Translation and validation of the Arabic version of the Boston carpal tunnel syndrome questionnaire

Objectives:To translate and validate the Arabic version of the Boston carpal tunnel questionnaire (BCTQ-A).Methods:We recruited consecutive patients with carpal tunnel syndrome (CTS). Reliability was assessed with Cronbach α, reproducibility with intraclass correlation coefficients, construct validity with factor analysis, and responsiveness post carpal tunnel release (CTR) with the Wilcoxon signed-rank test.Results:In 134 patients, the mean total scores for the symptom severity scale (SSS) and functional status scale (FSS) were 32.0±8.4 (α=0.88, ICC=0.88) and 18.5±7.6 (α=0.87, ICC=0.89), respectively. As in the original Boston carpal tunnel questionnaire (BCTQ), a 3-factor model of the BCTQ-A best fitted the data. The BCTQ-A, SSS, and FSS scores were significantly lower post-CTR.Conclusion:The BCTQ-A is reliable, valid, reproducible, and responsive to interventions. The Arabic version can be now used with Arabic-speaking patients with CTS.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy affecting the median nerve at the wrist. The diagnosis of CTS is made clinically and supported by the finding of median neuropathy at the wrist on electrodiagnostic studies (EDX). Atroshi et al1 reported a prevalence of clinically certain CTS of 3.8%, and a prevalence of clinically and EDX confirmed CTS of 2.7%.1 Both carpal tunnel release (CTR) and conservative interventions are used for the treatment of CTS; the former may be more effective in relieving symptoms and improving hand function.2 A recent study has estimated a lifetime prevalence of CTR of 3.1%.3 The use of a validated outcome measure is imperative to monitor the response to CTS therapy.The Boston carpal tunnel questionnaire (BCTQ) is a patient-reported outcome measure of proven reliability, validity, and responsiveness to surgical and non-surgical treatment.4-7 The BCTQ is composed of 2 scales, the symptom severity scale (SSS) and the functional status scale (FSS). The SSS consists of 11 items, incorporating 6 domains (pain, numbness, paresthesia, nocturnal symptoms, weakness, and overall functional status) scored on a 5-point scale ranging from 1 (never/none) to 5 (most severe). The FSS consists of 8 functional activities commonly affected by CTS scored on a 5-point scale ranging from 1 (no difficulty) to 5 (cannot perform the activity at all). The BCTQ score reflects CTS severity in a typical 24-hour period within the last 2 weeks before completing the questionnaire.4,8 The BCTQ has been translated and validated in many languages,5,9-13 but not yet in Arabic. Validation of an Arabic version of the BCTQ would be useful to help physicians assess the impact of CTS from the patients’ perspective and objectively assess post-intervention improvement. This study sought to translate and culturally adapt the BCTQ into Arabic and to assess its psychometric properties, including reliability, reproducibility, validity, and responsiveness to CTR.