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Kamath and Stothard Questionnaire
A clinical questionnaire developed in 2003 [ 49 ] for the diagnosis of CTS and to
assess whether the patients presenting with CTS symptoms should go for surgery.
The questionnaire consists of nine questions based on the work of Levine et al. [ 31 ].
The questionnaire has been validated in secondary care for the diagnosis of CTS
by Kamath and Stothard [ 49 ]. In their study, patients diagnosed as having CTS by
either the questionnaire, nerve conduction testing, or both, underwent decompres-
sion surgery. Symptom improvement was considered as the “gold standard” for true
CTS. The results revealed a sensitivity of 85 % for the scored questionnaire and
92 % for nerve conduction testing with a positive predictive value of 90 % for the
scored questionnaire and 92 % for neurophysiological assessment. Therefore, it was
concluded that a scored questionnaire can replace nerve conduction studies in the
initial assessment of whether patients presenting with dysesthesia in the fi ngers
should undergo surgery.
CTS-PROMs Questionnaire
The questionnaire, developed in 2006, is a composite patient-based outcome mea-
sure questionnaire developed specifi cally for CTS patients. One questionnaire was
designed for CTS diagnosis [ 49 ] (Appendix 2), whereas the other questionnaire
(CTS-PROMs Severity Scale Appendix 3) was for global assessment of symptoms
severity and functional status of CTS patients [ 50 ]. Both physicians and patients
were involved in the item generation process. After developing an item pool and a
list of the main clinical presenting symptoms was compiled, the CTS-PROMs for
diagnosis questionnaire was developed including 11 questions split over 5 scales:
paresthesia, nocturnal pain, diurnal pain, weakness, and repetitive stress injury
symptoms. This was the fi rst questionnaire to include specifi c three questions about
repetitive stress, which is the most important current underlying case for
CTS. Answering “yes” to the fi rst question about paresthesia in the median nerve
distribution plus any other two questions was considered diagnostic of CTS.
Support for construct validity was demonstrated in the study carried out by El
Miedany et al. [ 51 ], which included 233 patients presenting with CTS symptoms.
The results of the scale were compared to the results of other validated measure-
ments including: (1) the Boston Carpal Tunnel Questionnaire, (2) the clinical
assessment, (3) the neurophysiological study (NCS), and (4) ultrasound (US) evalu-
ation for both carpal tunnel and tendonitis. Comprehensibility and reproducibility
of the model were also assessed. Results revealed that overall scale and each domain
were internally consistent (Cronbach alpha, 0.86–0.94), and correlated signifi cantly
to other parameters. Reproducibility of the overall questionnaire and individual
domains was excellent (Spearman–Brown index, 0.94–0.98).
Y. El Miedany