Purpose
Patient-reported outcomes are important to assess improvement after surgery. Common instruments
for carpal tunnel syndrome include the Michigan Hand Outcomes Questionnaire (MHQ)
and Boston Carpal Tunnel Questionnaire (CTQ). The Patient-Reported Outcomes Measurement
Information System (PROMIS) are newer measures. We evaluated how the PROMIS Pain Interference
(PI) and Upper Extremity (UE) scores change after carpal tunnel release.
Methods
All adult patients with carpal tunnel syndrome treated surgically were asked to participate
in this prospective study. PROMIS instruments, MHQ, and CTQ were completed by 101
patients. Estimated means and standard errors were calculated, and piecewise linear
fixed effects regression models were applied to the data. Standardized response means
were calculated for each outcome measure.
Results
The MHQ Total Score did not show a considerable change from the preoperative to 1-week
postoperative visit but improved from the 1-week to 3-month postoperative visit (55
to 80). The CTQ Functional Status Score (FSS) worsened from 2.3 preoperatively to
2.6 at the 1-week postoperative visit before improving through the 3-month postoperative
visit (1.6). PROMIS UE showed responsiveness similar to the CTQ FSS with a decline
at the 1-week visit, 38 to 33, followed by improvement (45 at 3 mo). However, the
standardized response mean values were greater for the CTQ FSS compared with PROMIS
UE. The average administration time was shortest for PROMIS UE. The CTQ Symptom Severity
Scale and MHQ Pain Scores showed improvements as early as the 1-week visit. The CTQ
Symptom Severity Scale improved from 3.1 to 2.3, and MHQ Pain Scores improved from
55 to 46. PROMIS PI did not change at the 1-week visit but improved at 6 weeks and
3 months, from 56 to 52 and 49. The standardized response means for PROMIS PI achieved
a large effect size only at 3 months.
Conclusions
The CTQ FSS is more responsive than PROMIS UE and the MHQ, with the CTQ FSS showing
the largest effect sizes. PROMIS PI does not show the responsiveness seen in the CTQ
Symptom Severity Scale and MHQ Pain Score. PROMIS instruments require less time to
complete.
Clinical relevance
This study demonstrates the change in PROMIS scores after carpal tunnel release and
how they compare with legacy outcome instruments.
Key words
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Article info
Publication history
Published online: December 21, 2018
Accepted:
October 30,
2018
Received:
September 28,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
