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other disease parameters, nerve conduction, and ultrasonography testing. All ten
items had similar correlation coeffi cient with the principal component (0.71–0.84).
The authors concluded that the modifi ed BCTQ was found to be a reliable and valid
instrument that can be self-administered to evaluate the functional disability of
patients presenting with carpal tunnel syndrome manifestations.
The Michigan Hand Outcomes Questionnaire ( MHQ )
The questionnaire was developed in 1998 for use in the assessment of outcome for
various hand disorders [ 41 ]. Content was guided by several established question-
naires including items from the SF-36 and the Arthritis Impact Measurement Scale,
which were for dimensions relating to work performance and physical function,
whilst items from the McGill Pain Scale and Carpal Tunnel Questionnaire were
used for the development of questions for the pain domain. Additional items were
generated by a group of patients.
The instrument has 37 items and consists of 6 domains: (1) overall hand func-
tion, (2) activity of daily living, (3) pain, (4) work performance, (5) aesthetics, and
(6) patient satisfaction with hand function.
All items are in the form of questions ranked on a scale of 1–5. In the pain scale,
high scores indicate greater pain; while in the other 5 scales, high scores denote bet-
ter hand performance.
The raw scale score for each of the 6 scales is the sum of the responses of each
scale item. The raw score is converted to a score ranging from 0 to 100. The instru-
ment may be self-, interview-, or telephone-administered.
Several aspects of validity have been demonstrated by the authors of the original
evaluation of the MHQ [ 42 ]. Signifi cantly improved MHQ scores have been shown
after surgery for all dimensions, with pain being the most responsive dimension.
Kotsis et al. [ 43 ] reported that MHQ was more responsive to change than the
Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire (see
later) in CTS patients undergoing carpal tunnel decompression surgery. In contrast,
in another study [ 44 ], which included 53 CTS patients undergoing carpal tunnel
decompression surgery, signifi cant improvements were reported only in three of six
domains (function, work, and pain) when related to patient satisfaction.
The Six-Item CTS Symptoms Scale (CTS-6)
The questionnaire was developed in 2009 [ 39 ] as a brief outcome measure of symp-
toms in CTS. It was developed based on the 11-item Symptom Severity Scale sug-
gested by Levine et al. [ 31 ]. The questionnaire is composed of six tests varying from
history and physical exam, namely: (1) numbness in the hand and fi ngers supplied by
the median nerve, (2) muscle atrophy and/or weakness, (3) a positive Phalen’s test
Y. El Miedany