Hand Therapy > Volume 14, Number 2 > Pp. 39-45

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Patient satisfaction with carpal tunnel surgery: self-administered questionnaires versus physical testing

Romina P Astifidis ^*, Barbra J Koczan ^*, Norman H Dubin ^*, Frank D Burke  and E F Shaw Wilgis ^* 

^* The Curtis National Hand Center, Baltimore, MD, USA; The Pulvertaft Hand Centre, Derbyshire Royal Infirmary, Derby, UK

Correspondence: E F Shaw Wilgis MD, c/o Anne Rupert Mattson, Editor, Curtis National Hand Center, Union Memorial Hospital, 3333 N. Calvert Street, #200, Baltimore, MD 21218, USA. Email: anne.mattson{at}medstar.net

Purpose. A study was designed to compare the strength of correlation between the clinical tests such as grip, pinch and Semmes–Weinstein testing, and the Levine–Katz self-administered symptom severity and functional status questionnaires as well as their correlation with patients' satisfaction following carpal tunnel decompression. The purpose was to determine whether patient-completed outcome instruments would be additive to the physical measures, or could possibly replace the physical measures, in assessing the outcome of carpal tunnel release.

Methods. From two hand centres, 635 hands (cases) in 490 patients completed preoperative and postoperative assessments including Tinel's sign, Phalen's test, Semmes–Weinstein testing, grip and pinch strength testing and the Levine–Katz self-administered questionnaires. Patients were also asked whether they were satisfied with surgery at the six-month follow-up.

Results. Patients reporting satisfaction with surgery at six months had significantly greater changes in grip strength and Levine–Katz scores than those reporting no satisfaction. At six-months follow-up, grip strength increased slightly from 27.4 to 29.2 kg (6%) (P = 0.007), pinch strength increased from 7.8 to 8.1 kg (4%) (P = 0.04), Semmes–Weinstein scores decreased (improved) from 2.37 to 1.89 (20%) (P < 0.001), Levine–Katz functional status scores decreased from 2.30 to 1.48 (36%) (P < 0.001) and Levine–Katz symptom severity scores decreased from 2.83 to 1.44 (49%) (P < 0.001).

Conclusions. Improvement in Levine–Katz scores can be used to assess treatment outcomes after carpal tunnel release as an alternative to physical testing. This study offers further evidence that patient-rated outcome questionnaires offer a more complete picture of the eventual outcomes of carpal tunnel decompression surgery as compared with physical testing.

Key Words: Carpal tunnel decompression • grip strength • pinch strength • self-assessment • symptom severity • patient satisfaction

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