The Construct Validity and Responsiveness of Sensory Tests in Patients with Carpal Tunnel Syndrome

Derek K.M Cheung*, 1, JoyC MacDermid 2, 3, Dave Walton 1, Ruby Grewal 2, 4
1 Health and Rehabilitation Sciences Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
2 Hand and Upper Limb Clinic, St. Joseph’s Hospital, London, Ontario, Canada
3 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
4 Schulich School of Medicine, Western University, London, Ontario, Canada

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Creative Commons License
© Cheung et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Hand and Upper Limb Centre, Clinical Research Laboratory (Basement), St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario, N6A 4L6, Canada; Tel: 519-646-6000; Fax: 519-646-6049; E-mail:


Background and Purpose :

Sensory evaluation is fundamental to evaluation of patients with Carpal Tunnel Syndrome (CTS). The purpose of this study was to determine the construct validity and responsiveness for sensory threshold tests in patients with CTS.

Methods :

Sixty-three patients diagnosed with CTS were evaluated prior to orthotic intervention and again at follow up at 6 and 12 weeks. Sensory tests included touch threshold PSSD (Pressure Specified Sensory Device) and vibration threshold (Vibrometer). Construct validity was assessed by comparing sensory tests to hand function, and dexterity testing using Spearman rho (rs). Patients were classified as either responders or non-responders to orthotic intervention based on the change score of the Symptom Severity Scale (SSS) of 0.5. Responsiveness of the sensory tools was measured using ROC (receiver operating characteristic) curves, SRM (Standardized Response Mean), and ES (Effect Sizes).

Results :

The PSSD had low to moderate correlations (rs ≤ 0.32) while Vibrometer scores had moderate correlations (rs = 0.36 - 0.41) with dexterity scores. The Clinically Important Difference (CID) for the PSSD was estimated at 0.15 g/mm2 but was not discriminative. The Vibrometer demonstrated moderate responsiveness, with a SRM = 0.61 and an ES = 0.46 among responders. The PSSD had a SRM = 0.09 and an ES = 0.08 and showed low responsiveness for patients with a clinically important improvement in symptoms.

Conclusion :

Measurement properties suggest that the Vibrometer was preferable to the PSSD because it was more correlated to hand function, and was more responsive. Clinicians may choose use the Vibrometer opposed to the PSSD for determining important change in sensation after orthotic intervention.

Keywords: Carpal tunnel syndrome, clinically important difference, construct validity, orthotic intervention, psychometric properties, responsiveness, touch threshold, vibration threshold.