Project in collaboration with the UTMB in Galveston Core Symptoms of CTS: Measurement of patient perception of CTS using the CTS3 (Carpal Tunnel Symptoms Severity Scale)

Supported by the American Hand Therapy Foundation "Grab the Future" grant
Caroline W. Stegink Jansen, PT, PhD
cjansen@utmb.edu

Collaborators:
Caroline W. Stegink Jansen, PT, PhD
Steven F. Viegas, MD
Rita M. Patterson, PhD
University of Texas Medical Branch, Galveston, Texas

Kimberly Goldie Staines, OTR, CHT
Physiotherapy Associates, Houston, Texas

Thomas L. Sevier, MD
Performance Dynamics, Inc. Muncie, Indiana

David Hildreth, MD
The Methodist Hospital, Houston Texas

Background of the project

  • Patients with carpal tunnel syndrome experience various symptoms such as pain, tingling and numbness.
  • These symptoms are not expected to progress similarly with the progression of the underlying pathology.
  • The current measure symptom severity* is valid and reliable as a measure of total CTS severity, but the measure does not help sufficiently to further insight in the progression of symptoms.

* Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A Self-Administered Questionnaire for the Assessment of Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome. J of Bone and Joint Surgery. 1993;75A:1585-1592.

Purpose of the study

  • The overall goal of the study is to assess symptoms in isolation in order to model a "CTS profile of symptoms".
  • This is important so that we can follow the recovery of patients over time, and gain insight in the recovery of the median nerve.
  • Contributing Projects
    • Reliability
    • Correlation with the Gold standard by Levine et al.
    • Sensitivity and specificity of measurement
    • Sensitivity to measure change over time
    • Differences in CTS perception between a Turkish and a USA sample.

Background
Limitations of the gold standard: non linear relationship and lack of detail.


Non linear relationship between Electrodiagnostic testing (X axis) and patient reported symptoms. (Padua, et al 1999)


Non linear relationship between physician assessment of CTS severity (X axis) and patient reported symptoms (Padua et al. 2002)

Hypothesized progress of symptoms by CTS disease severity. We don't know?








Carpal Tunnel Syndrome Severity Scale: CTS3

Sample questions: severity


Sample Questions: Functional loss


A sampling of the results

  • Good internal consistency and test-retest reliability.
  • Excellent sensitivity (> 90%) and specificity (as measured in normals) (>90%).
  • Excellent power to measure change over time (>90%).
  • Pain is not the most bothersome for patients, but numbness and the sense of weakness is.
  • Turkish and USA CTS patients show the same profile of CTS symptoms.

Sensitivity to find change over time: Levine and CTS3 total score: The birds eye picture.


Phalens: pre: 20 seconds (SD 17); Post 27 seconds (SD 18)

Sensitivity to find change over time: the detailed picture: what makes the difference?

Perception Of Severity Of Carpal Tunnel Syndrome: A comparison between patients from Turkey and the U.S.A.

  • Stegink Jansen CW*, Hildreth DH**, Kalayci T***, and Karakas HM***
  • University of Texas Medical Branch, USA*,
  • Methodist Center for Orthopaedic Surgery, USA**,
  • Inonu University Medical Faculty, Turkey***





Thirty four subjects from the USA (5 males, 29 female subjects with a mean age 44.6 years old, and 21 subjects from Turkey (5 males, 16 females with a mean age 50.8 years)

Results: no difference in symptom profiles between subjects in both countries, except for hands feeling cold.

CTS3: How can the clinician use this? Patient and group profile


Future directions

  • What symptom predicts treatment success?
  • Add computerized version
  • Translate into Spanish
  • Perform a factor analysis to decrease the number of questions.
  • Compare to clinical measures
  • Workman's compensation patients


Conclusion
It is hoped for/expected that the CTS3 can bring "in focus" the perceptions of our patients, gain insight in the disease and help to establish targeted, effective treatments.