331favor of electrodiagnostic testing for the CTS diagnosis [ 17 – 19 ], abnormal nerve
conduction study results do not necessarily equate to the correct diagnosis.
Furthermore, earlier reports showed that nerve conduction testing can be normal in
early cases [ 20 ]. In concordance with these fi ndings, other studies revealed that neu-
rophysiological measures of the median nerve in CTS were “nonsensitive” to change
or management, hence, a poor predictor of treatment outcomes [ 21 , 22 ]. This disso-
ciation between clinical-neurophysiological outcomes and patients’ symptoms
paved the way for most of the recent research studies on CTS to rely on patient
symptoms analysis. Studies revealed that patient reported outcomes were able to
measure outcome dimensions not captured by traditional objective evaluations of
median nerve impairment [ 23 , 24 ].
Status and Response Measures in Carpal Tunnel Syndrome
When assessing patients with CTS, it is important to differentiate between two con-
cepts: “status” and “response” measures. Whilst “status measures” assess the dis-
ease severity at a specifi c point in time, “response measures” assess how disease
status changes over time, for example, response to management whether conserva-
tive or surgical. Therefore, remission is considered to be a status measure [ 25 ].
These measures are important when the treating health care professional evaluates
treatment strategies in individual CTS patients. Furthermore, as response measures
evaluate change in clinical status over time, it can be used, not only to determine
effi cacy but it can also be implemented in longitudinal observational studies to eval-
uate clinical change over time.
Outcome Measures
The evidence-based medicine is moving swiftly toward outcome-driven practice.
Data and consequent outcome analysis attained from various treatment protocols
are expected to facilitate the assessment of quality of the management provided and
potentially may help to modify our practice. Outcomes from carpal tunnel manage-
ment have been evaluated in several ways, including objective neurophysiological
assessment, clinical measures of sensory and muscle affection, patient-perceived
symptoms and functional ability, as well as the impact on activities of daily living
and work. Broadly, there is a lack of consensus among researchers over what could
be the most reliable, valid, and responsive tool to assess outcomes in CTS manage-
ment [ 26 – 28 ]. However, in general, there is an agreement on three domains that can
be used to describe the long- and short-term CTS consequences and should be con-
sidered in defi ning remission: clinical symptoms and signs, functional impairment,
and structural nerve damage (muscle wasting or weakness/sensory defi cit) [ 21 , 22 ].
13 PROMs for Carpal Tunnel Syndrome