Background 

It has been observed that patients with carpal tunnel syndrome (CTS) who also experience emotional distress, depression, or anxiety report more severe symptoms. As patients’ own perspectives about their health increasingly are guiding treatment decisions, it seems important to study the simultaneous association of psychological distress and neuropathology with hand disability in patients who have CTS, as this may help prioritize and sequence management steps.

Questions/purposes 

What are the relationships among validated scores for (1) depression, (2) anxiety, (3) pain catastrophizing, and (4) nerve electrodiagnostic severity with measures of hand disability in patients with confirmed CTS?

Methods 

Between 2017 and 2019, we evaluated 116 patients for CTS in a referral urban hospital in Mashhad, Iran. Of those, we considered 85% (99) as potentially eligible by considering the following Electromyography-Nerve Conduction Study (EMG-NCS) diagnostic criteria: sensory latency ≥ 3.5 Ms, median-ulnar latency difference ≥ 0.5 Ms, motor latency ≥ 4.2 Ms, and abnormal EMG findings in the opponens pollicis muscle (neurogenic motor unit action potentials, positive sharp waves, or fibrillation). A further 13% (15 of 116) were excluded because of nonidiopathic CTS and prior surgery, and another 12% (14 of 116) were lost because of incomplete datasets, leaving 60% (70 of 116) for final inclusion in this cross-sectional study. In all, 89% of patients were women with total mean age of 47 years. We measured depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) questionnaire (scored from 0 to 21, with a minimum clinically important difference [MCID] of 1.7 points), and we evaluated patients’ state of mind regarding pain using the Pain Catastrophizing Scale (PCS) (scored from 0 to 52). Higher scores on these questionnaires represent more distress and pain catastrophizing. Hand disability was assessed with Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire outcomes (scored from 0 [no disability] to 100 [most severe disability]; MCID of 15 points), Likert pain score (from 0 to 10), and grip/pinch dynamometry results. Correlational analyses were conducted once among HADS and PCS scores and again among EMG-NCS indices with pain and disability variables to answer our first, third, and fourth questions, respectively. Regression analysis was performed to assess the percentage of variance in QuickDASH and pain severity, which could be explained by psychological and electrodiagnostic factors. We did not include grip and pinch in our multivariable model (regression analysis) as dependent variables because they did not correlate with any of psychological or EMG-NCS variables (all p values > 0.1). Significance was set at p < 0.05.

Results 

Correlational analysis showed that the scores of all three psychological questionnaires correlated with the QuickDASH score (r = 0.50, 0.42, and 0.53 for HADS-A, HADS-D, and PCS, respectively; p < 0.001 for all three), while EMG-NCS parameters had no correlation with QuickDASH and pain scores. We also found that 37% of the variance in QuickDASH score can be explained by HADS and PCS scores (r² = 0.37; p < 0.001).

Conclusion 

Evaluation and treatment of psychological distress before deciding on elective surgery for CTS is important because patient-reported disability—often used as a factor in surgical decision-making—is substantially correlated with emotional distress. Future prospective, controlled studies on this topic are recommended; ideally, these should evaluate psychological interventions specifically to ascertain whether they improve patients’ ratings of hand disability.

Level of Evidence 

Level III, prognostic study.

中文翻译：

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哪些心理和电诊断因素与腕管综合征患者的肢体残疾相关？

背景 

据观察，患有情绪困扰、抑郁或焦虑的腕管综合征 (CTS) 患者会报告更严重的症状。随着患者对自己健康的看法越来越多地指导治疗决策，研究 CTS 患者的心理困扰和神经病理学与手部残疾的同时关联似乎很重要，因为这可能有助于确定管理步骤的优先顺序和顺序。

问题/目的 

确诊 CTS 患者的 (1) 抑郁、(2) 焦虑、(3) 疼痛灾难化和 (4) 神经电诊断严重程度的验证评分与手部残疾测量之间有何关系？

方法 

2017 年至 2019 年间，我们对伊朗马什哈德一家转诊城市医院的 116 名 CTS 患者进行了评估。其中，通过考虑以下肌电图-神经传导研究 (EMG-NCS) 诊断标准，我们认为 85% (99) 可能符合资格：感觉潜伏期 ≥ 3.5 Ms，中尺潜伏期差 ≥ 0.5 Ms，运动潜伏期 ≥ 4.2 Ms ，以及拇对肌肌电图异常（神经源性运动单位动作电位、正尖波或颤动）。另外 13%（116 人中的 15 人）因非特发性 CTS 和既往手术而被排除，另外 12%（116 人中的 14 人）由于数据集不完整而丢失，留下 60%（116 人中的 70 人）最终纳入该交叉研究中。截面研究。总的来说，89% 的患者是女性，平均年龄为 47 岁。我们使用医院焦虑和抑郁量表 (HADS) 问卷（评分从 0 到 21，最小临床重要差异 [MCID] 为 1.7 分）测量抑郁和焦虑，并使用疼痛评估患者对疼痛的心理状态灾难化量表 (PCS)（评分从 0 到 52）。这些问卷的得分越高，代表痛苦和痛苦越严重。手部残疾通过手臂、肩部和手部快速残疾 (QuickDASH) 问卷结果进行评估（评分从 0 [无残疾] 到 100 [最严重残疾]；MCID 为 15 分）、Likert 疼痛评分（从 0 到 10） ），以及握力/捏力测力结果。在 HADS 和 PCS 评分之间进行一次相关分析，并在 EMG-NCS 指数与疼痛和残疾变量之间进行一次相关分析，分别回答我们的第一、第三和第四个问题。进行回归分析以评估 QuickDASH 和疼痛严重程度的方差百分比，这可以通过心理和电诊断因素来解释。我们没有将握力和捏力作为因变量纳入我们的多变量模型（回归分析）中，因为它们与任何心理或 EMG-NCS 变量均不相关（所有 p 值 > 0.1）。显着性设置为 p < 0.05。

结果 

相关分析显示，所有三份心理问卷的分数均与 QuickDASH 分数相关（HADS-A、HADS-D 和 PCS 的 r 分别 = 0.50、0.42 和 0.53；所有三份问卷的 p < 0.001），而 EMG- NCS 参数与 QuickDASH 和疼痛评分没有相关性。我们还发现 QuickDASH 分数中 37% 的方差可以通过 HADS 和 PCS 分数来解释 (r ² = 0.37; p < 0.001)。

结论 

在决定 CTS 择期手术之前评估和治疗心理困扰非常重要，因为患者报告的残疾（通常被用作手术决策的一个因素）与情绪困扰密切相关。建议未来对该主题进行前瞻性、对照研究；理想情况下，这些应该专门评估心理干预措施，以确定它们是否可以改善患者的手部残疾评级。

证据水平 

III级，预后研究。