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conduction velocity test, the authors reported the added information from the electro-
diagnostic test was not enough to change the diagnosis. Furthermore, the authors
concluded that there was not much value added by the electrodiagnostic test—not
enough to support the cost and discomfort to the patient [ 60 ].
PROMs for Assessment of Functional Disability in CTS Patients
Traditionally, outcome assessment in hand therapy tended to focus on measures of
range of motion, strength, and sensation. However, in the last decade the focus has
shifted toward a patient-centered approach assessing health at the activity and par-
ticipation levels [ 61 , 62 ]. Specifi c patient-completed questionnaires were reported
to be the most effi cient way of collecting information on progress of cases or out-
come of management, for routine use, in cases such as infl ammatory arthritis or
CTS [ 63 , 64 ]. Reviewing the literature for assessment tools for functional ability in
CTS patients revealed two main questionnaire categories:
- SF-36 and the Nottingham Health Profi le, which are generic tools assessing the
patient’s whole state. - BCTQ and the modifi ed-BCTQ, which are tools designed specifi c for CTS patients.
Questionnaire such as DASH (Disabilities of the Arm, Shoulder and Hand) is
considered as discrete. A systematic review of the psychometric properties of the
BCTQ [ 35 ] revealed that the two sub-scales of the questionnaire, namely severity of
symptoms and functional status, are considered the most important reasons for
seeking treatment. The analysis of the relationship between patient satisfaction with
the overall results of surgery and the BCTQ Functional Status Scales showed sig-
nifi cant correlation with worse scores for functional ability in patients with lower
degree of satisfaction. Katz et al. [ 37 ] compared satisfaction with change in both
BCTQ functional status and symptom severity scores, perceived improvement in
quality of life, and perceived improvement in symptoms severity between recipients
and non-recipients of workers’ compensation. As hypothesized, there was evidence
of a difference between the two groups of patients for the BCTQ Functional Status
Scale and the Symptom Severity Scale. The modifi ed BCTQ [ 41 ] include items
relevant to specifi c groups, such as workers prone to repetitive stress injury. In addi-
tion to being reliable and valid instrument, it was reported also relevant to the
patients’ current functional status and work abilities.
PROMs for Assessment of Disease Severity
Anything that compromises the space available for the median nerve within the
carpal tunnel can induce CTS symptoms. Focal structural changes or swellings at
the wrist are known predisposing factors, including fracture of distal radius,
Y. El Miedany