Buntragulpoontawee Montana, Tongprasert Siam, Khorana Jiraporn, Kitisak Kittipong, Karinuntakul Waris, Pornjaksawan Sineenard, Phinyo Phichayut
Neuro-Mobility Unit, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Center of Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2025 Mar 25;20(3):e0319158. doi: 10.1371/journal.pone.0319158. eCollection 2025.
The CTS-6 Evaluation Tool is a clinical diagnostic tool for carpal tunnel syndrome. It was originally developed using data from non-disabled individuals and has never been validated in different population. This study aimed to validate CTS-6's diagnostic performance at a cutoff score of 12 in a new population of wheelchair users.
The participants were 54 Thai wheelchair users from a university hospital's neuropathy registry. Those with a history of nerve injury, fracture, neuropathy, or pregnancy were excluded from the study. All underwent clinical exam, CTS-6, and electrodiagnosis (blinded evaluator). Carpal tunnel syndrome was diagnosed based on clinical symptoms and electrodiagnostic criteria.
Of 54 participants, 13 were female (24.1%) with an average age of 46.9 (SD 12.2) years, and 18 (33.3%) participants had carpal tunnel syndrome. Duration of disability (years) was significantly longer in cases; median 24 (Q1 19.0, Q3 28.9), p < 0.001. Discriminative performance: Area under the receiver operating curve 0.935 (95%CI:0.891-0.978). At the 12 cutoff point, the sensitivity was 43.8% (95%CI:26.4-62.3%) and the specificity was 100.0% (95%CI:94.8-100.0%). A lower cutoff point showed increased sensitivity and specificity. Symptomatic subgroup analysis showed similar diagnostic performances.
The CTS-6 Evaluation Tool is a simple clinical diagnostic tool that does not require sophisticated investigation. The CTS-6's discriminative ability remains strong. The diagnostic performance at a cutoff score of 12 showed moderate sensitivity and high specificity. Applying a cutoff score of 12 could help rule in the diagnosis where access to electrodiagnosis is limited. A lower cutoff score that is 7.5 could be applied as a screening test to rule out the diagnosis, as it provides moderately higher sensitivity at the cost of increased false positives.
CTS - 6评估工具是一种用于诊断腕管综合征的临床诊断工具。它最初是使用非残疾个体的数据开发的，从未在不同人群中进行过验证。本研究旨在验证CTS - 6在新的轮椅使用者群体中截断分数为12时的诊断性能。
参与者为来自某大学医院神经病变登记处的54名泰国轮椅使用者。有神经损伤、骨折、神经病变或怀孕史的患者被排除在研究之外。所有参与者均接受了临床检查、CTS - 6评估和电诊断（评估者不知情）。根据临床症状和电诊断标准诊断腕管综合征。
54名参与者中，13名女性（24.1%），平均年龄46.9（标准差12.2）岁，18名（33.3%）参与者患有腕管综合征。病例组的残疾持续时间（年）明显更长；中位数为24（第一四分位数19.0，第三四分位数28.9），p < 0.001。鉴别性能：受试者操作特征曲线下面积为0.935（95%置信区间：0.891 - 0.978）。在截断分数为12时，敏感性为43.8%（95%置信区间：26.4 - 62.3%），特异性为100.0%（95%置信区间：94.8 - 100.0%）。较低的截断分数显示敏感性和特异性增加。有症状亚组分析显示了相似的诊断性能。
CTS - 6评估工具是一种简单的临床诊断工具，不需要复杂的检查。CTS - 6的鉴别能力仍然很强。截断分数为12时的诊断性能显示出中等敏感性和高特异性。应用截断分数12有助于在电诊断受限的情况下确诊。较低的截断分数7.5可作为排除诊断的筛查试验，因为它以增加假阳性为代价提供了适度更高的敏感性。
