J Orthop Sports Phys Ther. 2020 Nov;50(11):622-631. doi: 10.2519/jospt.2020.9599. Epub 2020 Sep 16.
To summarize and evaluate research on the accuracy of clinical diagnostic scales, questionnaires, and hand symptom diagrams/maps used for diagnosis of carpal tunnel syndrome (CTS).
Systematic review of diagnostic test accuracy.
A comprehensive literature search of the MEDLINE, CINAHL, and Embase databases was conducted on January 20, 2020.
Studies that assessed at least 1 diagnostic accuracy property of the scales, questionnaires, and hand symptom diagrams used for the diagnosis of CTS.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Risk of bias and applicability concerns were assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Diagnostic accuracy properties were summarized.
Out of 4052 citations after removing duplicates, 21 articles met the inclusion criteria. Twelve articles reported on the diagnostic accuracy of scales and questionnaires, including the Bland questionnaire, Kamath and Stothard questionnaire, 6-item carpal tunnel syndrome symptoms scale (CTS-6), Boston Carpal Tunnel Questionnaire, Wainner clinical prediction rule, and Lo clinical prediction rule. Positive likelihood ratios ranged from 0.94 for the Boston Carpal Tunnel Questionnaire to 10.5 for the CTS-6, and negative likelihood ratios ranged from 1.04 to 0.05 for the same diagnostic tools, respectively. Nine studies reported the diagnostic accuracy of the Katz and Stirrat hand symptom diagram. Positive and negative likelihood ratios ranged from 1.42 to 8 and from 0.78 to 0.05, respectively. Only 4 studies had high methodologic quality.
Limited evidence supports high accuracy of the CTS-6, Kamath and Stothard questionnaire, and Katz and Stirrat hand symptom diagram. Other scales have lesser and more conflicting evidence. Further high-quality studies are necessary to examine the diagnostic accuracy of these tests to assist ruling in or ruling out CTS. .
总结和评估用于诊断腕管综合征(CTS)的临床诊断量表、问卷和手部症状图/图的准确性研究。
诊断测试准确性的系统评价。
于 2020 年 1 月 20 日对 MEDLINE、CINAHL 和 Embase 数据库进行了全面的文献检索。
评估用于诊断 CTS 的量表、问卷和手部症状图至少有 1 种诊断准确性的研究。
遵循系统评价和荟萃分析的首选报告项目(PRISMA)指南。使用修订后的诊断准确性研究质量评估(QUADAS-2)工具评估偏倚风险和适用性问题。总结了诊断准确性特性。
在去除重复项后,4052 条引文中有 21 篇符合纳入标准。12 篇文章报告了量表和问卷的诊断准确性,包括 Bland 问卷、Kamath 和 Stothard 问卷、6 项腕管综合征症状量表(CTS-6)、波士顿腕管问卷、Wainner 临床预测规则和 Lo 临床预测规则。阳性似然比范围为波士顿腕管问卷的 0.94 至 CTS-6 的 10.5,阴性似然比范围为相同诊断工具的 1.04 至 0.05。9 项研究报告了 Katz 和 Stirrat 手部症状图的诊断准确性。阳性和阴性似然比范围分别为 1.42 至 8 和 0.78 至 0.05。仅有 4 项研究具有较高的方法学质量。
有限的证据支持 CTS-6、Kamath 和 Stothard 问卷以及 Katz 和 Stirrat 手部症状图具有较高的准确性。其他量表的证据较少且存在更多冲突。需要进一步进行高质量研究,以检查这些测试的诊断准确性,以帮助诊断或排除 CTS。