Hand PRO Tools – Boston Carpal Tunnel Questionnaire (BCTQ)

Boston Carpal Tunnel Questionnaire (BCTQ)

What is the Boston Carpal Tunnel Questionnaire (BCTQ)?

The Boston Carpal Tunnel Questionnaire (BCTQ) is a patient-reported outcome survey that is used to measure symptom severity and functional status in patients with carpal tunnel syndrome (CTS). It is the most frequently used outcome tool used to measure CTS, however, it is not intended to be used to diagnose carpal tunnel syndrome. The BCTQ has been found to be reliable and valid in patients with carpal tunnel syndrome who are treated non-operatively and operatively.

The BCTQ was first published in The Journal of Bone & Joint Surgery in November 1993 (Volume 75, Issue 11, Pages 1585-1592). This patient-reported outcome measure was developed by the Department of Orthopedic Surgery at Brigham and Women’s Hospital in Boston, Massachusetts. At the time of its original publication, the outcome tool was not given a formal name. As a result, you may also see the Boston Carpal Tunnel Questionnaire also referred to as:

  • Brigham and Women’s Carpal Tunnel Questionnaire
  • the Carpal Tunnel Syndrome Assessment
  • the CTS Instrument
  • the Brigham Carpal Tunnel Questionnaire

Boston Carpal Tunnel Questionnaire Survey Structure

The Boston Carpal Tunnel Questionnaire contains two modules: the Symptom Severity Scale and the Functional Status Scale (FSS). These two modules are scored separately and can be used together or independently of each other. (1) 

The Symptom Severity Scale module is an 11-question survey that addresses pain, numbness, weakness, tingling, and difficulty with fine motor skills. The questions ask patients to think about their symptoms over the past 2 weeks and rate their severity using a Likert scale.

The Functional Status Scale module is an 8-question survey that evaluates the relationship between symptoms and functionality by asking questions related to activities such as bathing, holding a book, or carrying a grocery basket. Patients are asked to rate their degree of difficulty carrying out these 8 tasks using a Likert scale as well.

How is the BCTQ Scored?

For both modules, each question has 5 possible answers. An answer of 1 equates to no symptoms or functional difficulty while an answer of 5 equates to maximum symptoms or the inability to perform the task. The mean score for each scale is calculated, with a higher score indicating worse symptoms or functionality. The Symptom Severity Scale and the Functional Status Scale are scored and calculated separately (3). The minimum clinically important difference (MCID) for the Symptom Severity Scale has been found to be 1.14. The MCID of the Functional Status scale has not yet been determined. Multiple studies have found the BCTQ to be valid and reliable, with no ceiling effects. 

Strengths

One of the biggest strengths of utilizing the BCTQ is how quick and easy the assessment is to administer. The full assessment contains 19 questions and on average takes less than 10 minutes for patients to complete. As the two modules within the BCTQ are scored independent of each other they can be used together or individually based on preference. In addition to the BCTQ’s publication in English, the outcome tool has been translated and validated in multiple different languages. All of these factors make for administering and completing the assessment relatively quickly. 

Considerations

While the Boston Carpal Tunnel Questionnaire is the most commonly used tool for measuring and monitoring carpal tunnel syndrome, there are other patient-reported outcome tools that are better suited for collecting more generalized hand, wrist, and arm symptoms including the DASH and the PROMIS Upper Extremity. 

Licensing

The Boston Carpal Tunnel Questionnaire is free to use and does not have any licensing requirements. 

References:

  1. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire – PMC
  2. Carpal Tunnel Questionnaire – an overview | ScienceDirect Topics
  3. Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery | BMC Musculoskeletal Disorders
  4. Brigham and Women’s Carpal Tunnel Questionnaire – Physiopedia
  5. Kim JK, Jeon SH. Minimal clinically important differences in the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Eur Vol. 2013 Jan;38(1):75-9. doi: 10.1177/1753193412442137. Epub 2012 Mar 28. PMID: 22457249.

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