Comparison of the Michigan Hand Outcomes Questionnaire, Boston Carpal Tunnel Questionnaire, and PROMIS Instruments in Carpal Tunnel Syndrome

Abstract

There is no financial information to disclose. Patient reported outcomes (PRO) are increasingly important to assess improvement following surgery. Commonly used instruments for carpal tunnel syndrome include Michigan Hand Outcomes Questionnaire (MHQ) and Boston Carpal Tunnel Questionnaire (CTQ). These were a Grade B recommendation in the 2009 AAOS clinical practice guidelines. The Patient Reported Outcomes Measurements System (PROMIS) instruments are newer PRO designed to measure various health domains. We tested the null hypothesis that PROMIS Pain Interference (PI) and Upper Extremity (UE) scores will have similar responsiveness when compared to the MHQ and CTQ following Carpal Tunnel Release. Secondary analysis included the time to completion of each PRO instrument. All adult patients with carpal tunnel syndrome treated surgically during the study period were asked to participate in this prospective study. The PROMIS instruments, MHQ, and CTQ were completed by 101 patients prior to surgery and postoperatively at 1-week, 6-week, and 3-month visits. Estimated mean and standard errors for each outcome measure were calculated and a piecewise linear mixed effects regression model was applied to the data. The MHQ Total Score did not show significant change from the preoperative to 1-week visit, but there was a significant improvement from the 1-week to 3-month visit (55.1 to 80.2). The CTQ Functional Status Score (FSS) worsened from 2.3 preoperatively to 2.6 at the 1-week visit before improving at the 6-week and 3-month visits (1.8 and 1.6). PROMIS Upper Extremity showed responsiveness similar to the CTQ FSS with a decline at the 1-week visit, 38.4 to 32.7, followed by increases at the 6-week and 3-month visits (41.5 and 44.8). The average administration time was shortest for PROMIS UE and longest for the MHQ. CTQ Symptoms Severity Scale (SSS) and MHQ Pain Scores showed improvements as early as the 1-week visit. The CTQ SSS improved from 3.1 to 2.3 and MHQ Pain Scores improved from 54.9 to 45.5. The PROMIS Pain Interference Score did not change at the 1-week visit, but demonstrated improvements at 6-weeks and 3-months, from 56.5 to 52.2 and 49.3. The CTQ FSS and PROMIS Upper Extremity instruments are more responsive, demonstrating both an initial decline in function 1-week postoperatively followed by improvement at the 6-week and 3-month visits, when compared to the MHQ. PROMIS Pain Interference does not show the responsiveness seen in the CTQ SSS and MHQ Pain Score. PROMIS instruments require less time to complete.