American Association for Hand Surgery
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Validity and Reliability of the CTS-6 for Carpal Tunnel Syndrome Administered by Medical Assistants
Louis C. Grandizio, DO1, Yagiz Ozdag, MD2, Alex Mettler, MD2, Victoria Garcia, PhD2, Anil Akoon, MD2, Liam Dwyer, MD2 and Joel C. Klena, MD3, (1)Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, (2)Geisinger, Danville, PA, (3)Geisinger Medical Center, Danville, PA

Purpose: The CTS-6 can be used clinically to diagnose carpal tunnel syndrome (CTS) and has demonstrated high levels of inter-rater reliability (IRR) when administered by non-expert clinicians. Our purpose was to assess both validity (sensitivity [Sn] and specificity [Sp]) and IRR of the CTS-6 when administered by medical assistants (MAs).

Methods: A series of patients presenting to an academic, upper-extremity surgery clinic were screened using the CTS-6 between May-June of 2023. The CTS-6 was first administered by one of five MAs and then by one of four fellowship-trained upper-extremity surgeons. In addition to recording baseline demographics, results of each of the six history and examination components of the CTS-6 were recorded, as was the cumulative CTS-6 score (0-26). Surgeons were blinded to the scores obtained by the MAs. IRR (Cohen’s kappa) was determined between the groups with respect to the diagnosis of CTS and the individual CTS-6 items. Sn/Sp were calculated for the MA-administered CTS-6, using the score obtained by the surgeon as the reference standard. A CTS-6 score >12 was considered diagnostic of CTS.

Results: 218 patients were included and 26% had a diagnosis of CTS. For diagnostic validity, the MA group demonstrated a Sn/Sp of 84% / 91% for the diagnosis of CTS. IRR was substantial (Cohen’s kappa 0.72, 95% CI [0.62 - 0.83]) for MAs compared to hand surgeons for the diagnosis of CTS. For individual CTS-6 components, agreement was lowest for the assessment of 2PD (fair) and highest for assessment of subjective numbness (near perfect).

Conclusions: The CTS-6 demonstrates substantial reliability and high diagnostic validity when administrated by MAs. These results suggest that for patients presenting with hand numbness to non-specialist clinics, incorporating the CTS-6 into customizable medical screening tools administered by MAs may aid in optimizing diagnostic and referral pathways.

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