The six-item CTS symptoms scale and palmar pain scale in carpal tunnel syndrome
Atroshi, Isam; Lyren, Per-Erik; Ornstein, Ewald; Gummesson, Christina
Journal of Hand Surgery - American Volume
PURPOSE: To evaluate measurement properties of 2 brief outcome measures for carpal tunnel syndrome: the 6-item carpal tunnel symptoms scale (CTS-6) and the 2-item palmar pain scale (measuring severity of pain in the scar/palm and pain-related activity limitation). Our hypothesis was that the CTS-6 is responsive to change in symptoms after surgical treatment and the pain scale is a valid measure of surgery-related pain. METHODS: This study followed 447 consecutive patients with carpal tunnel syndrome undergoing open release; 308 completed the CTS-6 and the Disabilities of the Arm, Shoulder, and Hand-short form (QuickDASH) before surgery and the CTS-6, QuickDASH, palmar pain scale, and 2 items regarding global rating of change and treatment satisfaction once after surgery (range, 2-13 mo). The mean scores for the CTS-6 (range, 1-5) and QuickDASH and palmar pain scales (range, 0-100) were calculated (lower score is better). Responsiveness was assessed with the effect size (ES). We estimated the CTS-6 score change indicating minimal clinically important difference based on scores for patients with moderate self-rated improvement. RESULTS: The mean baseline CTS-6 score was 3.16, mean change after surgery was -1.54 (95% confidence interval [CI], -1.65 to -1.44), and ES was 2.0. The ES was large (2.5) in patients with the largest self-rated improvement and decreased with lower self-rated improvement. A score change of 0.9 indicated a minimal clinically important difference. The mean change in QuickDASH score was -25.4 (95% CI, -27.8 to -23.0), and ES was 1.25. The mean palmar pain score for patients with time since surgery of less than 3 months was 38.5, at 3 to 6 months was 35.4, and greater than 6 months was 19.5; the mean score was significantly higher among patients with lower satisfaction. CONCLUSIONS: The CTS-6 is highly responsive to change in symptoms, and the palmar pain scale is a valid measure of surgery-related pain. These brief scales can be appropriate primary and secondary outcomes measures in clinical trials studying carpal tunnel syndrome. Copyright Copyright 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.