Brigham and Women’s Carpal Tunnel Questionnaire (CTQ) is an example of a disease-specific questionnaire designed to evaluate CTS [4]. The CTQ, developed by Levine et al., contains two separate scales: (1) symptom severity and (2) functional status [10]. Severity of CTS is measured using an 11-item multiple-choice questionnaire, focusing on pain, numbness, tingling, and nocturnal symptoms. Each item is scored from 1 (none or mild) to 5 (severe). The mean of all 11 scores is reported as the overall symptom severity of CTS. To measure functional status, an 8-item functioning questionnaire measures a range of activities [10]. Each listed activity is scored from 1 (no difficulty) to 5 (cannot do at all). A higher score on both scales shows a higher severity or a more limited hand/wrist function [10].

A multidisciplinary team of hand surgeons, rheumatologists, and CTS patients developed the CTQ; it contains all essential properties of a valid health instrument: reproducibility, internal consistency, validity, responsiveness, and ease of use (Table 9.2) [32]. The main advantage of this questionnaire is that it is focuses on symptoms and functions most often observed among CTS patients, so it is the most sensitive and responsive questionnaire for CTS. Pearson correlation coefficients of above 90% indicate excellent reliability/reproducibility attributes for both sections of this questionnaire [10]. In contrast, because it is disease specific, the CTQ does not allow for comparisons among different conditions [4].

Regarding validity of the questionnaire , a high correlation between mean scores obtained from the two sections of the test, severity of symptoms and function status, shows that patients with more severe scores had more function limitations. However, the correlation scores between both severity of symptoms and function status and traditional objective tools such as nerve conducting tests show low or poor correlation. For example, the correlation between the result of symptom severity evaluated by the CTQ and the two-point discrimination test, using the Spearman coefficient, was 0.15 and statistically not significant [10]. This is not an indication of low validity of the questionnaire; the provocative and nerve conducting tests and the CTQ capture different outcomes and should be used as complementary tools [10–12, 29].

With the average effect size of 0.82, the CTQ proved to be a responsive tool in measuring clinical outcome changes [10]. Additionally, patients’ satisfaction with the result of treatment was associated with significant improvement in symptom relief and function status [10].

The MHQ is a 57-item hand-specific questionnaire with six different domains that can be administered all together or in isolation [33]. The six domains of the questionnaire include (1) function, (2) activities of daily living, (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction [33]. The MHQ is widely used for various hand disorders [34] and has been translated into many different languages and used in other countries [35, 36].

Patients are asked to answer each question for each domain using a scale of 1–5 [33]. The sum of scores for each domain can total up to 100. With the exception of the pain domain, in all other domains a score of 0 represents the worst outcome and score of 100 represents the best [33, 37]. Like DASH, the MHQ can also be used for other hand disorders [38, 39]. However, because it covers hand and the wrist in the global assessment, it is more specific. The MHQ is the only hand questionnaire that distinguishes between the two hands and can be used to compare the severity of symptoms and function of one hand with the other [30].

Like DASH, the MHQ also has a 12-item brief MHQ to reduce the burden of answering long questionnaires for patients [40]. Both the MHQ and brief MHQ have been proven to be reliable, valid, and responsive hand outcome instruments and used to assess effectiveness of treatments for different hand disorders including CTS [30, 39, 40]. The MHQ has many advantages over other similar hand questionnaires. The MHQ is specific to hands but not to any specific disorder; this gives the questionnaire a desirable depth and adequate breadth. Additionally, having different domains makes it flexible and responsive for each specific disorder. For example, in assessment of CTS, the aesthetics domain can be excluded without affecting the results of the questionnaire [30]. Also, because the MHQ distinguishes between the two hands makes it possible to compare the outcomes of the affected hand with the unaffected hand. Most importantly, because the MHQ can measure outcomes of all hand and wrist conditions (e.g., CTS, carpometacarpal thumb arthritis, rheumatoid arthritis of hand, etc.), it can be utilized in comparative effectiveness studies across various conditions.

DASH is a 30-item self-administered questionnaire that was designed to measure physical function and severity of symptoms in patients with any upper extremity musculoskeletal disorder [41–43]. DASH was developed to fill the gap in longitudinal assessment of patients with one or multiple upper extremity disorders or injuries [41]. DASH contains two main domains: (1) symptoms and (2) function status, including physical, social, and psychological functioning [43]. Patients are asked to choose the level of difficulty of doing an activity or severity of a symptom, using a five-point Likert scale, with a higher score indicating a greater level of severity and disability [41]. To calculate the DASH total score, one needs to add all the responses (ranging between 1 and 5) and subtract 30 from the total; then, the total has to be divided by 1.2 to get a DASH score out of 100 [41]. If more than three items are not answered (missing), the overall DASH score cannot be calculated [41]. DASH combines questions related to symptom severity and functioning into one single questionnaire. The total score ranges from 0 to 100, with 0 representing perfect functioning and 100 representing the worst symptoms and disability [43]. Examples of activities include preparing a meal, pushing a heavy door, and making a bed. The functioning portion of the questionnaire includes general questions regarding pain, weakness, or tingling of the arm, shoulder, or hand, ranging from none to extreme [41].

DASH has been translated into many different languages and used widely in other countries [42]. Late in 2005, a shorter version of DASH , an 11-item questionnaire called QuickDASH, was developed to ease the burden of answering too many questions for the patients [44]. Both the DASH and QuickDASH questionnaires have proven to be reliable, valid, and responsive to clinical changes for upper extremity injuries and disorders (Table 9.3) [42, 46].