Comment on Diagnostic questionairre
Hello Dr B,
I had Electro-physiology tests some 4 years ago, and know I have CTS (again) so was a little surprised at my lower than expected score. That said, I think this a very useful and efficient tool - presumably patients for assessment arrive at clinic having completed the diagnostic tool and better informed, better for everyone.
The questionnaire is (as would be expected) somewhat "black and white" and does not allow for important Quality of Life nuances such as "sometimes" or "intermittently" or "in conjunction with certain activities" and important data outside the categories presented can be missed: for example "Neck Pain Yes/No" is tricky, I have shoulder pain (neuropathic pain) but not strictly neck per se. The question on Driving is misleading too as it only applies to *driving* what if you dont/can't drive?: there should be one for "Riding a bike / motorcycle" - this is a huge provoker of CTS symptoms and would be missed for people because they dont drive not because they dont have symptoms operating a vehicle...
Great job though, thanks
Peter
p.s.
I had to pause for pain/numbness (induced by mouse use and typing) about 20+ times during writing this...
In fact your symptom score of 69% is quite high and very suggestive of CTS as a diagnosis though it is worth bearing in mind that the questionnaire is calibrated for patients who do not already have an established diagnosis and has not been tested in subjects with known CTS - it is likely that the weightings for answers related to previous treatment would need to be different to obtain ideal diagnostic performance in already diagnosed patients.
The questionnaire is of course only a preliminary data collection tool, intended to get routine questions out of the way and leave more time in the face to face consultation for the exploration of nuances of the history. A few of the questions are not my responsibility as such - they are included because other investigators have suggested they are useful and if I am to check this in my own patients I have to ask the same question - the neck pain question is one of those. I also cannot alter the 'Boston' questionnaire which forms the last section as that is a standard instrument and I want to retain comparability with other people who use it. People who want to warn me in advance of other details of their symptoms which cannot be covered in the standard questions do of course have the option of posting a message in the forums here.
I agree that riding a motorcycle is pretty much a guaranteed way of triggering the symptoms of CTS but I am afraid you motorcyclists are a small minority compared to drivers, especially in the age group where CTS is common, and the questionnaire is designed for the majority :-) I think the questionnaire is quite long enough as it is so further additions really do have to 'pay their way' in terms of yielding useful information from most patients.
Thankyou for the comments as you can see there is relatively little feedback and everything is welcome! JB