347assess the ability of self-reported measures to predict treatment response in CTS
patients revealed that the patients who had higher self-reported symptom severity
scores at initial evaluation, as assessed by BCTQ, were signifi cantly more likely to
fail conservative treatment and undergo surgery during the next 2-year period.
Therefore, the symptom severity questionnaire was reported as useful not only in
evaluating response to therapy but also in predicting response to therapy. In another
systematic review [ 26 ], responsiveness of the BCTQ to clinical change was assessed.
The data on effect sizes and standard response means demonstrated that the
Symptom Severity Scale and Functional Status Scales were able to detect clinically
meaningful change resulting from the CTS treatment and yielded large effect sizes
over a 6-month interval.
One study [ 52 ] was carried out to assess the ability of CTS-PROMs Severity
Scoring System to identify outcome response (symptoms severity as well as func-
tional status) in response to management in patients presenting with carpal tunnel
syndrome. Response to therapy (CTS-response) was considered if there has been an
improvement achieved by >20 % of the following: (1) score of paresthesia as well
as scores of two out of the four domains (nocturnal pain, diurnal pain, weakness,
and repetitive stress pain), in addition to (2) >20 % improvement of the functional
status score (CTS-response 20). To evaluate sensitivity to change in clinical status,
each patient was assigned to one of the following groups: <20 % improvement in the
CTS-response, 20–49 % improvement, 50–69 % improvement, and >70 % improve-
ment. Results revealed that the defi nitions of improvement were valid and were
signifi cantly correlated with changes in NCS and/or US fi ndings. In addition, they
have the advantage of quantifying the outcome measures. The GSS showed signifi -
cant sensitivity to change after 1, 3, and 6 months and was signifi cantly correlated
with the nerve conduction studies and ultrasound fi ndings (standardized effect size
was 2.12, 2.41, and 2.47 after 1, 3, and 6, months, respectively).
PROMs and Treat-to-Target in Carpal Tunnel Syndrome
Searching for markers identifying key targets for the valuation of major outcomes
in musculoskeletal diseases has become one of the hot issues in rheumatology.
Possible markers should be objectively measured, indicatory of normal biology as
well as the pathologic process, indicator of response to therapy and prognosis. It
should also be a good indicator of modifi cation of the pathological process and help
to identify (in early cases) the patients who are going to respond quickly to therapy
with the vision of tailoring the management to the individual patient’s status [ 72 ,
73 ]. So far this target has not been achieved in CTS. Earlier study revealed that CTS
management can be tailored to the patient underlying pathology [ 74 ]. Another
recent study [ 21 ], carried out to assess the use of US as a biomarker for a treat-to-
target approach in CTS patients, was set up based on the analysis of the baseline
parameters in association with the clinical as well as patient-reported management
outcomes, and relied on improvement of the patient reported outcome measures as
13 PROMs for Carpal Tunnel Syndrome