A Comparison of Nerve-Specific, Condition-Specific, and Upper Extremity-Specific Patient-Reported Outcome Measures in Patients With Carpal and Cubital Tunnel Syndrome

Published:August 24, 2021DOI:


      Arm-, region-, tissue-, and condition-specific patient-reported outcome measures (PROMs) are available to address idiopathic mononeuropathy. This study compared PROMs with varying specificities in patients with idiopathic neuropathy of the upper extremity with respect to correlations with each another, sources of variation in scores, and floor and ceiling effects.


      One hundred fifty patients (130 with carpal tunnel syndrome, 30 with cubital tunnel syndrome, and 10 with both conditions) completed a nerve-specific PROM (Impact of Hand Nerve Disorders), a condition-specific PROM (Boston Carpal Tunnel Syndrome Questionnaire and/or Patient-Rated Ulnar Nerve Evaluation), and an upper extremity–specific PROM (Patient-Reported Outcomes Measurement Information System Physical Function Upper Extremity 7). We also gathered demographic and condition-related data (side, electrodiagnostic studies present, muscle atrophy, static loss of sensibility), and patients completed questionnaires measuring self-efficacy, kinesiophobia, and symptoms of depression. Correlation of the PROMs with each another and factors accounting for their variation were assessed, as well as the number of items to complete, time to complete, and floor and ceiling effects.


      Pearson correlations between PROMs were moderate to strong (0.56–0.90). Self-reported symptoms of depression were best able to account for the variations in symptom intensity and activity intolerance on all PROMs (adjusted R2 between 0.09 and 0.31). The Impact of Hand Nerve Disorders is a long questionnaire and took the most time to complete. All instruments had comparable floor effects; Patient-Reported Outcomes Measurement Information System Physical Function Upper Extremity had a ceiling of effect of 16%.


      This study adds to the evidence that specific and general PROMs correlate with each another, perhaps in part through their correlation with mental health. Based on this line of evidence and pending testing of potentially greater responsiveness in specific settings, we prefer to use a single simple, brief, and general PROM to quantify symptom intensity and activity intolerance for both routine patient care and research.

      Type of study/level of evidence

      Prognostic II.

      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


        • Cella D.
        • Riley W.
        • Stone A.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Kaat A.J.
        • Buckenmaier III, C.T.
        • Cook K.F.
        • et al.
        The expansion and validation of a new upper extremity item bank for the Patient-Reported Outcomes Measurement Information System (PROMIS).
        J Patient Rep Outcomes. 2019; 3: 69
        • Chung K.C.
        • Pillsbury M.S.
        • Walters M.R.
        • Hayward R.A.
        Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.
        J Hand Surg Am. 1998; 23: 575-587
        • Levine D.W.
        • Simmons B.P.
        • Koris M.J.
        • et al.
        A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.
        J Bone Joint Surg Am. 1993; 75: 1585-1592
        • MacDermid J.C.
        • Grewal R.
        Development and validation of the patient-rated ulnar nerve evaluation.
        BMC Musculoskelet Disord. 2013; 14: 146
        • Ashwood M.
        • Jerosch-Herold C.
        • Shepstone L.
        Development and validation of a new patient-reported outcome measure for peripheral nerve disorders of the hand, the I-HaND scale.
        J Hand Surg Eur. 2018; 43: 864-874
        • Doring A.C.
        • Nota S.P.
        • Hageman M.G.
        • Ring D.C.
        Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System.
        J Hand Surg Am. 2014; 39: 1160-1165
        • Jayakumar P.
        • Teunis T.
        • Vranceanu A.M.
        • et al.
        Construct validity and precision of different patient-reported outcome measures during recovery after upper extremity fractures.
        Clin Orthop Relat Res. 2019; 477: 2521-2530
        • Mackinnon S.E.
        • Novak C.B.
        in: Wolfe S.W. Hotchkiss R.N. Pederson W.C. Kozin S.H. Cohen M.S. Green’s Operative Hand Surgery. 7th ed. Elsevier, 2017: 921-958
        • Bot A.G.J.
        • Nota S.P.F.T.
        • Ring D.
        The creation of an abbreviated version of the PSEQ: the PSEQ-2.
        Psychosomatics. 2014; 55: 381-385
        • Archer K.R.
        • Phelps K.D.
        • Seebach C.L.
        • Song Y.
        • Riley III, L.H.
        • Wegener S.T.
        Comparative study of short forms of the Tampa Scale for Kinesiophobia: fear of movement in a surgical spine population.
        Arch Phys Med Rehabil. 2012; 93: 1460-1462
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The Patient Health Questionnaire-2: validity of a two-item depression screener.
        Med Care. 2003; 41: 1284-1292
        • PROMIS
        PROMIS PF Scoring.
        (Accessed June 27, 2021)
        • Schober P.
        • Boer C.
        • Schwarte L.A.
        Correlation coefficients: appropriate use and interpretation.
        Anesth Analg. 2018; 126: 1763-1768
        • Teunis T.
        • Jayakumar P.
        • Ring D.
        The problem of collinearity in mental health and patient reported outcome research.
        J Hand Surg Am. 2021; 46: e1-e2
        • Graham B.
        • Regehr G.
        • Naglie G.
        • Wright J.G.
        Development and validation of diagnostic criteria for carpal tunnel syndrome.
        J Hand Surg Am. 2006; 31: 919-924
        • Koh J.
        • Azari K.K.
        • Benhaim P.
        Clinical diagnosis of coincident carpal and cubital tunnel syndromes.
        Plast Reconstr Surg. 2015; 136: 22-23
        • Tulipan J.E.
        • Lutsky K.F.
        • Maltenfort M.G.
        • Freedman M.K.
        • Beredjiklian P.K.
        Patient-reported disability measures do not correlate with electrodiagnostic severity in carpal tunnel syndrome.
        Plast Reconstr Surg Glob Open. 2017; 5e1440
        • Kortlever J.T.P.
        • Becker S.J.E.
        • Zhao M.
        • Ring D.
        Borderline nerve conduction velocities for median neuropathy at the carpal tunnel.
        J Hand Surg Am. 2020; 45: 379-388.e1
        • Bernstein D.N.
        • Houck J.R.
        • Mahmood B.
        • Hammert W.C.
        Responsiveness of the PROMIS and its concurrent validity with other region- and condition-specific PROMs in patients undergoing carpal tunnel release.
        Clin Orthop Relat Res. 2019; 477: 2544-2551
        • Phillips J.L.H.
        • Freedman M.K.
        • Simon J.I.
        • Beredjiklian P.K.
        The PROMIS upper extremity computer adaptive test correlates with previously validated metrics in patients with carpal tunnel syndrome.
        Hand (N Y). 2021; 16: 164-169
        • Jayakumar P.
        • Overbeek C.L.
        • Lamb S.
        • et al.
        What factors are associated with disability after upper extremity injuries? A systematic review.
        Clin Orthop Relat Res. 2018; 476: 2190-2215
        • Shin Y.H.
        • Yoon J.O.
        • Kim Y.K.
        • Kim J.K.
        Psychological status is associated with symptom severity in patients with carpal tunnel syndrome.
        J Hand Surg Am. 2018; 43: 484.e1-484.e8
        • Hobby J.L.
        • Venkatesh R.
        • Motkur P.
        The effect of psychological disturbance on symptoms, self-reported disability and surgical outcome in carpal tunnel syndrome.
        J Bone Joint Surg Br. 2005; 87: 196-200
        • Sun P.O.
        • Walbeehm E.T.
        • Selles R.W.
        • et al.
        Influence of illness perceptions, psychological distress and pain catastrophizing on self-reported symptom severity and functional status in patients with carpal tunnel syndrome.
        J Psychosom Res. 2019; 126: 109820
        • Gausden E.B.
        • Levack A.E.
        • Sin D.N.
        • et al.
        Validating the Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests for upper extremity fracture care.
        J Shoulder Elbow Surg. 2018; 27: 1191-1197
        • Northwestern University–HealthMeasures
        PROMIS item bank v2.0–upper extremity.
        (Accessed March 22, 2021)