Boston Carpal Tunnel Questionnaire / Levine Carpal Tunnel Syndrome

Abstract

The Boston Carpal Tunnel Questionnaire (BCTQ), also known as the Levine Carpal Tunnel Syndrome questionnaire, is a specialized, patient-reported outcome measure developed specifically for individuals diagnosed with Carpal Tunnel Syndrome (CTS). Its primary function is to provide comprehensive insight into the severity of symptoms and the associated functional limitations experienced by the patient.

The instrument evaluates typical 24-hour periods across the preceding two weeks, capturing the recent manifestation of the disorder. The BCTQ is highly adaptable in its administration, allowing for self-completion by the client, or administration via structured interview or telephonically, ensuring broad utility in various clinical and research settings.

Keywords

Boston Carpal Tunnel Questionnaire, BCTQ, Carpal Tunnel Syndrome, CTS, symptom severity, functional status, upper extremity, peripheral nervous system, patient-reported outcome.

Authors

Levine DW, et al. (1993), Smits FVM, et al. (2004) (Dutch Version)

Purpose

The primary purpose of the BCTQ is dual: to quantify the severity of sensory and motor symptoms associated with CTS, and to assess the functional limitations patients experience during activities of daily living (ADLs). It serves as a crucial tool for baseline assessment, monitoring disease progression, and evaluating the efficacy of surgical or conservative treatments.

The structure of the questionnaire allows clinicians to differentiate between the subjective experience of pain and numbness (Symptom Severity Scale) and the objective difficulty in performing hand-intensive tasks (Functional Status Scale), providing a holistic view of the patient’s condition related to the peripheral nervous system disorder.

Construct

The BCTQ measures the quality of life and functional impact related to median nerve compression at the carpal tunnel. The construct is inherently multidimensional, divided into two distinct subscales: the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS).

The SSS focuses on the intensity, frequency, and nature of sensory deficits (e.g., pain, numbness, tingling), while the FSS assesses the ability to perform common tasks involving the upper extremity, such as gripping, writing, and dressing. Collectively, these scales quantify the overall burden of the condition on the patient’s mobility and daily activities.

Validity

The validity of the Boston Carpal Tunnel Questionnaire has been extensively studied across numerous languages and cultural contexts. The instrument demonstrates strong evidence of construct validity, showing significant correlations with objective measures of nerve conduction studies and clinical grading systems for CTS severity.

Furthermore, it exhibits excellent responsiveness (or longitudinal validity), proving sensitive to clinically meaningful changes following interventions such as carpal tunnel release surgery. Both the Symptom Severity Scale and the Functional Status Scale have confirmed their ability to accurately capture different aspects of the disease experience.

Reliability

The BCTQ is recognized for its high internal consistency and test-retest reliability. Studies typically report high Cronbach’s alpha coefficients for both the SSS and FSS subscales, often exceeding 0.80, indicating that the items within each scale measure the same underlying construct consistently.

Inter-rater reliability is also high, particularly when the questionnaire is administered via interview, solidifying its status as a robust and consistent measurement tool for assessing the impact of peripheral nervous system disorders in the upper extremity.

Factor Analysis

Confirmatory and exploratory factor analyses consistently support the intended two-factor structure of the BCTQ: the Symptom Severity factor and the Functional Status factor. These analyses confirm that the items cluster appropriately into these two distinct domains, validating the conceptual framework established by the original authors (Levine et al., 1993).

While some minor variations in item loading have been observed in non-English translations, the fundamental bifactorial model remains stable, ensuring the scale accurately reflects the separate dimensions of pain/sensation and functional ability in CTS patients.

Instrument

Test Type: Questionnaire

Format: Patient-Reported Outcome Measure (PROM)

Language Available: Original English, Dutch (Smits FVM, et al., 2004), and numerous other validated translations globally.

Population Group: Clinical population suffering from Carpal Tunnel Syndrome (CTS).

Age Group: Adults and the Elderly.

Population Details: Individuals presenting with symptoms related to compression of the median nerve, affecting sensory functions, pain, mobility, and activities of the upper extremity.

Test Methodology: Self-administered, Interview-based, or Telephonic administration. Measures symptoms and function over the preceding two weeks (14-day recall period).

Keywords

BCTQ, Symptom Severity Scale, Functional Status Scale, upper extremity function, mobility, pain assessment, rehabilitation outcome, validity, reliability.

Authors

Author ORCID Identifier: N/A (Information not provided in source)

Affiliation Email addresses: N/A (Information not provided in source)

Correspondence Address: N/A (Information not provided in source)

Permissions & Fee and Test Year

The original version of the scale was developed and published in 1993 by Levine DW, et al. The Dutch translation was published in 2004 by Smits FVM, et al. Specific details regarding current licensing, permissions, and associated fees must be obtained directly from the copyright holders or relevant publishing bodies.

Reference’s

• Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585-1592.
• Smits FVM, et al. Nederlandse versie van de Boston Carpal Tunnel Questionnaire (BCTQ): Validatie en betrouwbaarheid. [Dutch version of the Boston Carpal Tunnel Questionnaire (BCTQ): Validation and Reliability]. Ned Tijdschr Geneeskd. 2004;148(42):2095-2100.
• The original PDF explaining the scale methodology can be downloaded here: Toelichtingsformulier (Explanation Form).
• The original PDF of the measurement instrument can be downloaded here: Meetinstrument (Measurement Instrument).

Items of the Boston Carpal Tunnel Questionnaire / Levine Carpaal Tunnel Syndroom

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific items comprising the Boston Carpal Tunnel Questionnaire (BCTQ) were not provided in the source material. However, the BCTQ is generally divided into two main sections: the Symptom Severity Scale (SSS, typically 11 items) and the Functional Status Scale (FSS, typically 8 items).