Alpha Omega Alpha Honor Medical Society

2012 Research Abstract

Responsiveness of Patients’ DASH Scores following Ulnar Nerve Transposition for Cubital Tunnel Syndrome

Investigator: Gregory Ebersole, Washington University in St. Louis School of Medicine

Mentor: Susan MacKinnon, MD, Washington University in St. Louis School of Medicine

Purpose: This study sought to determine the validity and responsiveness of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire in cubital tunnel syndrome

Methods: All consecutive patients with cubital tunnel syndrome treated by anterior ulnar nerve transposition between September 2009 and December 2011 were retrospectively reviewed. Questionnaires were completed preoperatively and at 1.5, 3, 6 and 12 months postoperatively. To assess construct validity, the relationship of the DASH to measures of pain, health status (SF-8), pinch and grip strength was evaluated using Spearman’s correlation coefficients. Responsiveness of the DASH was analyzed using Cohen’s effect size, and was compared to responsiveness of the physical exam, pain, and SF-8 measures.

Results: The final cohort included 69 patients with isolated cubital tunnel syndrome (CuTS) and 39 patients with concurrent cubital and carpal tunnel syndromes (CuTS/CTS). In both groups,DASH scores correlated as expected with other measures. Moderate-to-strong correlations were observed with pain visual analogue scale (VAS) and SF-8 scores, and weak-to-moderate correlations with pinch and grip strength. Effect sizes for the DASH were small (<0.3) at 6 weeks and moderate (0.35-0.57) at 3, 6 and 12 months postoperatively in both CuTS and CuTS/CTS groups. Pain VAS scores demonstrated large effect sizes (>0.8) at all postoperative time points, whereas SF-8, pinch and grip strength were poorly responsive.

Discussion: The DASH is a valid measure in cubital tunnel syndrome, and is moderately responsive to change beyond 3 months follow-up. Pain VAS scores are highly sensitive to change in this population, while physical and health status measures were poorly responsive in the first postoperative year. These findings help to guide the appropriate use of the DASH in evaluating and comparing outcomes in patients with cubital tunnel syndrome.

Updated on October 24, 2012.

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