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Confirmatory Factor Analysis of the Boston Carpal Tunnel Questionnaire

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Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

Purpose Carpal tunnel syndrome (CTS) is one of the most common hand problems and a major cause of work disability. The purpose of this study was to use confirmatory factor analysis (CFA) to assess the factor structure of the Boston Carpal Tunnel Questionnaire (BCTQ) in patients with CTS. Methods One hundred and twenty-three patients with CTS were recruited from two hospitals. Each patient completed the functional status scale and the symptom severity scale of the BCTQ. CFA was used to assess the model fit between the data and pre-established theoretical measurement models. Results CFA showed that all three-factor models were better than the original two-factor model. Among the three-factor models, the simplified model, with 11 items assessing daytime pain, nocturnal numbness/tingling, and hand function was the best, for the model fit the data better than did the other models. Specifically, the Comparative Indices were larger than 0.95 (Tucker–Lewis Index and Comparative Fit Index values), and the Absolute Fit Indices and information-theoretic measures were the smallest. Moreover, all factor loadings were significant and high in magnitude (ranging from 0.66 to 0.99), the composite reliabilities exceeded 0.60 (ranging from 0.78 to 0.94), and the average variance extracted exceeded 0.50 (ranging from 0.61 to 0.89). Conclusion The simplified model showed the highest reliability and validity, and the factor structure was the simplest/clearest one. The simplified model is recommended for clinical use due to its convenience and precision for assessing the problems of patients with CTS.

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References

  1. Luckhaupt SE, Dahlhamer JM, Ward BW, Sweeney MH, Sestito JP, Calvert GM. Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 national health interview survey. Am J Ind Med. 2012. doi:10.1002/ajim.22048.

    Google Scholar 

  2. Bureau of Labor Statistics, United States. Nonfatal occupational injuries and illnesses requiring days away from work. Washington, DC: Department of Labor; 2011.

    Google Scholar 

  3. Bureau of Labor Statistics, United States. Nonfatal occupational injuries and illnesses requiring days away from work. Washington, DC: Department of Labor; 2012.

    Google Scholar 

  4. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–92.

    CAS  PubMed  Google Scholar 

  5. Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006. doi:10.1186/1471-2474-7-78.

    Google Scholar 

  6. Sambandam SN, Priyanka P, Gul A, Ilango B. Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome. Int Orthop. 2008;32:497–504.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Vasiliadis HS, Georgoulas P, Shrier I, Salanti G, Scholten RJPM. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014. doi:10.1002/14651858.CD008265.pub2.

    PubMed  Google Scholar 

  8. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012. doi:10.1002/14651858.CD009601.

    Google Scholar 

  9. Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, Hollingworth W, Kerrigan CL, Deyo RA. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009;374:1074–81.

    Article  PubMed  Google Scholar 

  10. Lue YJ, Lu YM, Lin GT, Liu YF. Validation of the Chinese version of the Boston Carpal Tunnel Questionnaire. J Occup Rehabil. 2014;24:139–45.

    Article  PubMed  Google Scholar 

  11. de Campos CC, Manzano GM, Leopoldino JF, Nóbrega JAM, Saňudo A, de Araujo Peres C, Castelo A. The relationship between symptoms and electrophysiological detected compression of the median nerve at the wrist. Acta Neurol Scand. 2004;110:398–402.

    Article  PubMed  Google Scholar 

  12. Ortiz-Corredor F, Calambas N, Mendoza-Pulido C, Galeano J, Díaz-Ruíz J, Delgado O. Factor analysis of carpal tunnel syndrome questionnaire in relation to nerve conduction studies. Clin Neurophysiol. 2011;122:2067–70.

    Article  PubMed  Google Scholar 

  13. Atroshi I, Lyrén PE, Gummersson C. The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res. 2009;18:347–58.

    Article  PubMed  Google Scholar 

  14. Floyd FJ, Widaman KF. Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995;7:286–99.

    Article  Google Scholar 

  15. Jackson DL, Gillaspy JA, Purc-Stephenson R. Reporting practices in confirmatory factor analysis: an overview and some recommendations. Psychol Methods. 2009;14:6–23.

    Article  PubMed  Google Scholar 

  16. Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88:588–606.

    Article  Google Scholar 

  17. Liu YF, Lin GT, Lu YM, Fu YC, Lue YJ. Cross-cultural adaptation of the Chinese version of the Boston Carpal Tunnel Questionnaire. FJPT. 2008;33:75–85.

    Google Scholar 

  18. Schreiber JB. Core reporting practices in structural equation modeling. Res Social Adm Pharm. 2008;4:83–97.

    Article  PubMed  Google Scholar 

  19. Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychol Methods. 1996;1:16–29.

    Article  Google Scholar 

  20. Bagozzi RP, Yi Y. On the evaluation of structural equation models. JAMS. 1988;16:74–94.

    Article  Google Scholar 

  21. Cole DA. Utility of confirmatory factor analysis in test validation research. J Consult Clin Psychol. 1987;55:584–94.

    Article  CAS  PubMed  Google Scholar 

  22. Akaile H. Factor analysis and AIC. Psychometrika. 1987;52:317–32.

    Article  Google Scholar 

  23. Bozdogan H. Model selection and Akaike’s information criteria (AIC): the general theory and its analytical extensions. Psychometrika. 1987;52:345–70.

    Article  Google Scholar 

  24. Bentler PM. Comparative fit indices in structural models. Psychol Bull. 1990;107:238–46.

    Article  CAS  PubMed  Google Scholar 

  25. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1–55.

    Article  Google Scholar 

  26. Browne MW, Cudeck R. Alternative ways of assessing model fit. Socio Methods Res. 1992;21:230–58.

    Article  Google Scholar 

  27. Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika. 1973;38:1–10.

    Article  Google Scholar 

  28. Bentler PM, Bonett DG. Significant tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88:588–606.

    Article  Google Scholar 

  29. Arbuckle JL. Amos™ 16.0 user’s guide. Spring House, PA: Amos Development Corporation; 2007.

    Google Scholar 

  30. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113:1373–81.

    Article  PubMed  Google Scholar 

  31. Tamburin S, Cacciatori C, Praitano ML, Cazzarolli C, Foscato C, Fiaschi A, Giampietro Z. Median nerve small- and large-fiber damage in carpal tunnel syndrome: a quantitative sensory testing study. J Pain. 2011;12:205–12.

    Article  PubMed  Google Scholar 

  32. Turini A, Padua L, Biasiotta A, Caliandro P, Pazzaglia C, Galeotti F, Inghilleri M, Cruccu G. Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome. Pain. 2009;145:105–9.

    Article  Google Scholar 

  33. Tamburin S, Cacciatori C, Maranin S, Zanette G. Pain and motor function in carpal tunnel syndrome: a clinical, neurophysiological and psychophysical study. J Neurol. 2008;255:1636–43.

    Article  CAS  PubMed  Google Scholar 

  34. Gong HS, Han J, Bin SW, Kim WS, Chung MS, Baek GH. Clinical features influencing the patient-based outcome after carpal tunnel release. J Hand Surg Am. 2008;33:1512–7.

    Article  PubMed  Google Scholar 

  35. Bearden WO, Sharma S, Teel JE. Sample size effects of Chi square and other statistics used in evaluating causal models. J Mark Res. 1982;19:425–30.

    Article  Google Scholar 

  36. Guadagnoli E, Velicer WF. Relation of sample size to the stability of component patterns. Psychol Bull. 1988;103:265–75.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Grants from the Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (kmhk-96-022). We are most grateful to the study participants for their contribution to the study.

Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yi-Jing Lue

  2. Master’s Program, Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yi-Jing Lue

  3. Department of Special Education, National Kaohsiung Normal University, Kaohsiung, Taiwan

    Yuh-Yih Wu

  4. Department of Physical Medicine and Rehabilitation, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ya-Fen Liu

  5. Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Gau-Tyan Lin & Yen-Mou Lu

  6. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Gau-Tyan Lin

  7. Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, TzYou 1st Rd., Kaohsiung, 80708, Taiwan

    Yen-Mou Lu

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  1. Yi-Jing Lue
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Correspondence to Yen-Mou Lu.

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Lue, YJ., Wu, YY., Liu, YF. et al. Confirmatory Factor Analysis of the Boston Carpal Tunnel Questionnaire. J Occup Rehabil 25, 717–724 (2015). https://doi.org/10.1007/s10926-015-9579-0

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  • DOI: https://doi.org/10.1007/s10926-015-9579-0

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