Evaluation of ultrasound as diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: Study protocol for a diagnostic testing study.

BACKGROUND: Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy, accounting for 90% of all neuropathies. Its prevalence ranges from 3.8%-7.8% in the population. The gold standard for its diagnosis is the neurophysiological study (85% sensitivity and 95% specificity), with the disadvantage of being invasive, complex and expensive, which means an increase in cost and time for the diagnosis of the disease. The main objective of this diagnostic test evaluation study is to investigate the value of ultrasound in the diagnosis of CTS, and among the secondary objectives, to establish the ultrasound parameters that are predictors of CTS in comparison with neurophysiological studies, attempting to standardize a protocol and reference values that determine the presence or absence of CTS. METHODS: Prospective, cross-sectional study. The reference test with which we compared the ultrasound is the neurophysiological test (NPT). Patients will come consecutively from the Neurophysiology Department of the Virgen Macarena Hospital, with clinical suspicion of CTS and fulfilling the inclusion/exclusion criteria. To calculate the sample size (EPIDAT program) we proposed a sensitivity of 78% and specificity of 87% with a confidence level of 95%, requiring 438 patients (264 NPT positive, 174 NPT negative). We followed an ultrasound study protocol that included the ultrasound variables: cross-sectional area at the entrance and exit of the tunnel, range of nerve thinning, wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and the existence of adjacent wrists or masses. We propose a timeline for the study to be performed between 2020 and 2023. Finally, we propose a cost-effectiveness analysis. DISCUSSION: Ultrasound not only allows to objectify the alterations of the median nerve but also the underlying pathological mechanisms in CTS. A multitude of ultrasound parameters have been described that should be regarded in syndrome's study, among which we included the cross-sectional area, the range of nerve thinning, the wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and assessment of anatomical alterations. The use of ultrasound as a diagnostic tool in CTS has many advantages for both doctors and the patients, as it is a non-invasive, convenient, and fast tool increasingly accessible to professionals. TRIAL REGISTRATION: Trials registry number: NCT05556278.

[Development of the Spanish version of the Wisconsin Gait Scale. Reliability and consistency analysis of spatial and temporal parameters with gait assessment in stroke patients]. / Desarrollo de la versión española de la Wisconsin Gait Scale. Análisis de consistencia de los parámetros temporo-espaciales con la valoración de la marcha en pacientes con ictus.

BACKGROUND AND OBJECTIVE: We aimed to perform a cross-cultural adaptation of the Wisconsin Gait Scale (WGS) to Spanish and ensure its reliability, validity and sensitivity. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted in patients with stroke between September 2017 and March 2019. We developed the Spanish version through the translation-back-translation method, and reached a consensus on the problematic items. The Spanish version of the WGS was applied in 25 post-stroke patients, assessed in the Hospital Movement Analysis Unit. All patients were evaluated by 2 independent evaluators, subsequently performing the instrumented gait analysis using the Elite System (BTS), SMART System. Interobserver confirmation (intraclass correlation coefficient), internal consistency (Cronbach's alpha), and validation were verified by checking their relationship with spatial and temporal parameters and sensitivity to change (Pearson's correlation). RESULTS: After the translation-back-translation, the committee found cultural equivalence in all but 2 items and reached a consensus on the final version. Interobserver reliability had an intraclass coefficient of 0.99 for the total score, and > 0.7 for each item; Cronbach's alpha was > 0.8; the validity between the WGS and the spatial and temporal parameters was significant (p < 0.05). Sensitivity to change was significant on comparison of the results of the scale at baseline and at 1 month (correlation coefficient 0.92). CONCLUSION: The Spanish version of the WGS is a culturally equivalent instrument to the original version, providing an objective means to document observational analysis of gait in post-stroke patients by rehabilitation teams.