Editor's Choice| Volume 45, ISSUE 7, P589-596, July 2020

Download started.


Single Assessment Numeric Evaluation (SANE) in Hand Surgery: Does a One-Question Outcome Instrument Compare Favorably?


      Patient-reported outcome measures are increasingly used to measure patient status, impairments, and disability, but often require lengthy surveys and place a considerable burden on patients. We hypothesized that the Single Assessment Numeric Evaluation (SANE), composed of a single question, would be a valid and responsive instrument to provide a global assessment of hand function.


      The SANE, Patient-Reported Outcomes Measurement Information System–Upper Extremity (PROMIS-UE), and Quick–Disabilities of the Arm, Shoulder, and Hand (QuickDASH) data are routinely collected electronically in our hand and upper-extremity center. To identify our cohort, we used Current Procedural Terminology codes to query our electronic medical record research data repository for the 7 most common hand surgery procedures performed over 2 years from December 2016 to 2018. These procedures included carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, wrist arthroscopy, distal radius fracture fixation, first dorsal compartment release, and cubital tunnel release. Patients undergoing a single isolated procedure with questionnaires obtained in the preoperative and/or postoperative period were included in the analysis. Convergent validity, coverage, and responsiveness for each instrument were assessed.


      We identified 214 patients for inclusion. The SANE score had a moderate to strong correlation with the QuickDASH and PROMIS-UE. Floor and ceiling effects for the SANE were less than 10% at baseline and follow-up. Overall, the QuickDASH was the most responsive, followed by SANE and PROMIS-UE; all 3 instruments exceeded the acceptable thresholds for responsiveness and demonstrated significant changes before to after surgery. Responsiveness of the SANE varied by procedure and was acceptable for carpal tunnel release, carpometacarpal arthroplasty, wrist arthroscopy, and trigger finger release.


      The single-item SANE is a reasonable measure of global function in patients undergoing common hand procedures and demonstrates psychometric properties comparable to those of the PROMIS-UE and QuickDASH outcome scores.

      Clinical relevance

      The SANE score is a reasonable outcome measure of global hand function that may have utility in demonstrating response to treatment in a practice setting and may provide a useful adjunct to multiple-item measures in clinical research studies.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sayeed Z.
        • El-Othmani M.
        • Shaffer W.O.
        • Saleh K.J.
        The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: what’s new?.
        J Am Acad Orthop Surg. 2017; 25: e121-e130
        • Gummesson C.
        • Ward M.M.
        • Atroshi I.
        The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006; 7: 44
        • Beaton D.E.
        • Wright J.G.
        • Katz J.N.
        • Group U.E.C.
        Development of the QuickDASH: comparison of three item-reduction approaches.
        J Bone Joint Surg Am. 2005; 87: 1038-1046
        • Beleckas C.M.
        • Padovano A.
        • Guattery J.
        • Chamberlain A.M.
        • Keener J.D.
        • Calfee R.P.
        Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) versus physical function (PF) computer adaptive tests (CATs) in upper extremity clinics.
        J Hand Surg Am. 2017; 42: 867-874
        • Beckmann J.T.
        • Hung M.
        • Voss M.W.
        • Crum A.B.
        • Bounsanga J.
        • Tyser A.R.
        Evaluation of the patient-reported outcomes measurement information system upper extremity computer adaptive test.
        J Hand Surg Am. 2016; 41: 739-744
        • Cella D.
        • Gershon R.
        • Lai J.-S.
        • Choi S.
        The future of outcomes measurement: item banking, tailored short-forms, and computerized adaptive assessment.
        Qual Life Res. 2007; 16: 133-141
        • Sciascia A.D.
        • Morris B.J.
        • Jacobs C.A.
        • Edwards T.B.
        Responsiveness and internal validity of common patient-reported outcome measures following total shoulder arthroplasty.
        Orthopedics. 2017; 40: e513-e519
        • Shelbourne K.D.
        • Barnes A.F.
        • Gray T.
        Correlation of a single assessment numeric evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy.
        Am J Sports Med. 2012; 40: 2487-2491
        • Winterstein A.P.
        • McGuine T.A.
        • Carr K.E.
        • Hetzel S.J.
        Comparison of IKDC and SANE outcome measures following knee injury in active female patients.
        Sports Health. 2013; 5: 523-529
        • Gobbi A.
        • Bathan L.
        • Boldrini L.
        Primary repair combined with bone marrow stimulation in acute anterior cruciate ligament lesions: results in a group of athletes.
        Am J Sports Med. 2009; 37: 571-578
        • Williams G.N.
        • Gangel T.J.
        • Arciero R.A.
        • Uhorchak J.M.
        • Taylor D.C.
        Comparison of the single assessment numeric evaluation method and two shoulder rating scales.
        Am J Sports Med. 1999; 27: 214-221
        • Sueyoshi T.
        • Emoto G.
        • Yato T.
        Correlation between single assessment numerical evaluation score and Lysholm score in primary total knee arthroplasty patients.
        Arthroplast Today. 2018; 4: 99-102
        • Williams G.N.
        • Taylor D.C.
        • Gangel T.J.
        • Uhorchak J.M.
        • Arciero R.A.
        Comparison of the single assessment numeric evaluation method and the Lysholm score.
        Clin Orthop Relat Res. 2000; 373: 184-192
        • Thigpen C.A.
        • Shanley E.
        • Momaya A.M.
        • et al.
        Validity and responsiveness of the single alpha-numeric evaluation for shoulder patients.
        Am J Sports Med. 2018; 46: 3480-3485
        • Hudak P.L.
        • Amadio P.C.
        • Bombardier C.
        Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG).
        Am J Ind Med. 1996; 29: 602-608
        • Kennedy C.A.
        • Beaton D.E.
        • Solway S.
        • McConnell S.
        • Bombardier C.
        The DASH and QuickDASH Outcome Measure User's Manual.
        Third Ed. Institute for Work & Health, Toronto, ON2011
        • Ring D.
        Self-reported upper extremity health status correlates with depression.
        J Bone Joint Surg Am. 2006; 88: 1983-1988
        • Bot A.G.J.
        • Becker S.J.E.
        • Van Dijk C.N.
        • Ring D.
        • Vranceanu A.M.
        Abbreviated psychologic questionnaires are valid in patients with hand conditions hand.
        Clin Orthop Relat Res. 2013; 471: 4037-4044
        • Hung M.
        • Saltzman C.L.
        • Greene T.
        • et al.
        The responsiveness of the PROMIS instruments and the qDASH in an upper extremity population.
        J Patient Rep Outcomes. 2017; 1: 12
        • Hays R.D.
        • Spritzer K.L.
        • Amtmann D.
        • et al.
        Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank.
        Arch Phys Med Rehabil. 2013; 94: 2291-2296
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Academic Press, New York, NY1977
        • Kazis L.E.
        • Anderson J.J.
        • Meenan R.F.
        Effect sizes for interpreting changes in health status.
        Med Care. 1989; 27: S178-S189
        • Koltsov J.C.B.
        • Greenfield S.T.
        • Soukup D.
        • Do H.T.
        • Ellis S.J.
        Validation of Patient-Reported Outcomes Measurement Information System computerized adaptive tests against the Foot and Ankle Outcome Score for 6 common foot and ankle pathologies.
        Foot Ankle Int. 2017; 38: 870-878
        • HealthMeasures
        • Group PHO and PC
        PROMIS Item Bank v2.0–Upper Extremity.
        (Available at:)
        • Tyser A.R.
        • Hung M.
        • Bounsanga J.
        • Voss M.W.
        • Kazmers N.H.
        Evaluation of version 2.0 of the PROMIS Upper Extremity Computer Adaptive Test in nonshoulder upper extremity patients.
        J Hand Surg Am. 2019; 44: 267-273
        • Mahmood B.
        • Chongshu C.
        • Qiu X.
        • Messing S.
        • Hammert W.C.
        Comparison of the Michigan Hand Outcomes Questionnaire, Boston Carpal Tunnel Questionnaire, and PROMIS Instruments in carpal tunnel syndrome.
        J Hand Surg Am. 2018; 44: 366-373