339The CTS-PROMs severity scale [ 52 ] is another self-administered questionnaire
for global assessment of symptoms severity and the functional status (global sever-
ity score: GSS). The questionnaire consists of multi-item scales including the fol-
lowing domains: paresthesia, nocturnal pain, diurnal pain, weakness/clumsiness,
repetitive stress pain, and global functional assessment. Each domain was graded
separately and the patients were asked to rate their symptoms on a visual analogue
scale of 0–10, where 0 = no symptoms and 10 = severe symptoms. Mean of the total
score was calculated; consequently the relative severity measure for each domain
was calculated by dividing the patient’s rating for that symptom by the patient’s
total symptom severity mean score. A score >1 would indicate the relevance of this
symptom and its value in monitoring the patient’s condition as well as outcome of
management.
Validity studies revealed that the scale was internally consistent (Cronbach alpha,
0.93 and 0.91 for severity of symptoms and functional status, respectively).
Reproducibility of the overall questionnaire and individual domains was excellent
(Spearman–Brown index, 0.94–0.98). Responsiveness to management was assessed
in a third study [ 53 ], which included 106 patients treated either conservatively (55
patients) or surgically (51 patients). This study represented a step forward toward
“optimizing outcomes in CTS patients” with inadequate responses to management
whether treated conservatively or surgically. Response to therapy ( CTS-response )
was considered to separate patients into non-overlapping groups according to their
responses to treatment. Results of the work revealed that CTS-response 20, 50, and
70 enabled the treating health care professional to interpret and quantitate treatment
outcomes.
The Disabilities of the Arm, Shoulder and Hand (DASH)
Outcome Questionnaire
The DASH outcome instrument is not specifi c to CTS. It was developed in 1996 as
a joint initiative of the American Academy of Orthopaedic Surgeon (AAOS), the
council of Musculoskeletal Specialty Societies (COMSS), and the Institute for
Work and Health (Toronto, Ontario, Canada) [ 54 ]. It can be used to measure func-
tion in people with musculoskeletal disorders of the upper limb. The fi nal version of
the DASH is a 30-item scale and consists of 2 dimensions: (1) Physical Functioning
and Symptoms, which include three scales under physical function (physical, social,
and psychological) and (2) fi ve scales within symptoms (pain, weakness, tingling
and numbness, and stiffness). The questionnaire items focus on the upper-extremity
activities and are intended to assess disability. The DASH questionnaire can be
self-, interview-, or telephone-administered.
Assessment for construct validity of DASH revealed signifi cant correlation with
BCTQ score [ 55 ] as well as the Patient Evaluation Measure score both before and
after carpal tunnel decompression surgery [ 48 ]. In concordance, signifi cantly
13 PROMs for Carpal Tunnel Syndrome