Purpose
To assess the interrater reliability of the CTS-6 for examiners with varying levels
of clinical expertise. We also aimed to analyze this instrument's sensitivity (Sn)
and specificity (Sp), using the CTS-6 score obtained by a hand surgeon as a reference
standard.
Methods
Three examining groups consisting of medical students, occupational hand therapists,
and hand surgeons examined a consecutive series of patients in an academic upper-extremity
clinic. A total of 3 examiners (1 from each group) recorded a CTS-6 score for each
patient. The examiners were blinded to the scores from the other groups. The interrater
reliability was determined between the groups with respect to the diagnosis of CTS
and the individual CTS-6 components. Sn and Sp were calculated for each of the groups
using the CTS-6 obtained by the hand surgeons as the reference standard.
Results
Two hundred seven patients were included. For the diagnosis of CTS (CTS-6 score of
12 or greater as determined by a hand surgeon), there was substantial agreement between
the 3 groups (Fleiss kappa 0.73; 95% CI [0.65 –0.82]; P < .05). For individual CTS-6 components, the agreement between the groups was highest
for assessing subjective numbness and lowest for assessing a Tinel sign (Fleiss kappa
of 0.77 and 0.49, respectively). The Sn/Sp for diagnosing CTS was 87%/91% for the
medical student group and 81%/95% for the occupational hand therapist group.
Conclusions
The CTS-6 can be reliably used as a screening and diagnostic tool for CTS by clinicians
with a variety of experience levels and without specific fellowship training in upper-extremity
surgery.
Type of study/level of evidence
Diagnostic I.
Key words
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Article info
Publication history
Published online: March 05, 2022
Accepted:
January 25,
2022
Received:
October 1,
2021
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
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
