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a primary end point. A multidimensional model of predictors was implemented
including patient-reported management outcomes, severity of symptoms, functional
disability, as well as patients’ satisfaction. Results of this work showed that the
patient reported outcome measures, which represent the key indicators of successful
management approach from the patient’s point of view, were sensitive to change
and correlated signifi cantly to changes in the US outcome measures starting from
the fi rst week after treatment. Underlying pathology such as tenosynovitis of the
fl exors of the hands was in favor of conservative management with successful out-
comes, whereas good postsurgical outcomes were reported in other conditions such
as metabolic disorders and focal swellings.
Which Questionnaire to Use
Several studies were carried out to compare the variable questionnaires on their
capacity to assess the CTS patients’ subjective symptoms. Most of the published
research revealed that BCTQ had the best characteristics as an assessment tool for
function as well as symptoms. In comparison to generic questionnaires, BCTQ had
signifi cantly better sensitivity and specifi city ratios. The modifi ed BCTQ was pub-
lished recently addressing some domains, closely linked to the condition pathogen-
esis, which were not present when the original questionnaire was developed. A
possible alternative to the BCTQ is the CTS-PROMs questionnaire, which offers a
symptom scale for the diagnosis as well as a severity scale to assess the severity of
the condition and to monitor response to therapy. It has been utilized in CTS patients
treated conservatively as well as those undergoing carpal tunnel surgery and has
proven to be reliable, valid, and responsive. The option of Carpal Tunnel Response
“CTS-response 20/70/90” represents a forward move in the calibration of the treat-
ment outcomes.
The DASH questionnaire (Disability Arm Shoulder and Hand questionnaire ) can
be categorized as a “discrete or district questionnaire.” This classifi cation was con-
sidered as it assesses only one bodily district of the body (upper limb); therefore, it
represents a midway between specifi c and generic questionnaires. In contrast,
SF-36 in CTS received initially a lot of attention, in particular toward the analysis
of this tool in orthopedics (which applies to CTS too). However, its limitations were
highlighted in some research studies [ 75 – 78 ]. Another study revealed its poor effi -
cacy as well as inconsistent responsiveness in CTS. This gave SF-36 a secondary
role in CTS assessment [ 79 ].
Y. El Miedany