Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) |
Symptom severity scale (11 items) |
1. How severe is the hand or wrist pain that you have at night? |
2. How often did hand or wrist pain wake you up during a typical night in the past two weeks? |
3. Do you typically have pain in your hand or wrist during the daytime? |
4. How often do you have hand or wrist pain during daytime? |
5. How long on average does an episode of pain last during the daytime? |
6. Do you have numbness (loss of sensation) in your hand? |
7. Do you have weakness in your hand or wrist? |
8. Do you have tingling sensations in your hand? |
9. How severe is numbness (loss of sensation) or tingling at night? |
10. How often did hand numbness or tingling wake you up during a typical night during the past two weeks? |
11. Do you have difficulty with the grasping and use of small objects such as keys or pens? |
Functional status scale (8 items) |
1. Writing |
2. Buttoning of clothes |
3. Holding a book while reading |
4. Gripping of a telephone handle |
5. Opening of jars |
6. Household chores |
7. Carrying of grocery basket |
8. Bathing and dressing |
Clinical rating scale (Hi-Ob scale) |
(A) any kind of paraesthesia in the hand (numbness, tingling, burning, etc.) with regard to its temporal onset and duration |
(B) sensory function in the median nerve distribution of the hand |
(C) motor function of median innervated muscles of the hand |
(D) trophism of the thenar eminence |
(E) pain, reported as dull or aching discomfort, in the hand, forearm or upper arm |
Patient Evaluation Measure (PEM) |
Part One: Treatment |
Please put a circle around the number that is closest to the way you feel about how things have been for you. There are no right or wrong answers. |
1. Throughout my treatment I have seen the same doctor: |
2. When the doctor saw me, he or she knew about my case: |
3. When I was with the doctor, he or she gave me the chance to talk: |
4. When I did talk to the doctor, he or she listened and understood me: |
5. I was given information about my treatment and progress: |
Part Two: How Your Hand is Now? |
1. The FEELING in my hand is now: |
2. When my hand is cold and/or damp, the PAIN is now: |
3. Most of the time, the PAIN in my hand is now: |
4. When I try to USE my hand for fiddly things, it is now: |
5. Generally, when I MOVE my hand it is: |
6. The GRIP in my hand is now: |
7. For everyday ACTIVITIES, my hand is now: |
8. For WORK, my hand is now: |
9. When I look at the appearance of my hand now, I feel: |
10. Generally, when I think about my hand, I feel: |
Part Three: Overall Assessment |
1. Generally, my treatment at the hospital has been: |
2. Generally, my hand is now: |
3. Bearing in mind my original injury or condition, my hand is now: |
Are there any other comments you wish to make? |
Thank you very much indeed for your help |