Cheung Derek K M, MacDermid JoyC, Walton Dave, Grewal Ruby
Health and Rehabilitation Sciences Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
Hand and Upper Limb Clinic, St. Joseph's Hospital, London, Ontario, Canada ; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Open Orthop J. 2014 May 16;8:100-7. doi: 10.2174/1874325001408010100. eCollection 2014.
Sensory evaluation is fundamental to evaluation of patients with Carpal Tunnel Syndrome (CTS). The purpose of this study was to determine the construct validity and responsiveness for sensory threshold tests in patients with CTS.
Sixty-three patients diagnosed with CTS were evaluated prior to orthotic intervention and again at follow up at 6 and 12 weeks. Sensory tests included touch threshold PSSD (Pressure Specified Sensory Device) and vibration threshold (Vibrometer). Construct validity was assessed by comparing sensory tests to hand function, and dexterity testing using Spearman rho (rs). Patients were classified as either responders or non-responders to orthotic intervention based on the change score of the Symptom Severity Scale (SSS) of 0.5. Responsiveness of the sensory tools was measured using ROC (receiver operating characteristic) curves, SRM (Standardized Response Mean), and ES (Effect Sizes).
The PSSD had low to moderate correlations (rs ≤ 0.32) while Vibrometer scores had moderate correlations (rs = 0.36 - 0.41) with dexterity scores. The Clinically Important Difference (CID) for the PSSD was estimated at 0.15 g/mm(2) but was not discriminative. The Vibrometer demonstrated moderate responsiveness, with a SRM = 0.61 and an ES = 0.46 among responders. The PSSD had a SRM = 0.09 and an ES = 0.08 and showed low responsiveness for patients with a clinically important improvement in symptoms.
Measurement properties suggest that the Vibrometer was preferable to the PSSD because it was more correlated to hand function, and was more responsive. Clinicians may choose use the Vibrometer opposed to the PSSD for determining important change in sensation after orthotic intervention.
感觉评估是腕管综合征（CTS）患者评估的基础。本研究的目的是确定CTS患者感觉阈值测试的结构效度和反应性。
63例被诊断为CTS的患者在进行矫形器干预前进行评估，并在6周和12周的随访时再次评估。感觉测试包括触觉阈值PSSD（压力特定感觉装置）和振动阈值（振动计）。通过将感觉测试与手部功能以及使用Spearman等级相关系数（rs）的灵巧性测试进行比较来评估结构效度。根据症状严重程度量表（SSS）变化得分0.5，将患者分为矫形器干预的反应者或无反应者。使用ROC（受试者工作特征）曲线、SRM（标准化反应均值）和ES（效应大小）来测量感觉工具的反应性。
PSSD与灵巧性得分的相关性较低至中等（rs≤0.32），而振动计得分与灵巧性得分的相关性中等（rs = 0.36 - 0.41）。PSSD的临床重要差异（CID）估计为0.15 g/mm²，但无鉴别能力。振动计显示出中等反应性，反应者中的SRM = 0.61，ES = 0.46。PSSD的SRM = 0.09，ES = 0.08，对于症状有临床重要改善的患者显示出低反应性。
测量特性表明，振动计优于PSSD，因为它与手部功能的相关性更强，反应性也更高。临床医生在确定矫形器干预后感觉的重要变化时，可选择使用振动计而非PSSD。
