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Effect of Health Literacy on Carpal Tunnel Severity at Presentation
Kristofer Bires, MD
1, Jeffrey G Stepan, MD, MS
2, Sarthak Aggarwal, BS
2; Michael Koch, BS
1(1)University of Chicago, Chicago, IL, (2)University of Chicago Medical Center, Chicago, IL
Introduction:
Multiple studies have shown that patients with low health literacy (HL) or high social deprivation have lower patient rated outcome (PROs) scores when presenting with carpal tunnel syndrome (CTS). Less is known, however, on objective disease severity of these patients on presentation. We hypothesized that patients with low HL will have both worse PROs scores and a higher disease severity at presentation.
Materials and Methods:
This prospective study enrolled patients >18 years old presenting to our hand clinic with a new diagnosis of carpal tunnel syndrome (CTS-6 > 12.5). Patients were excluded if they were non-English speaking or were previously treated for CTS by another surgeon. Patients initially completed PROMIS Upper Extremity Questionnaire 2.0 (PROMIS) and the Boston Carpal Tunnel Questionnaire (BCTQ). A clinical exam including 2-point discrimination (2PD), and presence of thenar atrophy was documented. Patients completed a validated HL screening questionnaire, the Newest Vital Sign (NVS). BCTQ, CTS-6, PROMIS, and 2-point discrimination were compared between adequate and low HL groups. Disease severity scores were compared using a 2-tailed independent t-test, and physical exam findings were compared using chi-square analysis.
Results:
130 patients met inclusion criteria over a 2-year period and completed both NVS and disease severity score questionnaires. The results are displayed in the table below. There was no statistical difference in BCTQ, CTS-6, 2PD or thenar atrophy between the groups. There was a statistically significant higher PROMIS score in the adequate health literacy group.
Comparison BCTQ Symptom Severity Score (SSS), BCTQ Functional Severity Score (FSS), CTS-6, PROMIS UE, 2PD and thenar atrophy between adequate and low HL groups. | Adequate HL (n=50) | Low HL (n=80) | p-value |
BCTQ SSS | 37.9 +/- 8.5 | 40.8 +/- 9.6 | 0.09 |
BCTQ FSS | 2.85 +/- 1.0 | 3.1 +/- 0.9 | 0.13 |
CTS-6 | 16.3 +/- 4.4 | 17.1 +/- 4.2 | 0.30 |
Promis UE | 35.9 +/- 8.1 | 32.2 +/- 7.4 | 0.01 |
| Adequate HL (n=47) | Low HL (n=76) | |
Abnormal 2PD (%) | 12 (26) | 26 (34) | 0.31
|
Normal 2PD (%) | 35 (74) | 50 (66) |
| Adequate HL (n=48) | Low HL (n=77) | |
Thenar Atrophy | 9 (19) | 15 (19) | 0.91 |
No Thenar Atrophy | 39 (81) | 62 (81) | |
Conclusion:
Patients with lower health literacy had worse PROMIS scores than those with adequate health literacy despite the same CTS severity as measured by physical exam and by disease specific scores. These findings suggest that in patients with low health literacy, generalized UE scores such as the PROMIS UE may overestimate disease specific severity.
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