Spanish validation of the Boston Carpal Tunnel Questionnaire

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Marín, José A. Matas, Javier Vaquero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "ÿngel" "apellidos" => "Oteo-ÿlvaro" "email" => array:1 [ 0 => "angel_oteo@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "⿿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María T." "apellidos" => "Marín" ] 2 => array:2 [ "nombre" => "José A." "apellidos" => "Matas" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Vaquero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⿿" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación al castellano de la escala Boston Carpal Tunnel Questionnaire" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3030 "Ancho" => 1595 "Tamanyo" => 208461 ] ] "descripcion" => array:1 [ "en" => "Average score on the severity and functionality subscales by the degree of atrophy (above) and the degree of electromyographic involvement (below). BCTQ: Boston Carpal Tunnel Questionnaire; EMG: electromyography." ] ] ] "textoCompleto" => "IntroductionCarpal tunnel syndrome (CTS) is a malady defined as the clinical condition resulting from the compression of the median nerve as it passes beneath the transverse carpal ligament, which causes pain, paresthesia, numbness and weakness in the area of that nerve.<a class="elsevierStyleCrossRef" href="#bib0085">1</a> It is the direct cause of neuropathic pain<a class="elsevierStyleCrossRef" href="#bib0090">2</a> and is a highly prevalent condition, observed in 0.1% of the general population. It is also one of the most common causes of work disability, affecting 5% of workers who work in certain professional activities. It is the most common hand peripheral neuropathy cause by entrapment, affecting up to 3% of the general population, with a higher incidence in women between the fourth and sixth decades of life.<a class="elsevierStyleCrossRef" href="#bib0095">3</a>A large number of patients with pain in the hand and wrist are evaluated daily by electrophysiological studies and these symptoms are often due to CTS. Its social and economic implications are important because of its high incidence in developed countries,<a class="elsevierStyleCrossRef" href="#bib0100">4</a> resulting in costs of approximately $30,000 per affected worker in the USA.<a class="elsevierStyleCrossRef" href="#bib0105">5</a> Our days are getting longer, and although the most common cause is idiopathic,<a class="elsevierStyleCrossRef" href="#bib0105">5</a> there is a certain suspicion that it is work related,<a class="elsevierStyleCrossRef" href="#bib0095">3</a> but to date no epidemiological evidence<a class="elsevierStyleCrossRef" href="#bib0110">6</a> has been established for this theory.Although the surgical release of the median nerve results in a high rate of satisfaction,<a class="elsevierStyleCrossRef" href="#bib0115">7</a> some patients report dissatisfaction with results obtained.<a class="elsevierStyleCrossRef" href="#bib0120">8</a> Given that electromyographic (EMG) studies after the release of the median nerve show no relationship with patient satisfaction,<a class="elsevierStyleCrossRef" href="#bib0125">9</a> tools such as the Boston Carpal Tunnel Questionnaire (BCTQ; Levine et al., 1993)<a class="elsevierStyleCrossRef" href="#bib0130">10</a> are needed for a proper evaluation of different treatment methods.To date, this questionnaire has been translated and validated into Italian<a class="elsevierStyleCrossRef" href="#bib0135">11</a> and Portuguese.<a class="elsevierStyleCrossRef" href="#bib0140">12</a> On March 27, 2012 approval from Dr. Jeffrey N. Katz was received to translate and validate the questionnaire into Spanish. The purpose of this study is to validate the BCTQ scale into Spanish, in addition to confirming the psychometric properties of the instrument in the Spanish population.Materials and methodsStudy designThe general recommendations for cultural adaptation and validation of quality of life instruments<a class="elsevierStyleCrossRef" href="#bib0145">13</a> were followed for the adaptation process. First, a panel of experts was created to oversee the adaptation process. This panel was formed by three experts: one in Orthopedics And Traumatology; Another, In Family And Community Medicine (both compressive neuropathy experts); and an epidemiologist expert in methodology. The original questionnaire was translated by two independent translators from English into Spanish (Spain). The expert panel reviewed the translations and produced a standardized version.The standardized version was piloted in a sample of 20 patients to assess the comprehensibility of the terms used and the wording of questions. Not having found any difficulty in its comprehension or any significant response bias, the version was considered linguistically acceptable and returned for a back translation into English to identify any possible discrepancies (<a class="elsevierStyleCrossRef" href="#sec0070">Annex I</a>).The research was designed as an observational, cross-sectional, multi-center study under routine clinical practice conditions. A random sample of 90 patients selected by two researchers was chosen according to demand for treatment (see below).The selected patients complied with the following inclusion criteria: patients of both sexes, over 18-years-old, with the presence of hand and wrist pain, and paresthesia, able to read and understand Spanish, who had given their informed consent. Patients who were unable to read or understand the questionnaire were excluded.Under no circumstances was the researcher's decision on the most appropriate medical care or treatment for the patient interfered with and all participants gave their informed consent to freely to participate in the study and allow their data to be used. The study was conducted in the field of primary care and clinical specialties hospital in Spain. The study was approved by the European Foundation for Health Research and Education (CEI-EFHRE-EU-201302) Research Ethics Committee. The information was collected from 27/06/2013 to 27/05/2014.VariablesPatients⿿ social and demographic information and clinical variables of interest were collected in addition to the designation of the painful area on a map of the hand in order to determine whether that area included the median nerve. The BCTQ questionnaire was included as well as the measures necessary for validation, which are detailed below.Concurrent measurementsGrip force: affected hand's maximum strength and difference between both hands (three grips with an interval of 2min between each grip starting with the dominant hand). When the hand being assessed was not the dominant hand, the result was offset by adding 10%. The grip was evaluated by a manual dynamometer (Jamar® Hydraulic Hand Dynamometer).Differentiation between 2 points: sensory ability to differentiate between 2 adjacent points. An open clip with a distance between both ends of 5mm was used, placing both ends at the same time on the skin of the fingertip (distal phalanx) and lightly pressing 10 times. A differentiation of >5mm on the fingertip in seven out of the 10 times is considered abnormal.Muscle atrophy assessment: Atrophy assessment of the thenar area of the hand by the clinician in a 3-point scale (mild, moderate and severe).Electromyography study: measurement of the orthodromic sensory nerve conduction velocity from fingers 2, 3 and 4, and when they decreased, the fifth finger (ulnar nerve) as a comparator. In normal situations there should be no division of the fourth finger (innervated by the median and ulnar nerve). The distal motor latency and differential latency were evaluated, using surface electrodes, setting three degrees: mild, moderate and significant/extreme (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Brief Pain Inventory (BPI)<a class="elsevierStyleCrossRef" href="#bib0150">14</a>: a self-administered questionnaire consisting of 11 items. The BPI consists of two sections: ⿿Pain intensity⿿ (4 items) and ⿿interference in every-day activities⿿ (7 items). Each of the items is scored using a Likert scale with ratings, 0=no pain/interference in daily life and 10=worst imaginable pain/maximum involvement in daily life. The 11 items provided two score summary, one for each section.Douleur Neuropatique four questions (DN4, ⿿Neuropathic Pain Scale⿿)<a class="elsevierStyleCrossRef" href="#bib0155">15</a>: a mixed-scale for the screening of neuropathic pain, comprising of seven self-administered questions and three clinical examination questions. The 10 dichotomous items cover different types of painful sensations, the presence of hypoesthesia and the presence of pain caused by touch. A score of ⿥4 points is considered symptomatic of neuropathic pain. Its sensitivity and specificity are at 80⿿90%.Understanding and ease of use: the time required to complete the questionnaire was recorded and two questions were asked, one about its understanding and the other about its ease of its application, with 3 answers: Yes, No, and I do not know.Sample sizeThe study was designed with the same methodology as the previous validations of the BCTQ questionnaire. It was determined that at least 80 patients needed to be included. A sub-sample of 21 patients underwent a re-test of the questionnaire 2⿿3 days after the first one was conducted. A sub-sample of 40 patients underwent a prospective follow-up and were re-evaluated a second time: 30 were assessed 2⿿3 months after median nerve decompression surgery and 9 were assessed before surgery (the monitoring of one patient was discontinued). This sample design was considered sufficient for the validation of the scale, reproducing the scheme used in previous validations. 90 patients were finally included in the study (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Statistical analysisTo validate the BCTQ scale, the suppositions of classical test theory were assumed and the psychometric properties described here were evaluated. Analysis of items: distribution of responses by category for each item, the presence of floor/ceiling effect (over 40% of respondents in an extreme category) and blank responses. Feasibility: time needed to complete the questionnaire, understanding of the questions, ease of filling out the questionnaire, proportion of useful questionnaires and number of blank responses per questionnaire. Reliability: internal consistency (Cronbach's α and intraclass correlation coefficient [ICC]) and temporal stability (test⿿retest correlation). α>0.8 were taken as criterion of goodness values. The test⿿retest correlation was calculated with a sample of 21 patients, after 2⿿3 days.Structural validity. An exploratory factor analysis (EFA) was performed using the extraction of principal components method and oblique Promax rotation. The following was used as criteria for retention factors: number of Kaiser⿿Guttman eigenvalues >1, Cattell sedimentation test and proportion of explained variance. Three models for confirmatory factor analysis (CFA) were suggested for each sub-scale: a one-dimensional model, a model with two factors correlated with a division of a subset of items and a model with a general second-order factor and 2 specific factors of the first-order: the following values for statistical goodness of fit<a class="elsevierStyleCrossRef" href="#bib0160">16</a> were used as criteria: Ͽ2 (p>0.05); Ͽ2/gl<5; GFI>0.95; AGFI>0.9; TLI>0.9; CFI>0.9; RMSEA<0.08; WRMR⿤1. The estimation methods used were the maximum likelihood and MLMV methods (for ordinal scores).Evidence of concurrent validity were obtained by assessing, at baseline, the correlation of the BCTQ sub-scales with scores obtained on the use scales that had already been validated: DN4 and BPI. The Pearson correlation coefficient was used.Construct validity. Comparison of average scores in regard to the clinical classification defined by the sensory differentiation, muscle atrophy and EMG involvement. The t-test for independent groups or analysis of variance was used (by number of groups) for comparisons of averages. The hypothesis established was that patients with greater severity of clinical characteristics would obtain higher scores on BCTQ sub-scales.Sensitivity to clinical change in those patients who underwent decompression surgery was assessed by comparing the average score before the operation (pre) and 30⿿60 days after surgery (post). The t-test was used for related and statistical data of the effect size (calculated as the difference between pre- and post-scores divided by the standard deviation of the pre-score). All patients answered that they had experienced a functional recovery and thus no comparisons in this respect could be made.The analyses were performed with the statistical software packages SAS®, IBM® SPSS® version 20, IBM® AMOS® version 20 and MPlus® version 17.ResultsParticipantsA sample of 90 patients diagnosed with CTS was selected. 63.3% were women, the mean age was 53.6 years (SD=14.5) and 43.0% were currently working (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). 37.8% of patients had a concomitant disease (see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), the most frequent being hypertension (30.0%).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In 65 patients (72.2%) the hand that was affected by CTS was the dominant hand; 42.2% of patients showed abnormal measurement between 2 points, 28.0% moderate or severe muscle atrophy of the thenar region of the hand and the degree of EMG involvement was intense in 41.1% of cases. The grip strength in the affected dominant hand showed no significant clinical differences from the affected non-dominant hand; however, the grip difference in hands was found to be near significance (dif.=0.59kg; ST=0.293; p=0.046). In all cases (100%) the painful area corresponded to the region of the median nerve.The average score on the DN4 questionnaire was 4.9 symptoms (SD=2.07), ranging between one and 10. 76.7% of patients received a score of ⿥4; the most frequent symptoms were tingling (98.9%) and burning (96.7%) feelings, and less frequent, stinging (11%) and allodynia (11%) feelings.The average scores on the BPI questionnaire sections were: in the pain intensity section, 3.2 (SD=1.8), and in the interference in every-day activities section, 2.2 (SD=1.8). Categorizing by levels, 58.9% presented mild (0⿿3), 35.6% moderate (4⿿6) and 5.6% severe (7⿿10) intensity. 87.8% showed marked interference in daily life (5⿿10).Of the 30 patients with post-operative follow-up assessment, all showed a good clinical impression of post-operative functional recovery, while 33.3% reported that the pain remained, and 16.7% reported suffering from hypostasis and paresthesias. Regarding the nine patients who had been assessed before surgery, all maintained the presence of pain, paresthesia and hypoesthesia.Psychometric validationAll patients gave valid answers to all items on the severity sub-scale. The answers were distributed across all the response categories for all items. Four of the items showed a certain tendency to floor effect, accumulating between 31 and 42% of respondents in the lowest category (p1, p2, p7, p11); however, the following maximum frequency category was not the next one, showing that there may be a subset of patients that do not experience that kind of pain. In addition, all subjects responded to all the items in the sub-scale of functionality and only the maximum category of item 8 did not receive any answers. On this occasion, items 1, 2 and 8 (relating to smooth motility) showed a clear floor effect, accumulating 63, 50 and 86% of respondents in the category of the previous answer, respectively although always followed by the next highest frequency in the next category.The average score on the severity sub-scale was 2.76 points (SD=0.84; Min=1.18; Max=4.91), and functional sub-scale was 2.32 points (SD=0.84; Min=1; Max=4.25). The correlation between sub-scales was r=0.772.The response time ranged between 5 and 11min, with an average of 8.02min (SD=2.203). All patients reported correctly understanding all questions and not find difficulties in responding.The internal consistency of the severity sub-scale was very good (α=0.909), with a confidence interval of 95% from 0.878 to 0.934 and an inter-item correlation average of r=0.475. Regarding the sub-scale functionality, internal consistency was slightly less (α=0.872), and the confidence interval was 0.831⿿0.901. The removal of any of the items would decrease reliability and inter-item average correlation was r=0.461.For the 21 patients who completed the re-test, the test⿿re-test correlation of the severity sub-scale was r=0.939, with an ICC=0.926, demonstrating excellent temporal stability. Furthermore, the functional sub-scale obtained a correlation r=0.986 and ICC=0.909.The EFA of the severity sub-scale resulted in two eigenvalues greater than one, which explained 66% of the available variance. Sedimentation test showed a first eigenvalue of great magnitude that explained most of the variance (54%), followed by three other eigenvalues in gradual decrease in size. Comparison of the solutions before and after rotation showed the presence of a dimension that was common to all items of which a second dimension divided from, grouping (mainly) intensity, frequency and duration of pain during the day. Moreover, the correlation between the two dimensions was high (r=0.505). As for the sub-scale of functionality, the EFA also resulted in two eigenvalues greater than the unit, which explained 66% of the variance. The scree plot made the existence of a priority dimension more obvious. The solution obtained showed the presence of a single common dimension, from which a second dimension split corresponding to the three functions of smooth motility (writing, buttoning and getting ready/dressed). Two dimensions showed a high correlation (r=0.549).The results of the CFA by MLMV estimation methods showed the best fit for two equivalent structures: Two related dimensions or two explained dimensions by a second-order factor (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The severity sub-scale adequately adjusted to a structure with an overall dimension of severity that substantially correlated (Ͽ21=0.52) with another dimension which includes daytime symptoms: p3, p4 and p5, or, equivalently, two dimensions measuring a general factor of severity. All saturations were significant (p<0.05) and the statistical goodness of fit were good or acceptable: CFI=0.944; TLI=0.928; RMSEA=0.177; Ͽ2/gl=3.82; WRMR=1.130. The structure of the best fit for the functional sub-scale corresponded to a two dimension correlated configuration (Ͽ21=0.73), one corresponding to the gross motor skills and another corresponding to fine motor skills: p1, p2 and p8, or an equivalent structure of 2 factors that saturate in a general factor of functionality (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). All saturations were significant (p<0.05) and the fit statistics were good or very good: CFI=0.990; TLI=0.985; RMSEA=0.091; Ͽ2/gl=1.75; WRMR=0.573. The maximum likelihood estimate yielded similar values.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The correlation between the sub-scale severity of BCTQ and pain intensity of the BPI was high (r=0.707), as was the correlation between the functional sub-scale and interference in every-day activities area (r=0.747). These correlations were slightly higher than those obtained for the not conceptually consistent dimension (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). In addition, scores on the BCTQ sub-scales correlated with the number of DN4 neuropathic pain symptoms, both of similar correlations: severity (r=0.673) and functionality (r=0.662).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Although the BCTQ sub-scales showed a high and significant correlation (r=0.77), the correlation was not quite perfect (r>0.9), supporting the idea of sufficient discriminant validity between the two dimensions (both sub-scales only share 49% information).The correlations of the scale scores with the measurements obtained by the dynamometer were high and significant (p<0.001) for both sub-scales: severity (r=0.77) and functionality (r=0.75).Patients with abnormal differentiation between two points had higher scores on the symptom severity sub-scales (MS=3.2; SDS=0.7) and functional condition (MF=2.7; SDF=0.7) than those with normal discrimination (MS=2.4; SDS=0.8; MF=2.1; SDF=0.9), both differences being significant (p<0.001).Sub-scale BCTQ scores were sensitive to muscle atrophy, the more sensitive being the functional sub-scale. Patients with moderate or severe muscle atrophy had higher scores on the severity sub-scale (MS=3.3; SDS=0.5) than those with or without mild atrophy (MS=2.5; SDS=0.8; p<0.001). Furthermore, the functional sub-scale showed different average scores for patients with severe atrophy (MF=3.7; SDF=0.1), moderate atrophy (MF=2.8; SDF=0.6) and mild/normal atrophy (MF=2.1; SDF=0.8), although the difference between groups of moderate and severe atrophy was not significant (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>The degree of EMG involvement was also reflected in BCTQ scores, the more sensitive being the severity sub-scale. Patients with severe impairment had higher scores on the severity sub-scale (MS=3.3; SDS=0.7) than those with moderate (MS=2.9; SDS=0.6) or mild impairment (MS=1.8; SDS=0.3), all comparisons were significant (p<0.05). In the functional sub-scale, patients with severe impairment (MF=2.8; SDF=0.7) had higher average scores than those with moderate impairment (MF=2.5; SDF=0.8) and those with mild impairment (MF=1.5; SDF=0.3), although the difference between the first two did not reach significance (p=0.154).Comparing pre- and post-surgery scores (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>): an average decrease was seen in the severity sub-scale οS=⿿2.0 points (SD=0.6; p<0.001), and in the sub-scale functionality, a decrease οF=⿿1.3 points (SD=0.7; p<0.001), corresponding to large effect sizes (dS=⿿3.3 and dF=⿿1.9, respectively). In the group of patients that was assessed a second time before surgery, the observed changes showed a slight worsening, with an average change οS=0.2 points (SD=0.2; p=0.03) in the severity sub-scale and οF=0.1 points (SD=0.1; p=0.18) in the functional sub-scale, corresponding to small effect sizes (dS=0.3 and dF=0.13). The BPI questionnaire was also sensitive to the effect of the surgery.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>DiscussionThe BTCQ questionnaire was well accepted by patients. All participants were able to answer all questions without help and the time taken to complete it was minimal (8min). Analysis of individual items showed a certain floor effect in 3 items on the functional sub-scale (writing, buttoning, and getting ready and dressing). All items correspond to smooth motility and show that there is a subset of patients without such limitations or who may have adapted to the clinical situation. However, this does not affect the distribution of the two summary scores, as in both cases scores for almost the entire spectrum were observed.The reliability of the two sub-scales was very good, with values of Cronbach's α close to 0.90 in both cases. This supports the unidimensionality hypothesis of each sub-scale, as it is a requirement for obtaining such high internal consistency values. The stability of the scores was very good, reaching a correlation between consecutive administrations of 0.94. This means that 88% of the variability of scores is attributable to clinical differences among patients, and only one measurement error of approximately 12% of the average value was made.The structure of the questionnaire was validated by EFA and CFA solutions. It was observed that the basic structure corresponded to a common dimension for both sub-scales, able to explain all of the correlations observed between the items, but a better fit was obtained when dividing the general dimension into two dimensions correlated to each other. The sub-scale severity can be divided into a dimension that includes daytime symptoms (intensity, frequency and duration of pain throughout the day) and another that includes typical neuropathic symptoms along with pain at night. This division is compatible with a second-order common factor structure that encompasses both dimensions and that would lead to an identical adjustment to the one obtained (after setting the necessary restrictions on the model so it is identified). However, the statistical goodness of fit suggests that there are particular relationships between pairs of items due to the casuistry of patients (not all patients feel tingling and weakness simultaneously, or pain during the day and during the night, for example). Meanwhile, the functional sub-scale obtains an excellent fit when the corresponding functionality is separated from fine motor skills (writing, getting ready, buttoning up), gross motor skills or strength (holding books, opening jars, cleaning the house, carrying bags), but both dimensions are very interrelated and could also be explained as 2 sub-dimensions of a second-order overall functional dimension. The results obtained indicate that the originally proposed structure has been reproduced in our sample of patients, and that each sub-scale measures a general aspect of the severity and impact on the functionality derived from the condition of CTS.The measurements obtained by the BCTQ converged with those obtained by other questionnaires already validated into Spanish, that are widely used and measure similar concepts. Correlations with BPI dimensions were high, as were the number of symptoms of neuropathic pain collected by the DN4 scale. The fact that the correlation between conceptually consistent dimensions of BCTQ and BPI was higher than those observed between diverging dimensions, and that the correlation between the BCTQ sub-scales were not excessively high, supported the evidence of discriminant validity.The fact that there were relations between BCTQ scores and other clinical measures of CTS diagnosis was also confirmed, supporting the validity of the construct. The correlation with the dynamometer measurements was high; the instrument was able to identify patients with problems differentiating between 2 points, also singling out those with muscular atrophy and detected differences based on the degree of impairment according to EMG determination.Finally, the Spanish version of BCTQ also proved to be sensitive to clinical changes, it observed differences in patients⿿ scores after nerve release surgery. The sub-scale of symptom severity was where major differences were observed, with an average change of ⿿2 points (on a scale of 1⿿5), while in the functional interference sub-scale the average change was ⿿1.3 points. Both changes correspond to effect sizes greater than 0.50, so they should be considered major changes. By contrast, patients who were evaluated for the second time before surgical intervention not only experienced no improvement, but showed a slight worsening.Although the sample size is adequate for the purpose of the study, it is not so extensive that it can ensure epidemiological representation, which may have influenced the relatively low prevalence of some symptoms.FundingThe study was funded through a Pfizer, S.L.U. Unconditioned Research Grant.Conflict of interestThe validation of the scale was carried out with a Pfizer, S.L.U unconditioned research grant." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres828432" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec824633" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres828431" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec824632" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Variables" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Concurrent measurements" ] ] ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Sample size" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Psychometric validation" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-26" "fechaAceptado" => "2015-10-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec824633" "palabras" => array:5 [ 0 => "Carpal tunnel syndrome" 1 => "Validation studies" 2 => "Pain" 3 => "Neuralgia" 4 => "Quality of life" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec824632" "palabras" => array:5 [ 0 => "Síndrome del túnel carpiano" 1 => "Estudios de validación" 2 => "Dolor" 3 => "Neuralgia" 4 => "Calidad de vida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectiveTo describe the process of cultural adaptation and validation of the Boston Carpal Tunnel Questionnaire (BCTQ) measuring symptom intensity, functional status and quality of life in carpal tunnel syndrome patients and to report the psychometric properties of this version. Material and methodsA 3 expert panel supervised the adaptation process. After translation, review and back-translation of the original instrument, a new Spanish version was obtained, which was administered to 2 patient samples: a pilot sample of 20 patients for assessing comprehension, and a 90 patient sample for assessing structural validity (factor analysis and reliability), construct validity and sensitivity to change. A re-test measurement was carried out in 21 patients. Follow-up was accomplished in 40 patients. ResultsThe questionnaire was well accepted by all participants. Celling effect was observed for 3 items. Reliability was very good, internal consistency: αS=0.91 and αF=0.87; test⿿retest stability: rS=0.939 and rF=0.986. Both subscales fitted to a general dimension. Subscales correlated with dynamometer measurements (rS=0.77 and rF=0.75) and showed to be related to abnormal 2-point discrimination, muscle atrophy and electromyography deterioration level. Scores properly correlated with other validated instruments: Douleur Neuropatique 4 questions and Brief Pain Inventory. BCTQ demonstrated to be sensitive to clinical changes, with large effect sizes (dS=⿿3.3 and dF=⿿1.9). ConclusionsThe Spanish version of the BCTQ shows good psychometric properties warranting its use in clinical settings." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivoDescribir el proceso de adaptación cultural y validación al español del cuestionario Boston Carpal Tunnel Questionnaire (BCTQ) de intensidad de los síntomas, capacidad funcional y calidad de vida en pacientes con síndrome del túnel carpiano, e informar de sus propiedades psicométricas. Material y métodosUn panel de 3 expertos supervisó el proceso de adaptación. Tras la traducción, revisión y retrotraducción del instrumento se obtuvo un cuestionario en español que fue administrado a 2 muestras de pacientes: una muestra piloto de 20 pacientes para valorar la comprensibilidad y una de 90 pacientes para comprobar la validez estructural (análisis factorial y fiabilidad), la validez de constructo y la sensibilidad al cambio. Se realizó medición retest a 21 pacientes. Se realizó seguimiento a 40 pacientes. ResultadosEl cuestionario fue bien entendido por todos los participantes. Tres ítems presentaron efecto suelo. La fiabilidad fue muy buena, consistencia interna: αS=0,91 y αF=0,87; estabilidad temporal test-retest: rS=0,939 y rF=0,986. Se comprobó que ambas subescalas del cuestionario se ajustaban a una dimensión general. Las subescalas correlacionaron con las medidas del dinamómetro (rS=0,77 y rF=0,75) y mostraron relación con la discriminación anormal entre 2 puntos, la atrofia muscular y el nivel de afectación según electromiografía. Las puntuaciones correlacionaron adecuadamente con cuestionarios ya validados: Douleur Neuropatique 4 questions y Cuestionario Breve de Dolor. El BCTQ demostró ser sensible a los cambio clínicos, con tamaños del efecto grandes (dS=⿿3,3 y dF=⿿1,9). ConclusionesLa versión en castellano del BCTQ ha demostrado tener buenas propiedades psicométricas, lo que garantiza su uso en el ámbito clínico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⿿" "nota" => "Please cite this article as: Oteo-ÿlvaro ÿ, Marín MT, Matas JA, Vaquero J. Validación al castellano de la escala Boston Carpal Tunnel Questionnaire. Med Clin (Barc). 2016;146:247⿿253." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1363 "Ancho" => 1666 "Tamanyo" => 169889 ] ] "descripcion" => array:1 [ "en" => "Flowchart of patients." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1582 "Ancho" => 1661 "Tamanyo" => 110655 ] ] "descripcion" => array:1 [ "en" => "Confirmatory standardized solution of 2 factors correlated to the severity sub-scale." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1233 "Ancho" => 1656 "Tamanyo" => 88809 ] ] "descripcion" => array:1 [ "en" => "Confirmatory standardized solution of 2 factors correlated to the functional sub-scale." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3030 "Ancho" => 1595 "Tamanyo" => 208461 ] ] "descripcion" => array:1 [ "en" => "Average score on the severity and functionality subscales by the degree of atrophy (above) and the degree of electromyographic involvement (below). BCTQ: Boston Carpal Tunnel Questionnaire; EMG: electromyography." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NCV: sensory nerve conduction velocity.Normal values: normal distal latency <4ms; normal differential latency <1ms." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Degree \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SCV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Division \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Distal motor latency \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Differential latency \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal or >40m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><40m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal or extended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Significant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><40m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Extended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Extended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extreme \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="4" align="left" valign="top">Absence of sensory and motor conduction</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393873.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Criteria for evaluating the severity used in the electromyographic study." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: standard deviation; BMI: body mass index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age in years, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.6 (14.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Sex, %</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Educational level, %</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No qualifications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Higher education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Employment status, %</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Employed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unemployed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retired \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Housewife/husband \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incapacity for work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Student \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Pregnant</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Origin</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI in kg/m2, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.5 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Circumference of waist in cm, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5 (1.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Smoker, %</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cigarettes per day, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393871.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of the sample (n=90)." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "COPD: chronic obstructive pulmonary disease." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diseases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Associated comorbidities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (37.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (30.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypercholesterolemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypothyroidism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bronchial asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibromyalgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antiphospholipid syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393875.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comorbidities (n=90)." ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "BCTQ: Boston Carpal Tunnel Questionnaire; BPI: Brief Pain Inventory Questionnaire; DN4: Douleur Neuropatique four questions." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scale \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Abbreviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BCTQ-S \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BCTQ-F \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BPI-D \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BPI-A \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DN4 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severity of symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BCTQ-S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.772<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.707<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.635<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.673<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Functional condition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BCTQ-F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.772<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.720<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.747<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.662<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pain intensity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BPI-D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.707<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.720<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.629<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.544<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interference in every-day activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BPI-A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.635<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.747<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.629<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.500<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neuropathic symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DN4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.673<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.662<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.544<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.500<a class="elsevierStyleCrossRef" href="#tblfn0005">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393874.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "**" "nota" => "p<0.01 (bilateral)." ] ] ] "descripcion" => array:1 [ "en" => "Correlations between concurrent scales." ] ] 8 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Dif: difference in scores Post⿿Pre or Pre2⿿Pre1.Data are expressed as mean (standard deviation).*p<0.05." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Scale \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No surgery</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dif. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dif. \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Boston Carpal Tunnel Questionnaire</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severity of symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.35 (0.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.33 (0.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">⿿2.03 (0.64)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.05 (0.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.18 (0.82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 (0.22)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Functional condition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.59 (0.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.29 (0.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">⿿1.30 (0.69)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.03 (0.82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.14 (0.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 (0.14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Brief Pain Inventory Questionnaire</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pain intensity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.07 (1.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82 (0.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.26 (2.24)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.78 (1.43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.17 (1.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">⿿0.39 (0.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interference in every-day activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.45 (1.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 (0.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.23 (1.38)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.19 (1.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.51 (1.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">⿿0.32 (0.94) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393872.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "p<0.001." ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity to change of the Boston Carpal Tunnel Questionnaire and Brief Pain Inventory questionnaire dimensions per group being monitored." ] ] 9 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 50176 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimal management of carpal tunnel syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. 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Spanish validation of the Boston Carpal Tunnel Questionnaire

Validación al castellano de la escala Boston Carpal Tunnel Questionnaire

ÿngel Oteo-ÿlvaro⿿

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angel_oteo@telefonica.net

Corresponding author.

, María T. Marín, José A. Matas, Javier Vaquero

Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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It is the most common hand peripheral neuropathy cause by entrapment&#44; affecting up to 3&#37; of the general population&#44; with a higher incidence in women between the fourth and sixth decades of life&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A large number of patients with pain in the hand and wrist are evaluated daily by electrophysiological studies and these symptoms are often due to CTS&#46; Its social and economic implications are important because of its high incidence in developed countries&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> resulting in costs of approximately &#36;30&#44;000 per affected worker in the USA&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> Our days are getting longer&#44; and although the most common cause is idiopathic&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> there is a certain suspicion that it is work related&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> but to date no epidemiological evidence<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> has been established for this theory&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the surgical release of the median nerve results in a high rate of satisfaction&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> some patients report dissatisfaction with results obtained&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> Given that electromyographic &#40;EMG&#41; studies after the release of the median nerve show no relationship with patient satisfaction&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> tools such as the Boston Carpal Tunnel Questionnaire &#40;BCTQ&#59; Levine et al&#46;&#44; 1993&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> are needed for a proper evaluation of different treatment methods&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To date&#44; this questionnaire has been translated and validated into Italian<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> and Portuguese&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> On March 27&#44; 2012 approval from Dr&#46; Jeffrey N&#46; Katz was received to translate and validate the questionnaire into Spanish&#46; The purpose of this study is to validate the BCTQ scale into Spanish&#44; 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patients of both sexes&#44; over 18-years-old&#44; with the presence of hand and wrist pain&#44; and paresthesia&#44; able to read and understand Spanish&#44; who had given their informed consent&#46; Patients who were unable to read or understand the questionnaire were excluded&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Under no circumstances was the researcher&#39;s decision on the most appropriate medical care or treatment for the patient interfered with and all participants gave their informed consent to freely to participate in the study and allow their data to be used&#46; The study was conducted in the field of primary care and clinical specialties hospital in Spain&#46; The study was approved by the European Foundation for Health Research and Education &#40;CEI-EFHRE-EU-201302&#41; Research Ethics Committee&#46; The information was collected from 27&#47;06&#47;2013 to 27&#47;05&#47;2014&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients&#12287; social and demographic information and clinical variables of interest were collected in addition to the designation of the painful area on a map of the hand in order to determine whether that area included the median nerve&#46; The BCTQ questionnaire was included as well as the measures necessary for validation&#44; which are detailed below&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Concurrent measurements</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Grip force&#58;</span> affected hand&#39;s maximum strength and difference between both hands &#40;three grips with an interval of 2<span class="elsevierStyleHsp" style=""></span>min between each grip starting with the dominant hand&#41;&#46; When the hand being assessed was not the dominant hand&#44; the result was offset by adding 10&#37;&#46; The grip was evaluated by a manual dynamometer &#40;Jamar<span class="elsevierStyleSup">&#174;</span> Hydraulic Hand Dynamometer&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Differentiation between 2 points&#58;</span> sensory ability to differentiate between 2 adjacent points&#46; An open clip with a distance between both ends of 5<span class="elsevierStyleHsp" style=""></span>mm was used&#44; placing both ends at the same time on the skin of the fingertip &#40;distal phalanx&#41; and lightly pressing 10 times&#46; A differentiation of &#62;5<span class="elsevierStyleHsp" style=""></span>mm on the fingertip in seven out of the 10 times is considered abnormal&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Muscle atrophy assessment</span>&#58; Atrophy assessment of the thenar area of the hand by the clinician in a 3-point scale &#40;mild&#44; moderate and severe&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Electromyography study</span>&#58; measurement of the orthodromic sensory nerve conduction velocity from fingers 2&#44; 3 and 4&#44; and when they decreased&#44; the fifth finger &#40;ulnar nerve&#41; as a comparator&#46; In normal situations there should be no division of the fourth finger &#40;innervated by the median and ulnar nerve&#41;&#46; The distal motor latency and differential latency were evaluated&#44; using surface electrodes&#44; setting three degrees&#58; mild&#44; moderate and significant&#47;extreme &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Brief Pain Inventory &#40;BPI&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a>&#58; a self-administered questionnaire consisting of 11 items&#46; The BPI consists of two sections&#58; &#12287;Pain intensity&#12287; &#40;4 items&#41; and &#12287;interference in every-day activities&#12287; &#40;7 items&#41;&#46; Each of the items is scored using a Likert scale with ratings&#44; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no pain&#47;interference in daily life and 10<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>worst imaginable pain&#47;maximum involvement in daily life&#46; The 11 items provided two score summary&#44; one for each section&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Douleur Neuropatique four questions &#40;DN4&#44; &#12287;Neuropathic Pain Scale&#12287;&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a>&#58; a mixed-scale for the screening of neuropathic pain&#44; comprising of seven self-administered questions and three clinical examination questions&#46; The 10 dichotomous items cover different types of painful sensations&#44; the presence of hypoesthesia and the presence of pain caused by touch&#46; A score of &#12261;4 points is considered symptomatic of neuropathic pain&#46; Its sensitivity and specificity are at 80&#12287;90&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Understanding and ease of use</span>&#58; the time required to complete the questionnaire was recorded and two questions were asked&#44; one about its understanding and the other about its ease of its application&#44; with 3 answers&#58; Yes&#44; No&#44; and I do not know&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sample size</span><p id="par0090" class="elsevierStylePara elsevierViewall">The study was designed with the same methodology as the previous validations of the BCTQ questionnaire&#46; It was determined that at least 80 patients needed to be included&#46; A sub-sample of 21 patients underwent a re-test of the questionnaire 2&#12287;3 days after the first one was conducted&#46; A sub-sample of 40 patients underwent a prospective follow-up and were re-evaluated a second time&#58; 30 were assessed 2&#12287;3 months after median nerve decompression surgery and 9 were assessed before surgery &#40;the monitoring of one patient was discontinued&#41;&#46; This sample design was considered sufficient for the validation of the scale&#44; reproducing the scheme used in previous validations&#46; 90 patients were finally included in the study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">To validate the BCTQ scale&#44; the suppositions of classical test theory were assumed and the psychometric properties described here were evaluated&#46; <span class="elsevierStyleItalic">Analysis of items</span>&#58; distribution of responses by category for each item&#44; the presence of floor&#47;ceiling effect &#40;over 40&#37; of respondents in an extreme category&#41; and blank responses&#46; <span class="elsevierStyleItalic">Feasibility</span>&#58; time needed to complete the questionnaire&#44; understanding of the questions&#44; ease of filling out the questionnaire&#44; proportion of useful questionnaires and number of blank responses per questionnaire&#46; <span class="elsevierStyleItalic">Reliability</span>&#58; internal consistency &#40;Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> and intraclass correlation coefficient &#91;ICC&#93;&#41; and temporal stability &#40;test&#12287;retest correlation&#41;&#46; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8 were taken as criterion of goodness values&#46; The test&#12287;retest correlation was calculated with a sample of 21 patients&#44; after 2&#12287;3 days&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Structural validity&#46;</span> An exploratory factor analysis &#40;EFA&#41; was performed using the extraction of principal components method and oblique Promax rotation&#46; The following was used as criteria for retention factors&#58; number of Kaiser&#12287;Guttman eigenvalues &#62;1&#44; Cattell sedimentation test and proportion of explained variance&#46; Three models for confirmatory factor analysis &#40;CFA&#41; were suggested for each sub-scale&#58; a one-dimensional model&#44; a model with two factors correlated with a division of a subset of items and a model with a general second-order factor and 2 specific factors of the first-order&#58; the following values for statistical goodness of fit<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> were used as criteria&#58; <span class="elsevierStyleItalic">&#1023;</span><span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#59; <span class="elsevierStyleItalic">&#1023;</span><span class="elsevierStyleSup">2</span>&#47;gl<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&#59; GFI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;95&#59; AGFI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#59; TLI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#59; CFI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#59; RMSEA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#59; WRMR<span class="elsevierStyleHsp" style=""></span>&#12260;<span class="elsevierStyleHsp" style=""></span>1&#46; The estimation methods used were the maximum likelihood and MLMV methods &#40;for ordinal scores&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Evidence of concurrent validity were obtained by assessing&#44; at baseline&#44; the correlation of the BCTQ sub-scales with scores obtained on the use scales that had already been validated&#58; DN4 and BPI&#46; The Pearson correlation coefficient was used&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Construct validity&#46;</span> Comparison of average scores in regard to the clinical classification defined by the sensory differentiation&#44; muscle atrophy and EMG involvement&#46; The <span class="elsevierStyleItalic">t</span>-test for independent groups or analysis of variance was used &#40;by number of groups&#41; for comparisons of averages&#46; The hypothesis established was that patients with greater severity of clinical characteristics would obtain higher scores on BCTQ sub-scales&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Sensitivity to clinical change in those patients who underwent decompression surgery was assessed by comparing the average score before the operation &#40;pre&#41; and 30&#12287;60 days after surgery &#40;post&#41;&#46; The <span class="elsevierStyleItalic">t</span>-test was used for related and statistical data of the effect size &#40;calculated as the difference between pre- and post-scores divided by the standard deviation of the pre-score&#41;&#46; All patients answered that they had experienced a functional recovery and thus no comparisons in this respect could be made&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The analyses were performed with the statistical software packages SAS<span class="elsevierStyleSup">&#174;</span>&#44; IBM<span class="elsevierStyleSup">&#174;</span> SPSS<span class="elsevierStyleSup">&#174;</span> version 20&#44; IBM<span class="elsevierStyleSup">&#174;</span> AMOS<span class="elsevierStyleSup">&#174;</span> version 20 and MPlus<span class="elsevierStyleSup">&#174;</span> version 17&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Participants</span><p id="par0125" class="elsevierStylePara elsevierViewall">A sample of 90 patients diagnosed with CTS was selected&#46; 63&#46;3&#37; were women&#44; the mean age was 53&#46;6 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#46;5&#41; and 43&#46;0&#37; were currently working &#40;see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; 37&#46;8&#37; of patients had a concomitant disease &#40;see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; the most frequent being hypertension &#40;30&#46;0&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">In 65 patients &#40;72&#46;2&#37;&#41; the hand that was affected by CTS was the dominant hand&#59; 42&#46;2&#37; of patients showed abnormal measurement between 2 points&#44; 28&#46;0&#37; moderate or severe muscle atrophy of the thenar region of the hand and the degree of EMG involvement was intense in 41&#46;1&#37; of cases&#46; The grip strength in the affected dominant hand showed no significant clinical differences from the affected non-dominant hand&#59; however&#44; the grip difference in hands was found to be near significance &#40;dif&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;59<span class="elsevierStyleHsp" style=""></span>kg&#59; ST<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;293&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41;&#46; In all cases &#40;100&#37;&#41; the painful area corresponded to the region of the median nerve&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The average score on the DN4 questionnaire was 4&#46;9 symptoms &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;07&#41;&#44; ranging between one and 10&#46; 76&#46;7&#37; of patients received a score of &#12261;4&#59; the most frequent symptoms were tingling &#40;98&#46;9&#37;&#41; and burning &#40;96&#46;7&#37;&#41; feelings&#44; and less frequent&#44; stinging &#40;11&#37;&#41; and allodynia &#40;11&#37;&#41; feelings&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The average scores on the BPI questionnaire sections were&#58; in the pain intensity section&#44; 3&#46;2 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;8&#41;&#44; and in the interference in every-day activities section&#44; 2&#46;2 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;8&#41;&#46; Categorizing by levels&#44; 58&#46;9&#37; presented mild &#40;0&#12287;3&#41;&#44; 35&#46;6&#37; moderate &#40;4&#12287;6&#41; and 5&#46;6&#37; severe &#40;7&#12287;10&#41; intensity&#46; 87&#46;8&#37; showed marked interference in daily life &#40;5&#12287;10&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Of the 30 patients with post-operative follow-up assessment&#44; all showed a good clinical impression of post-operative functional recovery&#44; while 33&#46;3&#37; reported that the pain remained&#44; and 16&#46;7&#37; reported suffering from hypostasis and paresthesias&#46; Regarding the nine patients who had been assessed before surgery&#44; all maintained the presence of pain&#44; paresthesia and hypoesthesia&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Psychometric validation</span><p id="par0150" class="elsevierStylePara elsevierViewall">All patients gave valid answers to all items on the severity sub-scale&#46; The answers were distributed across all the response categories for all items&#46; Four of the items showed a certain tendency to floor effect&#44; accumulating between 31 and 42&#37; of respondents in the lowest category &#40;p1&#44; p2&#44; p7&#44; p11&#41;&#59; however&#44; the following maximum frequency category was not the next one&#44; showing that there may be a subset of patients that do not experience that kind of pain&#46; In addition&#44; all subjects responded to all the items in the sub-scale of functionality and only the maximum category of item 8 did not receive any answers&#46; On this occasion&#44; items 1&#44; 2 and 8 &#40;relating to smooth motility&#41; showed a clear floor effect&#44; accumulating 63&#44; 50 and 86&#37; of respondents in the category of the previous answer&#44; respectively although always followed by the next highest frequency in the next category&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The average score on the severity sub-scale was 2&#46;76 points &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;84&#59; Min<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;18&#59; Max<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;91&#41;&#44; and functional sub-scale was 2&#46;32 points &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;84&#59; Min<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; Max<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;25&#41;&#46; The correlation between sub-scales was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;772&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The response time ranged between 5 and 11<span class="elsevierStyleHsp" style=""></span>min&#44; with an average of 8&#46;02<span class="elsevierStyleHsp" style=""></span>min &#40;SD<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>2&#46;203&#41;&#46; All patients reported correctly understanding all questions and not find difficulties in responding&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The internal consistency of the severity sub-scale was very good &#40;<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;909&#41;&#44; with a confidence interval of 95&#37; from 0&#46;878 to 0&#46;934 and an inter-item correlation average of <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;475&#46; Regarding the sub-scale functionality&#44; internal consistency was slightly less &#40;<span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;872&#41;&#44; and the confidence interval was 0&#46;831&#12287;0&#46;901&#46; The removal of any of the items would decrease reliability and inter-item average correlation was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;461&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">For the 21 patients who completed the re-test&#44; the test&#12287;re-test correlation of the severity sub-scale was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;939&#44; with an ICC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;926&#44; demonstrating excellent temporal stability&#46; Furthermore&#44; the functional sub-scale obtained a correlation <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;986 and ICC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;909&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The EFA of the severity sub-scale resulted in two eigenvalues greater than one&#44; which explained 66&#37; of the available variance&#46; Sedimentation test showed a first eigenvalue of great magnitude that explained most of the variance &#40;54&#37;&#41;&#44; followed by three other eigenvalues in gradual decrease in size&#46; Comparison of the solutions before and after rotation showed the presence of a dimension that was common to all items of which a second dimension divided from&#44; grouping &#40;mainly&#41; intensity&#44; frequency and duration of pain during the day&#46; Moreover&#44; the correlation between the two dimensions was high &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;505&#41;&#46; As for the sub-scale of functionality&#44; the EFA also resulted in two eigenvalues greater than the unit&#44; which explained 66&#37; of the variance&#46; The scree plot made the existence of a priority dimension more obvious&#46; The solution obtained showed the presence of a single common dimension&#44; from which a second dimension split corresponding to the three functions of smooth motility &#40;writing&#44; buttoning and getting ready&#47;dressed&#41;&#46; Two dimensions showed a high correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;549&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The results of the CFA by MLMV estimation methods showed the best fit for two equivalent structures&#58; Two related dimensions or two explained dimensions by a second-order factor &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The severity sub-scale adequately adjusted to a structure with an overall dimension of severity that substantially correlated &#40;<span class="elsevierStyleItalic">&#1023;</span><span class="elsevierStyleInf">21</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;52&#41; with another dimension which includes daytime symptoms&#58; p3&#44; p4 and p5&#44; or&#44; equivalently&#44; two dimensions measuring a general factor of severity&#46; All saturations were significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and the statistical goodness of fit were good or acceptable&#58; CFI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;944&#59; TLI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;928&#59; RMSEA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;177&#59; <span class="elsevierStyleItalic">&#1023;</span><span class="elsevierStyleSup">2</span>&#47;gl<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;82&#59; WRMR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;130&#46; The structure of the best fit for the functional sub-scale corresponded to a two dimension correlated configuration &#40;<span class="elsevierStyleItalic">&#1023;</span><span class="elsevierStyleInf">21</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&#41;&#44; one corresponding to the gross motor skills and another corresponding to fine motor skills&#58; p1&#44; p2 and p8&#44; or an equivalent structure of 2 factors that saturate in a general factor of functionality &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; All saturations were significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and the fit statistics were good or very good&#58; CFI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;990&#59; TLI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;985&#59; RMSEA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;091&#59; <span class="elsevierStyleItalic">&#1023;</span><span class="elsevierStyleSup">2</span>&#47;gl<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;75&#59; WRMR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;573&#46; The maximum likelihood estimate yielded similar values&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">The correlation between the sub-scale severity of BCTQ and pain intensity of the BPI was high &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;707&#41;&#44; as was the correlation between the functional sub-scale and interference in every-day activities area &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;747&#41;&#46; These correlations were slightly higher than those obtained for the not conceptually consistent dimension &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In addition&#44; scores on the BCTQ sub-scales correlated with the number of DN4 neuropathic pain symptoms&#44; both of similar correlations&#58; severity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;673&#41; and functionality &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;662&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Although the BCTQ sub-scales showed a high and significant correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;77&#41;&#44; the correlation was not quite perfect &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#62;</span><span class="elsevierStyleHsp" style=""></span>0&#46;9&#41;&#44; supporting the idea of sufficient discriminant validity between the two dimensions &#40;both sub-scales only share 49&#37; information&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The correlations of the scale scores with the measurements obtained by the dynamometer were high and significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for both sub-scales&#58; severity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;77&#41; and functionality &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Patients with abnormal differentiation between two points had higher scores on the symptom severity sub-scales &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;2&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41; and functional condition &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;7&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41; than those with normal discrimination &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;4&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#59; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#41;&#44; both differences being significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Sub-scale BCTQ scores were sensitive to muscle atrophy&#44; the more sensitive being the functional sub-scale&#46; Patients with moderate or severe muscle atrophy had higher scores on the severity sub-scale &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#41; than those with or without mild atrophy &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;5&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Furthermore&#44; the functional sub-scale showed different average scores for patients with severe atrophy &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;7&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#44; moderate atrophy &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;8&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#41; and mild&#47;normal atrophy &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41;&#44; although the difference between groups of moderate and severe atrophy was not significant &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">The degree of EMG involvement was also reflected in BCTQ scores&#44; the more sensitive being the severity sub-scale&#46; Patients with severe impairment had higher scores on the severity sub-scale &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;3&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41; than those with moderate &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;9&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#41; or mild impairment &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;8&#59; SD<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#41;&#44; all comparisons were significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In the functional sub-scale&#44; patients with severe impairment &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;8&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41; had higher average scores than those with moderate impairment &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;5&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41; and those with mild impairment &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;5&#59; SD<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#41;&#44; although the difference between the first two did not reach significance &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;154&#41;&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Comparing pre- and post-surgery scores &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#58; an average decrease was seen in the severity sub-scale <span class="elsevierStyleItalic">&#959;</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;2&#46;0 points &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and in the sub-scale functionality&#44; a decrease <span class="elsevierStyleItalic">&#959;</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;1&#46;3 points &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; corresponding to large effect sizes &#40;<span class="elsevierStyleItalic">d</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;3&#46;3 and <span class="elsevierStyleItalic">d</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;1&#46;9&#44; respectively&#41;&#46; In the group of patients that was assessed a second time before surgery&#44; the observed changes showed a slight worsening&#44; with an average change <span class="elsevierStyleItalic">&#959;</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;2 points &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;2&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; in the severity sub-scale and <span class="elsevierStyleItalic">&#959;</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1 points &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;18&#41; in the functional sub-scale&#44; corresponding to small effect sizes &#40;<span class="elsevierStyleItalic">d</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3 and <span class="elsevierStyleItalic">d</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;13&#41;&#46; The BPI questionnaire was also sensitive to the effect of the surgery&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0220" class="elsevierStylePara elsevierViewall">The BTCQ questionnaire was well accepted by patients&#46; All participants were able to answer all questions without help and the time taken to complete it was minimal &#40;8<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; Analysis of individual items showed a certain floor effect in 3 items on the functional sub-scale &#40;writing&#44; buttoning&#44; and getting ready and dressing&#41;&#46; All items correspond to smooth motility and show that there is a subset of patients without such limitations or who may have adapted to the clinical situation&#46; However&#44; this does not affect the distribution of the two summary scores&#44; as in both cases scores for almost the entire spectrum were observed&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The reliability of the two sub-scales was very good&#44; with values of Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> close to 0&#46;90 in both cases&#46; This supports the unidimensionality hypothesis of each sub-scale&#44; as it is a requirement for obtaining such high internal consistency values&#46; The stability of the scores was very good&#44; reaching a correlation between consecutive administrations of 0&#46;94&#46; This means that 88&#37; of the variability of scores is attributable to clinical differences among patients&#44; and only one measurement error of approximately 12&#37; of the average value was made&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The structure of the questionnaire was validated by EFA and CFA solutions&#46; It was observed that the basic structure corresponded to a common dimension for both sub-scales&#44; able to explain all of the correlations observed between the items&#44; but a better fit was obtained when dividing the general dimension into two dimensions correlated to each other&#46; The sub-scale severity can be divided into a dimension that includes daytime symptoms &#40;intensity&#44; frequency and duration of pain throughout the day&#41; and another that includes typical neuropathic symptoms along with pain at night&#46; This division is compatible with a second-order common factor structure that encompasses both dimensions and that would lead to an identical adjustment to the one obtained &#40;after setting the necessary restrictions on the model so it is identified&#41;&#46; However&#44; the statistical goodness of fit suggests that there are particular relationships between pairs of items due to the casuistry of patients &#40;not all patients feel tingling and weakness simultaneously&#44; or pain during the day and during the night&#44; for example&#41;&#46; Meanwhile&#44; the functional sub-scale obtains an excellent fit when the corresponding functionality is separated from fine motor skills &#40;writing&#44; getting ready&#44; buttoning up&#41;&#44; gross motor skills or strength &#40;holding books&#44; opening jars&#44; cleaning the house&#44; carrying bags&#41;&#44; but both dimensions are very interrelated and could also be explained as 2 sub-dimensions of a second-order overall functional dimension&#46; The results obtained indicate that the originally proposed structure has been reproduced in our sample of patients&#44; and that each sub-scale measures a general aspect of the severity and impact on the functionality derived from the condition of CTS&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The measurements obtained by the BCTQ converged with those obtained by other questionnaires already validated into Spanish&#44; that are widely used and measure similar concepts&#46; Correlations with BPI dimensions were high&#44; as were the number of symptoms of neuropathic pain collected by the DN4 scale&#46; The fact that the correlation between conceptually consistent dimensions of BCTQ and BPI was higher than those observed between diverging dimensions&#44; and that the correlation between the BCTQ sub-scales were not excessively high&#44; supported the evidence of discriminant validity&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">The fact that there were relations between BCTQ scores and other clinical measures of CTS diagnosis was also confirmed&#44; supporting the validity of the construct&#46; The correlation with the dynamometer measurements was high&#59; the instrument was able to identify patients with problems differentiating between 2 points&#44; also singling out those with muscular atrophy and detected differences based on the degree of impairment according to EMG determination&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Finally&#44; the Spanish version of BCTQ also proved to be sensitive to clinical changes&#44; it observed differences in patients&#12287; scores after nerve release surgery&#46; The sub-scale of symptom severity was where major differences were observed&#44; with an average change of &#12287;2 points &#40;on a scale of 1&#12287;5&#41;&#44; while in the functional interference sub-scale the average change was &#12287;1&#46;3 points&#46; Both changes correspond to effect sizes greater than 0&#46;50&#44; so they should be considered major changes&#46; By contrast&#44; patients who were evaluated for the second time before surgical intervention not only experienced no improvement&#44; but showed a slight worsening&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Although the sample size is adequate for the purpose of the study&#44; it is not so extensive that it can ensure epidemiological representation&#44; which may have influenced the relatively low prevalence of some symptoms&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0255" class="elsevierStylePara elsevierViewall">The study was funded through a <span class="elsevierStyleGrantSponsor" id="gs1">Pfizer&#44; S&#46;L&#46;U&#46; Unconditioned Research Grant</span>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0260" class="elsevierStylePara elsevierViewall">The validation of the scale was carried out with a Pfizer&#44; S&#46;L&#46;U unconditioned research grant&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the process of cultural adaptation and validation of the Boston Carpal Tunnel Questionnaire &#40;BCTQ&#41; measuring symptom intensity&#44; functional status and quality of life in carpal tunnel syndrome patients and to report the psychometric properties of this version&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 3 expert panel supervised the adaptation process&#46; After translation&#44; review and back-translation of the original instrument&#44; a new Spanish version was obtained&#44; which was administered to 2 patient samples&#58; a pilot sample of 20 patients for assessing comprehension&#44; and a 90 patient sample for assessing structural validity &#40;factor analysis and reliability&#41;&#44; construct validity and sensitivity to change&#46; A re-test measurement was carried out in 21 patients&#46; Follow-up was accomplished in 40 patients&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The questionnaire was well accepted by all participants&#46; Celling effect was observed for 3 items&#46; Reliability was very good&#44; internal consistency&#58; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;91 and <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;87&#59; test&#12287;retest stability&#58; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;939 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;986&#46; Both subscales fitted to a general dimension&#46; Subscales correlated with dynamometer measurements &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;77 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75&#41; and showed to be related to abnormal 2-point discrimination&#44; muscle atrophy and electromyography deterioration level&#46; Scores properly correlated with other validated instruments&#58; <span class="elsevierStyleItalic">Douleur Neuropatique 4 questions</span> and Brief Pain Inventory&#46; BCTQ demonstrated to be sensitive to clinical changes&#44; with large effect sizes &#40;<span class="elsevierStyleItalic">d</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;3&#46;3 and <span class="elsevierStyleItalic">d</span><span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;1&#46;9&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Spanish version of the BCTQ shows good psychometric properties warranting its use in clinical settings&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir el proceso de adaptaci&#243;n cultural y validaci&#243;n al espa&#241;ol del cuestionario <span class="elsevierStyleItalic">Boston Carpal Tunnel Questionnaire</span> &#40;BCTQ&#41; de intensidad de los s&#237;ntomas&#44; capacidad funcional y calidad de vida en pacientes con s&#237;ndrome del t&#250;nel carpiano&#44; e informar de sus propiedades psicom&#233;tricas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un panel de 3 expertos supervis&#243; el proceso de adaptaci&#243;n&#46; Tras la traducci&#243;n&#44; revisi&#243;n y retrotraducci&#243;n del instrumento se obtuvo un cuestionario en espa&#241;ol que fue administrado a 2 muestras de pacientes&#58; una muestra piloto de 20 pacientes para valorar la comprensibilidad y una de 90 pacientes para comprobar la validez estructural &#40;an&#225;lisis factorial y fiabilidad&#41;&#44; la validez de constructo y la sensibilidad al cambio&#46; Se realiz&#243; medici&#243;n retest a 21 pacientes&#46; Se realiz&#243; seguimiento a 40 pacientes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El cuestionario fue bien entendido por todos los participantes&#46; Tres &#237;tems presentaron efecto suelo&#46; La fiabilidad fue muy buena&#44; consistencia interna&#58; &#945;<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;91 y &#945;<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;87&#59; estabilidad temporal test-retest&#58; r<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;939 y r<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;986&#46; Se comprob&#243; que ambas subescalas del cuestionario se ajustaban a una dimensi&#243;n general&#46; Las subescalas correlacionaron con las medidas del dinam&#243;metro &#40;r<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;77 y r<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;75&#41; y mostraron relaci&#243;n con la discriminaci&#243;n anormal entre 2 puntos&#44; la atrofia muscular y el nivel de afectaci&#243;n seg&#250;n electromiograf&#237;a&#46; Las puntuaciones correlacionaron adecuadamente con cuestionarios ya validados&#58; <span class="elsevierStyleItalic">Douleur Neuropatique 4 questions</span> y Cuestionario Breve de Dolor&#46; El BCTQ demostr&#243; ser sensible a los cambio cl&#237;nicos&#44; con tama&#241;os del efecto grandes &#40;d<span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;3&#44;3 y d<span class="elsevierStyleInf">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;1&#44;9&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n en castellano del BCTQ ha demostrado tener buenas propiedades psicom&#233;tricas&#44; lo que garantiza su uso en el &#225;mbito cl&#237;nico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#12287;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Oteo-&#255;lvaro &#255;&#44; Mar&#237;n MT&#44; Matas JA&#44; Vaquero J&#46; Validaci&#243;n al castellano de la escala <span class="elsevierStyleItalic">Boston Carpal Tunnel Questionnaire</span>&#46; Med Clin &#40;Barc&#41;&#46; 2016&#59;146&#58;247&#12287;253&#46;</p>"
      ]
    ]
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0270" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
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      0 => array:7 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Confirmatory standardized solution of 2 factors correlated to the severity sub-scale&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Confirmatory standardized solution of 2 factors correlated to the functional sub-scale&#46;</p>"
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      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Average score on the severity and functionality subscales by the degree of atrophy &#40;above&#41; and the degree of electromyographic involvement &#40;below&#41;&#46; BCTQ&#58; Boston Carpal Tunnel Questionnaire&#59; EMG&#58; electromyography&#46;</p>"
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at1"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NCV&#58; sensory nerve conduction velocity&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Normal values&#58; normal distal latency &#60;4<span class="elsevierStyleHsp" style=""></span>ms&#59; normal differential latency &#60;1<span class="elsevierStyleHsp" style=""></span>ms&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Division&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Distal motor latency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Differential latency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal or <span class="elsevierStyleMonospace">&#62;</span>40<span class="elsevierStyleHsp" style=""></span>m&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;40<span class="elsevierStyleHsp" style=""></span>m&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal or extended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Significant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;40<span class="elsevierStyleHsp" style=""></span>m&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Extended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Extended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extreme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Absence of sensory and motor conduction</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Criteria for evaluating the severity used in the electromyographic study&#46;</p>"
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      ]
      5 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; BMI&#58; body mass index&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age in years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;6 &#40;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Educational level&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No qualifications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primary school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secondary school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Employment status&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unemployed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Housewife&#47;husband&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incapacity for work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Student&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Pregnant</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Origin</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caucasian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI in kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;5 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Circumference of waist in cm&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5 &#40;1&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Smoker&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cigarettes per day&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;5 &#40;17&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Description of the sample &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&#41;&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Associated comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;37&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;30&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypercholesterolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic cardiomyopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypothyroidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bronchial asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibromyalgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antiphospholipid syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">BCTQ&#58; Boston Carpal Tunnel Questionnaire&#59; BPI&#58; Brief Pain Inventory Questionnaire&#59; DN4&#58; Douleur Neuropatique four questions&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scale&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DN4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severity of symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BCTQ-S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;772<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;707<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;635<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;673<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Functional condition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BCTQ-F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;772<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;720<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;747<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;662<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pain intensity&nbsp;\t\t\t\t\t\t\n
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                  "comentario" => "Available at&#58; <span class="elsevierStyleInterRef" id="intr0015" href="http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm">http&#58;&#47;&#47;www&#46;ninds&#46;nih&#46;gov&#47;disorders&#47;carpal&#95;tunnel&#47;detail&#95;carpal&#95;tunnel&#46;htm</span> &#91;accessed March 2012&#93;"
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