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Carpal tunnel syndrome is a condition that causes numbness, tingling, and weakness in the hand due to pressure on the median nerve in the wrist. This condition often negatively affects a person's hand functions and ability to perform daily activities. While various tests are used in clinics to measure hand function, dexterity, and fine motor skills, there is still a lack of clear consensus in the literature regarding the specific reliability and validity of these particular tests for this patient population. Consequently, it remains uncertain which of these tests are truly accurate, consistent, and most appropriate for routine clinical use in carpal tunnel syndrome. Therefore, it is crucial to scientifically evaluate these tests to fill this gap in the literature.
The purpose of this study is to investigate reliability and construct validity of the Jebsen-Taylor Hand Function Test (JTHFT), the Minnesota Dexterity Test (MDT), and the Nine-Hole Peg Test (NHPG) in patients with carpal tunnel syndrome (CTS).
To achieve these objectives, a rigorous methodological protocol will be implemented (COSMIN criteria). Test-retest reliability will be evaluated by repeating the assessments within a 7-to-14-day interval. To control for potential learning, fatigue, and adaptation effects, the order of all performance tests will be strictly randomized using a permutation approach during both the initial (baseline) and the second (retest) evaluation sessions. Additionally, measurement error will be calculated using Standard Error of Measurement and Minimal Detectable Change to determine the true clinical precision of these tools.
For construct validity, a specific testing sequence and strict randomization strategy will be utilized to minimize response bias. Participants will complete all patient-reported outcome questionnaires prior to undergoing any physical testing. This ensures that a patient's subjective evaluation of their daily life activities is not influenced by their immediate performance or perceived success on the physical tests. Following the questionnaires, hand strength measurements and dexterity performance tests will be administered. The sequence of these physical tests will be fully randomized both among different test modalities and within their internal subtests for each participant. Construct validity will be evaluated through predefined hypothesis testing based on COSMIN guidelines. Convergent validity will be confirmed if a moderate correlation (r≥0.40 or r≤-0.40) is observed between the dexterity tests and structurally related parameters. Divergent validity will be confirmed by a weak correlation (r≥-0.39 and r≤0.39) with structurally unrelated or distinct clinical parameters. Construct validity of the assessments will be considered satisfactory if at least 75% of these predefined hypotheses are confirmed by the statistical analysis.
Predefined hypothesis (the details of the used questionnaires and measurements are in Outcome Measures):
JTHFT-total score:
JTHFT Subtests:
Minnesota Dexterity Test (MDT) - Placing & Turning Scores:
Nine-Hole Peg Test (NHPT):
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standardized Hand Function and Dexterity Testing | Other | Participants will not receive any therapeutic, surgical, or pharmacological intervention as part of this observational study. The 'exposure or process of interest' consists solely of undergoing three standardized functional assessments (Jebsen-Taylor Hand Function Test, Minnesota Dexterity Test, and Nine-Hole Peg Test) to evaluate their psychometric properties (reliability and validity) in patients with carpal tunnel syndrome. All testing details are defined in the Outcome Measures section. |
| Measure | Description | Time Frame |
|---|---|---|
| Jebsen-Taylor Hand Function Test | A standardized, timed assessment designed to evaluate a broad range of uni-manual hand functions utilizing everyday functional activities. It consists of seven distinct subtests: writing, card turning, picking up small objects, simulated feeding, stacking checkers, picking up large light cans, picking up large heavy cans. The physiotherapist will demonstrate the test first, followed by a practice trial for the participant. A maximum time limit of 120 seconds is set for each subtest; if a task cannot be completed, the score is recorded as 120 seconds. | For test-retest reliability: baseline (first measurement) and retest (second measurement, 7 to 14 days after baseline) |
| Minnesota Dexterity Test | The Minnesota Dexterity Test is a standardized objective instrument used to evaluate rapid eye-hand coordination and gross arm-hand dexterity. It consists of two primary subtests: the Placing Test and the Turning Test. In the Placing Test, the subject fills the board with 60 cylindrical blocks as quickly as possible. In the Turning Test, the subject turns the blocks over in a specified sequence using both hands alternately. Each subtest will be performed two times. Separate total scores will be calculated for the Placing Test and the Turning Test based on the total time (in seconds) required to complete the trials. Higher scores (longer times) indicate greater impairment and poorer manual dexterity. | For test-retest reliability: baseline (first measurement) and retest (second measurement, 7 to 14 days after baseline) |
| Nine-Hole Peg Test | The Nine-Hole Peg Test is a brief, standardized quantitative assessment used to measure finger dexterity and fine manual velocity. The apparatus consists of a plastic board with nine holes and nine pegs. The participant will be instructed to pick up the pegs one by one from a container, place them into the nine holes as fast as possible, and then remove them one by one, returning them to the container. The test will be performed one time. The score will be recorded as the total time (in seconds) taken to complete the entire task. Higher scores (longer times) indicate worse fine motor dexterity and coordination. | For test-retest reliability: baseline (first measurement) and retest (second measurement, 7 to 14 days after baseline) |
| Measure | Description | Time Frame |
|---|---|---|
| Boston Carpal Tunnel Questionnaire | The Boston Carpal Tunnel Questionnaire is a patient-reported, disease-specific outcome measure designed to evaluate the severity of symptoms and functional status in patients with carpal tunnel syndrome. It comprises two independent subscales: the Symptom Severity Scale (11 items) and the Functional Status Scale (8 items). Each item is scored on a 5-point Likert scale ranging from 1 (no symptoms/no difficulty) to 5 (most severe symptoms/cannot perform activity). The score for each subscale is calculated as the mean of the completed items, yielding a final score between 1 and 5. Higher scores represent more severe symptoms and worse functional limitation. |
| Measure | Description | Time Frame |
|---|---|---|
| Mini-Mental State Examination | The Mini-Mental State Examination (MMSE) will be utilized as a brief screening tool to objectively assess the cognitive competence of the participants. The test evaluates global cognitive domains including orientation to time and place, registration, attention and calculation, short-term recall, language, and visuospatial praxis. Total scores range from 0 to 30, with higher scores reflecting better cognitive function. A cut-off score of 24 or above will be required for inclusion to ensure that participants possess the necessary cognitive capacity to fully understand, cooperate with, and accurately execute the multi-step instructions of the physical performance tests. |
Inclusion Criteria:
Exclusion Criteria:
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The study population will consist of adult patients diagnosed with carpal tunnel syndrome who apply for medical care or undergo clinical evaluation. Participants will be recruited directly from the outpatient clinics of the Department of Orthopedics and Traumatology at a tertiary care university hospital.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Gülbin Ergin, PhD | Contact | +902324930000 | gulbin.ergin@bakircay.edu.tr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| İzmir Bakırçay University | Recruiting | Izmir | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D002349 | Carpal Tunnel Syndrome |
| ID | Term |
|---|---|
| D020423 | Median Neuropathy |
| D020422 | Mononeuropathies |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
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| For validity: baseline |
| Michigan Hand Outcomes Questionnaire | The Michigan Hand Outcomes Questionnaire is a comprehensive, hand-specific psychometric instrument designed to assess a patient's perception of their hand function and quality of life. It contains 57 items divided into six distinct domains: Overall Hand Function, Activities of Daily Living, Work Performance, Pain, Aesthetics, and Patient Satisfaction. Items are scored on a 5-point scale, and responses are normalized and converted to a standardized score ranging from 0 to 100 for each domain. For the pain domain, a higher score denotes greater pain severity. For the remaining five domains, higher scores represent better hand performance, appearance, and satisfaction. | For validity: baseline |
| QuickDASH | The QuickDASH is a shortened, 11-item version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, used to measure physical symptoms and disability in individuals with musculoskeletal disorders of the upper limb. It evaluates symptoms (such as pain and tingling) and the ability to perform specific physical activities during the past week. Each item is rated on a 5-point Likert scale. The scores are summated and transformed to a standardized scale of 0 to 100, where 0 represents no disability and 100 represents the most severe disability and symptom expression. | For validity: baseline |
| EuroQol 5D-5L | The EuroQol 5D-5L is a standardized, generic instrument used to measure health-related quality of life. It consists of two main components: the EQ-5D descriptive system and the EQ Visual Analogue Scale (EQ VAS). The descriptive system covers five dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Each dimension is rated on 5 levels of severity ranging from 1 (no problems) to 5 (extreme problems). The EQ VAS records the respondent's self-rated health on a vertical visual analogue scale ranging from 0 (the worst health you can imagine) to 100 (the best health you can imagine) | For validity: baseline |
| Hand Grip Strength | Hand grip strength will be measured objectively using a calibrated hydraulic hand dynamometer to assess gross hand grip capacity. The testing will be performed with the subject seated comfortably, the shoulder adducted and neutrally rotated, the elbow flexed at 90 degrees, and the forearm and wrist in a neutral position. The assessment will be conducted for the affected hand, with three trials performed for the hand, and a brief rest period allowed between trials. The average score of the three trials is recorded in kilograms. Higher values indicate greater hand grip strength. | For validity: baseline |
| Pinch Strength | The pinch strength will be measured using a calibrated hydraulic pinch gauge. The testing will be performed with the subject seated comfortably, the shoulder adducted and neutrally rotated, the elbow flexed at 90 degrees, and the forearm and wrist in a neutral position. The assessment will be conducted for the affected hand, with three trials performed for the hand, and a brief rest period allowed between trials. The scores will be recorded in kilograms. Higher values represent stronger pinch capacity. | For validity: baseline |
| Baseline |
| D009422 | Nervous System Diseases |
| D009408 | Nerve Compression Syndromes |
| D012090 | Cumulative Trauma Disorders |
| D013180 | Sprains and Strains |
| D014947 | Wounds and Injuries |