (Thai BCTQ -S), the functional status scale (Thai BCTQ -F) and the subscales of the Thai MHQ were analyzed. Responsiveness was determined using the standardized response mean (SRM).

Results

Minor modification of the Thai version was made to better explain the term "tingling". The Thai BCTQ-S, Thai BCTQ-F and Thai BCTQ demonstrated adequate Cronbach's alpha values (0.91-0.94) and good test-retest reliability (ICC=0.89-0.98). Regarding related dimensions, a strong correlation (r=0.67, P<0.008) was found between the Thai BCTQ-F and the Function subscale of Thai MHQ as well as between Thai BCTQ-F and the Activities of Daily Living subscale of the Thai MHQ (r=0.75, P<0.008). In unrelated dimensions, there was a relatively weak correlation between the Thai BCTQ-S and the Aesthetics subscale of the Thai MHQ (r=0.32, P=0.0116). The SRM of the Thai BCTQ was 1.46, indicating large responsiveness.

Discussion

The Thai BCTQ has adequate internal consistency in both the symptom and function scales as well as good construct validity and test-retest reliability indicating it is suitable for evaluating Thai CTS patients. This tool also has a high ability to detect clinically significant changes in symptoms and function over time after receiving conservative or surgical treatment.

Boston Carpal Tunnel Questionnaire Scores Alone Do Not Predict Surgical Intervention for Patients With Carpal Tunnel Syndrome

BACKGROUND

With the expanded indications for telemedicine, there is increased utility for screening methods to determine which patients are likely to progress to surgical intervention, requiring in-person visits. Patient-rated tools such as the Boston Carpal Tunnel Questionnaire (BCTQ) may be one such tool for screening patients with carpal tunnel syndrome (CTS). The aim of the study was to evaluate whether BCTQ scores were predictive of offering conservative treatment or surgical intervention for CTS.

METHODS

Patients diagnosed with CTS from January 2017 to February 2020 completed BCTQ questionnaires prior to in-person office visits. Demographics, comorbidities, and highest level of intervention recommended were recorded for each patient as conservative, injection, or surgery. Pearson χ2 and independent-samples t tests were conducted to determine whether BCTQ symptom severity and functional scores were associated with intervention type.

RESULTS

A total of 200 patients with CTS were included. Of these, 103 were recommended conservative or injection treatment and 97 were recommended surgery. There were no differences in comorbidities between groups, including other upper extremity pathology (P = .57), previous upper extremity surgery (P = .32), hypertension (P = .17), hypothyroidism (P = .15), rheumatoid arthritis (P = .34), and diabetes (P = .30). Between these groups, there were no differences in BCTQ symptom severity score (symptom severity scale [SSS]; P = .16) or BCTQ functional severity score (functional severity scale [FSS]; P = .96).

CONCLUSIONS

There is no correlation between comorbidities and BCTQ SSS or FSS score, and offering surgery for CTS. In an era of minimizing non-essential health care visits, the BCTQ is insufficient in screening patients as potential surgical candidates.

The adaptation of Polish version of Six-Item Carpal Tunnel Syndrome Symptoms Scale

BACKGROUND

The Carpal Tunnel Syndrome is one of the most common peripheral neuropathy. The diagnosis could be made by taking the medical history from a patient or by physical examination or by performing electroneurography. The aims of the study were (1) to translate and adaptate the Polish version of the Six-Item Carpal Tunnel Syndrome Symptoms Scale (CTS-6 SS) and (2) to analyse the associations between different Patients-Reported Outcome Measures and nerve conduction studies (NCS).

METHODS

One-hundred and fifty patients consistent with inclusion criteria filled the CTS-6 SS, Boston Carpal Tunnel Questionnaire (BCTQ), Disabilities of the Arm, Shoulder and the Hand (DASH) and Michigan Hand Outcomes Questionnaire (MHQ) during their first visit to the clinic. Then, they had the NCS done. After two weeks, 99 patients filled the CTS-6 SS for the second time.

RESULTS

The Polish version of CTS-6 SS revealed good psychometric properties: high values of internal consistency, test-retest reliability and validity. The construct validity showed strong correlation with BCTQ - R = 0.87 (p < 0.05) for Symptoms Severity Scale (SSS) and R = 0.64 (p < 0.05) Functional Status Scale (FSS). Additionally CTS-6 SS has at least moderate correlation with DASH R = 0.53 (p < 0.05).

CONCLUSIONS

The Polish version of translated scale was adapted and used together with NCS complete the overall picture of patients suffering from CTS.

STUDY DESIGN

Prospective study.

Comparison of clinical findings and electromyography results in patients with preliminary diagnosis of carpal tunnel syndrome

OBJECTIVE

To evaluate the link between EMG findings and clinical status, the Boston questionnaire and the severity of pain in patients with pre-diagnosis of carpal tunnel syndrome.

METHODS

A total of 85 patients (133 hands) who presented to the Physical Therapy and Rehabilitation outpatient clinic consecutively with complaints of numbness, tingling, pain and weakness in their hands were evaluated for their demographic and clinical features. After the initial evaluation, the diagnosis of CTS was confirmed by EMG. Visual analog scale (VAS), the Boston Questionnaire (Symptom Severity Scale = SSS, Functional Status Scale = FSS) and nerve conduction study results (sensory conduction velocity = SCV, distal motor latency = DML, compound muscle action potential = CMAP) were enrolled.

RESULTS

Eighty-five patients (58 female and 27 male) participated in this study yielding 133 hands (73 right hands, 60 right hands) with CTS. The mean age was 48.3 ± 10.41 years. Of all patients, 68.2 % were female and 31.8 % were male. A statistically significant relationship was found between SSS and duration of symptoms, VAS, both right and left SCV, DML and CMAP. A statistically significant relationship was found between FSS and duration of symptoms, VAS and only right SCV, DML and CMAP.

CONCLUSION

The diagnosis of CTS should be evaluated not only as an electrodiagnostic finding, but also the clinical picture of the patients. According to our results, both SSS and FSS had good correlations with VAS and the findings of EMG. Therefore, the Boston Questionnaire can provide a standardized measure of symptom severity and functional status in patients with CTS.

The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial

INTRODUCTION

Carpal tunnel syndrome (CTS) is a common disorder that limits function and quality of life. Little evidence is available on the long-term effect of neurodynamics and exercise therapy.

PURPOSE OF THE STUDY

This study aimed to examine the long-term effect of neurodynamic techniques vs exercise therapy in managing patients with CTS.

STUDY DESIGN

Parallel group randomized clinical trial.

METHODS

Of 57 patients screened, 51 were randomly assigned to either receiving four sessions of neurodynamics and exercise or home exercise therapy alone as a control. Blinded assessment was performed before treatment allocation, at treatment completion, and 6 months posttreatment. Outcome measures included Symptom Severity Scale (SSS), Functional Status Scale (FSS), Shortened version of the Disabilities of the Arm, Shoulder, and Hand (DASH), Numerical Pain Rating Scale, grip strength and range of motion.

RESULTS

Data from 41 individuals (52 hands) were analyzed. The neurodynamics group demonstrated significant improvement in all outcome measures at 1 and 6 months (P < .05). Mean difference in SSS was 1.4 (95% CI= 0.9-1.4) at 1 month and 1.6 (95% CI = 0.9-2.2) at 6 months. Mean difference in FSS was 0.9 (95% CI = 0.4-1.4) at 1 month and 1.4 (95% CI = 0.7-2.0) at 6 months. Significant between-group differences were found in pain score at 1 month (-1.93) and in FSS (-0.5) and Shortened version of DASH (-12.6) at 6 months (P < .05). No patient needed surgery 1 year after treatment.

CONCLUSIONS

Although both treatments led to positive outcomes, neurodynamics therapy was superior in improving function and strength and in decreasing pain.

Using Carpal Tunnel Questionnaire in clinical practice: A systematic review of its measurement properties

INTRODUCTION

Carpal Tunnel Questionnaire (CTQ) is widely used for assessing condition-specific impairments in individuals with carpal tunnel syndrome (CTS) or for assessing outcomes after carpal tunnel surgery (carpal tunnel release [CTR]). A systematic review of its measurement properties can greatly facilitate its evidence-based use in clinical practice. The purpose of this study was to systematically locate, appraise, and synthesize the evidence concerning the reliability, responsiveness, validity, minimal detectable change (MDC), and minimal clinically important difference (MCID) for the CTQ and its scales.

STUDY DESIGN

This is a systematic review of measurement properties.

METHODS

Using predefined keywords, PubMed, CINAHL, PsychInfo, and ProQuest were searched to locate primary studies that assessed measurement properties of the CTQ. The methodological quality of the included studies was assessed using a standardized tool. Data concerning the measurement properties were extracted and synthesized. The pooled estimates for the indices of test-retest reliability, standard error of measurement, responsiveness, MDC, and MCID were calculated from the included studies.

RESULTS

A total of 34 articles were deemed eligible and included in this review. The methodological quality of these 34 studies was generally good. Most studies suggested that the CTQ and its scales had good test-retest reliability and internal consistency. However, few studies found that the Symptom Severity Scale had more than one factor. The responsiveness of the CTQ and its scales was excellent across the studies. The pooled estimates for the MDC₉₀ and MCID for Symptom Severity Scale/Functional Status Scale were 0.72/0.79 and 1.05/1.13, respectively.

DISCUSSION

The results of this review support the use of CTQ and its scales in assessing conditions-specific impairments in individuals with CTS or after CTR. However, an effort should be made to review and modify the content of the symptom severity scale due to multiple reports challenging its unidimensional structure.

CONCLUSIONS

The totality of evidence emerging from this systematic review suggests that the CTQ and its scales provide reliable and valid estimate of impairments resulting from CTS or after CTR.

Analysis of the Long-Term Outcome in Open Carpal Tunnel Release Surgeries with and without External Neurolysis of Median Nerve, Using Boston Carpal Tunnel Questionnaire (BCTQ)-Hindi Version

Background  The effectiveness of open carpal tunnel release (OCTR) in treating carpal tunnel syndrome (CTS) is well known. However, the role of ancillary external neurolysis of the median nerve is not well-documented. The Boston carpal tunnel questionnaire (BCTQ) is a commonly used disease-specific outcome instrument for CTS, which is validated across major languages of the world. No such validated Hindi version of BCTQ exists.

Objectives  To analyze and compare the long-term outcome in patients who underwent OCTR alone and OCTR with external neurolysis of the median nerve, using BCTQ–Hindi version, while checking its validity.

Materials and Methods  A retrospective, cross-sectional study was conducted at a tertiary care institute. The BCTQ was translated into Hindi language by a language expert. Eighty-four consecutive patients who underwent either unilateral/bilateral OCTR, with or without external neurolysis of the median nerve, between 2009 and 2019 were included in the study. Outcome analysis was done using BCTQ–Hindi version and patient satisfaction scoring. BCTQ–Hindi version was examined for statistical validity. Subgroup analysis of the outcome based on surgical technique (OCTR vs. OCTR with external neurolysis) used was carried out.

Results  Response rate was 80.9%. Total hands evaluated were 108. BCTQ–Hindi version showed statistical validity. Overall symptom severity score (SSS) and functional severity score (FSS) were 1.14 ± 0.4 and 1.12 ± 0.35, respectively. Subgroup analysis of outcome revealed statistically significant results in favor of OCTR with external neurolysis of the median nerve.

Conclusions  BCTQ–Hindi version is statistically validated. OCTR with external neurolysis of the median nerve is a promising avenue in surgical management of CTS. Further prospective studies are warranted.

Measurement properties of the Danish version of the Boston Carpal Tunnel Questionnaire

Background and Aims

Patient reported outcome measures are often used in medical research to evaluate symptoms and functional status in patients. The Boston Carpal Tunnel Questionnaire is specifically designed to evaluate functional status and symptom severity in patients with Carpal Tunnel Syndrome. The aim of this study was to validate and examine the measurement properties of the Functional Status Scale and Symptom Severity Scale from the Danish translated Boston Carpal Tunnel Questionnaire.

Material and Methods

We analyzed 88 prospectively enrolled patients in the validity and responsiveness group and 31 prospectively enrolled patients in the reliability group. Patients in the validity and responsiveness group answered the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire and the Danish translated Boston Carpal Tunnel Questionnaire preoperatively and after surgery. Patients in the responsiveness group answered the same questionnaire two times prior to surgery.

Results

Responsiveness of the two subscales were high (Effect Size 0.99/1.76; Standardized Response Mean 0.86/1.50). Correlation to the Danish validated QuickDASH was high (rho 0.75/0.89). Test-retest reliability was high (ICC 0.94/0.90) and the internal consistency was high (Cronbach's alpha 0.93/0.92).

Conclusion

Our study shows satisfactory results of both subscales of the Danish translated Boston Carpal Tunnel Questionnaire. This makes it highly useful when conducting research on patients with Carpal Tunnel Syndrome.

Trial registration

The Danish Data Protection Agency: jr. nr. 2007-58-0010.

Validation of the Slovakian version of Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ)

INTRODUCTION

The most common occupational disease is carpal tunnel syndrome. The aim of this study was to translate and validate the Slovakian version of BCTSQ.

METHODS

The original questionnaire was translated into the Slovakian language by two expert translators. Cronbach's alpha coefficient was used to analyze the internal consistency of the questionnaire. Construction validity was evaluated by using Pearson's correlation coefficient and Spearman's rank correlation. The results were processed in the statistical program SPSS 24. The level of significance p > 0.05 was considered significant. To analyze the validity, a factor analysis of the BCTSQ and the correlation between BCTSQ and SF-36 were obtained.

RESULTS

A total of 32 employees at risk of local muscular overload completed the BCTSQ and Health Questionnaire SF-36. Cronbach's alpha for SSS was >0.8. The alpha coefficient for FSS was >0.9. The Pearson's coefficient and Spearman's rank correlation was >0.9 for each domain. Cronbach's alpha for SF-36 was >0.7 and the Pearson's coefficient and Spearman's rank correlation was >0.6 and p-values <0.001.

CONCLUSIONS

The questionnaire has sufficient reliability, validity and can be a suitable tool for the evaluation of subjective response of employees at the risk of local muscular overload, as well as of patients with carpal tunnel syndrome.

A magnetoencephalographic study of longitudinal brain function alterations following carpal tunnel release

We investigate changes in brain function before and after carpal tunnel release. Magnetoencephalography (MEG), during which we recorded somatosensory evoked cortical magnetic fields (SEFs), and a clinical evaluation were performed before surgery and 6 months after. The distance on the vertical axis between the equivalent current dipoles (ECDs) for the first and third digits before surgery was significantly less than after surgery. There were no significant differences in values between the control participant and patients after surgery. In terms of distal motor latency, there was a negative correlation with the distance. The recovery function of the root mean square (RMS) before surgery for the N20m was less suppressed at 10 ms of ISI in patients, compared to controls. There were no significant differences in the RMS values for patients before and after surgery. Our results indicate that treating peripheral nerve lesions, such as in carpal tunnel release, positively modifies brain function.

Cross cultural adaptation, reliability and construct validity of the Boston Carpal Tunnel Questionnaire in standard Arabic language

PURPOSE

To perform cross cultural adaptation of Boston Carpal Tunnel Questionnaire in standard Arabic language and assess the reliability and construct validity of the new tool.

MATERIALS AND METHODS

Cross cultural adaptation was performed according to guidelines. One hundred and one Arabic patients with carpal tunnel syndrome agreed to participate in the study and filled the questionnaire. Cronbach's alpha was calculated to assess internal consistency. Test-retest reliability was assessed after two weeks by calculating Intraclass correlation coefficient. To assess construct validity; Spearman correlation coefficient with the Disabilities of the Arm, Shoulder and Hand Questionnaire was calculated.

RESULTS

Arabic Boston Carpal Tunnel Questionnaire version had excellent internal consistency, Cronbach's Alpha was 0.877 for Symptoms Severity Scale and 0.895 for Functional Status Scale. Test-retest reliability was excellent (Interclass Correlation Coefficient was 0.899 for Symptoms Severity Scale and 0.944 for Functional Status Scale). Correlation with the Disabilities of the Arm, Shoulder and Hand Questionnaire was high which reflects excellent construct validity. All results were similar to the results of previous studies.

CONCLUSIONS

Arabic Boston Carpal Tunnel Questionnaire was produced. The tool demonstrated excellent internal consistency, test-retest reliability and construct validity. The questionnaire is suitable for use with carpal tunnel syndrome patients in the Middle East and North Africa region. Implications for rehabilitation Carpal tunnel syndrome is the most common peripheral neuropathy worldwide with many affected in Arabic speaking countries. Specific outcome measures like Boston Carpal Tunnel Questionnaire are important in evaluating the impact of different interventions on patients' wellbeing. The Arabic Boston carpal tunnel questionnaire is a valid and reliable tool to use with Arabic speaking people with Carpal Tunnel Syndrome.