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Clinical construct validity and subgroup stability of the Romanian version of the Boston Carpal Tunnel Questionnaire in nerve-conduction-confirmed carpal tunnel syndrome – a cross-sectional study Cover

Clinical construct validity and subgroup stability of the Romanian version of the Boston Carpal Tunnel Questionnaire in nerve-conduction-confirmed carpal tunnel syndrome – a cross-sectional study

Romanian Journal of Internal Medicine
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By: ,  ,  ,  ,  ,  ,   and    
Open Access
|May 2026
Figures & tables

Figures & Tables

Figure 1.

STROBE-style flow diagram of patient and hand selection. Detailed exclusion criteria are provided in Table 1. CTS, carpal tunnel syndrome; NCS, nerve conduction studies.

Figure 2.

Median SSS (left; p = 0.006) and FSS scores (right; p < 0.001) according to the NCS-defined CTS severity class. P-values represent the significance level of Kruskal-Wallis tests. Per-group hand counts of NCS severity categories: mild (n=56), moderate (n=90) and severe (n=47). Abbreviations: BCTQ - Boston Carpal Tunnel Questionnaire; CTS – carpal tunnel syndrome; FSS - Functional Status Scale; SSS - Symptom Severity Scale.

Figure 3.

Forest plots of linear mixed models to predict SSS (panel A) and FSS scores (panel B). Notes: Each estimate comes from a separate adjusted model as specified in Table 4. For Tinel's and Phalen's signs, the plotted coefficient represents absence versus presence of the sign. Abbreviations: FSS - Functional Status Scale; MCV - Motor Conduction Velocity; SCV - Sensory Conduction Velocity; SSS - Symptom Severity Scale.

General and CTS characteristics of the sample (n = 100)

demographicsCTS characteristics
age (years)58.5±9.8right dominant hand95%
women93.0%left dominant hand3.0%
menopause age (years)47.8±5.6ambidextrous2.0%
urban dwelling62.0%history of CTS67.0%
secondary school10.0%time from menopause to CTS (years)12.0±9.5
high school64.0%bilateral CTS97.0%
college26.0%unilateral CTS of dominant hand3.0%
professionally active57.0%unilateral CTS of nondominant hand0
smoking, current18.0%professional vibration exposure23.0%
smoking, ever37.0%occupation involving manual load handling82.0%
alcohol, frequent48.0%keyboard work38.0%
BMI (kg/m2)29.2±5.0professional repetitive maneuvers83.0%
arterial hypertension57.0%extended flexion or extension52.0%
Raynaud’s phenomenon3.0%cold work environment30.0%

Associations between BCTQ scores and clinical, NCS, and patient-reported measures

Spearman’slinear mixed models* for F/SSS
rhopB95% CIppseudo-R2
grip strengthSSS−0.1610.028−0.431−0.727; −0.1350.0050.108
FSS−0.392<0.001−0.355−0.552; −0.158<0.0010.289
SCVSSS−0.330<0.001−0.298−0.429; −0.166<0.0010.181
FSS−0.308<0.001−0.273−0.361; −0.184<0.0010.332
MCVSSS−0.1900.012−0.221−0.415; −0.0270.0260.054
FSS−0.272<0.001−0.250−0.374; −0.126<0.0010.168
F waveSSS0.0070.924−0.067−0.191; 0.0560.283-
FSS−0.1850.011−0.100−0.193; −0.0080.0340.005
SNAPSSS−0.333<0.001−0.276−0.411; −0.142<0.0010.130
FSS−0.337<0.001−0.208−0.299; −0.117<0.0010.197
CMAPSSS−0.1330.077−0.855−1.428; −0.2810.0040.127
FSS−0.3050.000−0.879−1.268; −0.490<0.0010.189
DMLSSS0.300<0.0011.4840.661; 2.308<0.0010.127
FSS0.311<0.0011.3280.750; 1.905<0.0010.187
EQ-5D-5L DSSSSS0.381<0.0010.8820.488; 1.277<0.0010.125
FSS0.592<0.0010.9880.720; 1.255<0.0010.337

Number of excluded patients/hands (216 patients, 355 hands)

Exclusion criterionPatientsHands
history of paresis or cervical radiculopathy11
diabetic polyneuropathy1012
previous fractures or malunited callus of wrist22
prior carpal tunnel decompression surgery710
local glucocorticoid injection ≤3 months11
local physiotherapy ≤3 months11
pregnancy or postpartum ≤6 months24
decompensated hypothyroidism12
rheumatoid arthritis2234
psoriatic arthritis810
spondyloarthritis58
systemic lupus erythematosus1015
systemic sclerosis2229
Sjögren’s disease913
gout78
undifferentiated arthritis11
lack of diagnostic nerve conduction study criteria711
Total116162

Exploratory item-level analysis of the BCTQ questions and NCS-defined CTS severity (n=193 hands)_

p (χ2)answerNCS-defined CTS severity
mild (n=56)moderate (n=90)severe (n=47)
SSS question 60.004227.3%21.3%6.4%*
427.3%25.8%55.3%*
SSS question 80.049229.1%*12.4%10.6%
40%*11.2%10.6%
SSS question 90.005230.9%*14.6%10.6%
51.8%*15.7%25.5%*
SSS question 100.01251.8%*15.7%10.6%
SSS question 110.00249.1%11.2%36.2%*
FSS question 1<0.001158.2%48.3%6.4%*
314.5%18.046.8%*
50%0%4.3%*
FSS question 2<0.001152.7%*39.3%6.4%*
45.5%*16.9%29.8%*
501.1%17.0%*
FSS question 3<0.001130.9%23.6%4.3%*
410.9%19.1%40.4%*
FSS question 4<0.001240.0%*13.5%10.6%
320.0%21.3%42.6%
FSS question 50.03757.3%16.9%29.8%*
FSS question 70.001429.1%29.5%53.2%*
FSS question 80.006147.3%40.3%19.1%*
3 29.1%18.0%44.7%*
DOI: https://doi.org/10.2478/rjim-2026-0012 | Journal eISSN: 2501-062X | Journal ISSN: 1220-4749
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Language: English
Submitted on: May 19, 2026
Published on: May 27, 2026
Published by: N.G. Lupu Internal Medicine Foundation
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
carpal tunnel syndrome,
BCTQ,
validation,
Romanian
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Cardiology,
Gastroenterology,
Rheumatology

© 2026 Daniela Nicoleta Popescu, Claudiu Popescu, Oana Morari, Natalia Blidaru, Alice Rakoczy, Magda Ileana Parvu, Cătălin Codreanu, Luminița Enache, published by N.G. Lupu Internal Medicine Foundation
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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