Levine D W, Simmons B P, Koris M J, Daltroy L H, Hohl G G, Fossel A H, Katz J N
Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
J Bone Joint Surg Am. 1993 Nov;75(11):1585-92. doi: 10.2106/00004623-199311000-00002.
We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.
我们开发了一份用于评估腕管综合征患者症状严重程度和功能状态的自填式问卷。在一项临床研究中，对用于测量症状严重程度和功能状态的量表的可重复性、内部一致性、效度以及对临床变化的反应性进行了评估。这些量表具有高度可重复性（症状严重程度和功能状态的Pearson相关系数r分别为0.91和0.93）且内部一致（症状严重程度和功能状态的Cronbach α分别为0.89和0.91）。两个量表与两点辨别觉和Semmes-Weinstein单丝试验均呈正相关，但相关性中等或较弱（Spearman系数，r = 0.12至0.42）。在1990年接受手术且术后中位随访时间为14个月的38例患者中，平均症状严重程度评分从术前的3.4分改善至最近一次随访检查时的1.9分，而平均功能状态评分从3分改善至2分（每个量表中5分为最差评分，1分为最佳评分）。在26例术前和术后3个月接受评估的患者中也观察到了类似的改善。我们得出结论，用于测量症状严重程度和功能状态的量表具有可重复性、内部一致性且对临床变化有反应，并且它们测量的是正中神经损伤传统测量未涵盖的结局维度。这些量表应能提高腕管综合征治疗研究中结局测量的标准化程度。
