Establishing the Patient Acceptable Symptoms State for the Boston Carpal Tunnel Questionnaire in a Postoperative Carpal Tunnel Surgery Population

Threshold scores for patient acceptable symptom state (PASS) represent the score beyond which a patient considers themselves “well.” We aimed to determine PASS thresholds for the symptom severity scale (SSS) and functional status scale (FSS) of the Boston Carpal Tunnel Questionnaire in a sample of patients 1 year following carpal tunnel release. Adults (≥ 18 years) from a single, tertiary-care academic institution were contacted 12 ± 1 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire and two PASS anchor questions were administered via REDCap—one queried acceptability of their current symptoms, and the other queried function. Participants were classified as being in an acceptable symptom state (“PASS(+)”) if they answered “very satisfied” or “somewhat satisfied,” whereas those responding “neither satisfied nor dissatisfied,” “somewhat dissatisfied,” or “very dissatisfied” were classified as “PASS(−).” Threshold values were calculated using three methods: (1) the mean score for PASS(+) participants, (2) the 75th percentile score for PASS(+) patients, and (3) the Youden Index determined using receiver operating curve (ROC) analysis to maximize sensitivity and specificity. The 153 patients included in the study had a mean age of 60 ± 15 years and 60% (94/153) were women. At a mean follow-up of 1.0 ± 0.1 years, SSS and FSS scores were significantly lower (better) for PASS(+) than PASS(−) patients for both anchor questions. PASS estimates ranged from