Dabbagh Armaghan, MacDermid Joy C, Packham Tara L, Macedo Luciana G
School of Physical Therapy, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada.
McMaster University, Hamilton, ON, Canada.
Health Qual Life Outcomes. 2020 Nov 7;18(1):359. doi: 10.1186/s12955-020-01614-7.
Accurate diagnosis of carpal tunnel syndrome (CTS) is essential for directing appropriate treatment; and for making decisions about work injury claims. The Kamath and Stothard Questionnaire (KSQ) is a self-reported tool used for the diagnosis of CTS. Comprehensibility and comprehensiveness of this questionnaire are critical to diagnostic performance and need to be established. The purpose of the study was to describe how potential respondents, clinicians, and measurement researchers interpret KSQ questions in order to identify and resolve potential sources of misclassification.
Hand therapists, measurement researchers, participants with CTS, and a control group were interviewed using cognitive interviewing techniques (talk aloud, semi-structured interview probes) in Hamilton, Canada. All interviews were recorded and transcribed verbatim. A directed content analysis was done to analyze the interviews using a previously established framework.
Eighteen participants were interviewed. Areas, where questions were unclear to some participants, were recorded and categorized into five themes: Clarity and Comprehension (52%), Relativeness (38%), Inadequate Response Definition (4%), Perspective Modifiers (4%), and Reference Point (2%). Respondents also identified several symptoms of CTS that are not covered by the KSQ that might be of diagnostic value, e.g., weakness and dropping items.
The content validity of the current iteration of the KSQ was not established. The problematic questions identified in the study have been reported to have low specificity and negative predictive values in a previous quantitative study. The content validity issues identified may explain the poor performance. Recommendations were made to modify the wording of the KSQ and the potential addition of three new questions. Future studies should determine whether the modified questionnaire can provide better diagnostic accuracy and psychometric properties. The results of this study may assist in ruling in or out CTS diagnosis to a wide variety of target audience, such as hand specialists, physical and occupational therapists, as well as family doctors.
准确诊断腕管综合征（CTS）对于指导恰当治疗以及做出工伤索赔决定至关重要。卡马斯和斯托瑟德问卷（KSQ）是一种用于诊断CTS的自我报告工具。该问卷的可理解性和全面性对于诊断性能至关重要，需要加以确定。本研究的目的是描述潜在受访者、临床医生和测量研究人员如何解读KSQ问题，以识别并解决潜在的错误分类来源。
在加拿大汉密尔顿，采用认知访谈技术（出声思考、半结构化访谈探针）对手部治疗师、测量研究人员、CTS患者和对照组进行访谈。所有访谈均进行录音并逐字转录。使用先前建立的框架进行定向内容分析以分析访谈内容。
共访谈了18名参与者。记录了一些参与者对问题不清楚的领域，并将其分为五个主题：清晰度和理解度（52%）、相关性（38%）、反应定义不充分（4%）、视角修饰词（4%）和参考点（2%）。受访者还指出了KSQ未涵盖的几种可能具有诊断价值的CTS症状，例如无力和物品掉落。
KSQ当前版本的内容效度尚未确立。在先前一项定量研究中，本研究中识别出的有问题的问题已被报道具有较低的特异性和阴性预测值。所识别出的内容效度问题可能解释了其不佳的表现。建议修改KSQ的措辞，并可能增加三个新问题。未来的研究应确定修改后的问卷是否能提供更好的诊断准确性和心理测量特性。本研究结果可能有助于各类目标受众（如手部专家、物理治疗师和职业治疗师以及家庭医生）对CTS诊断进行判断。
