Patient Acceptable Symptom State and BCTQ MCID Capture Distinct Outcomes After Carpal Tunnel Release

Patient-reported outcomes after carpal tunnel release (CTR) are commonly assessed using change-based metrics such as the minimal clinically important difference (MCID) and state-based measures such as the Patient Acceptable Symptom State (PASS). Whether these metrics capture similar dimensions of recovery after CTR remains unclear.

We performed a retrospective cohort study of adults undergoing primary CTR with preoperative and postoperative Boston Carpal Tunnel Questionnaire (BCTQ) data. Minimal clinically important difference attainment was calculated for the Symptom Severity Scale (SSS) and Functional Status Scale (FSS) using baseline-dependent thresholds. Patient Acceptable Symptom State was assessed at the final follow-up using a standardized single-item question and dichotomized as PASS-positive or PASS-negative. Agreement between PASS and MCID was evaluated using contingency tables and Cohen's kappa. Hands were categorized into concordant and discordant outcome groups, and exploratory analyses assessed factors associated with discordance.

A total of 190 hands were included. Overall agreement between PASS and MCID was 68.4% for both SSS and FSS, with moderate agreement (SSS κ = 0.325; FSS κ = 0.306). Among PASS-positive hands, 35.3% did not meet MCID for SSS, and 34.0% did not meet MCID for FSS. Conversely, a minority of PASS-negative hands achieved MCID. Lower baseline BCTQ scores were consistently associated with PASS-positive/MCID-negative outcomes, reflecting a baseline-dependent ceiling effect.

Patient Acceptable Symptom State and MCID demonstrate moderate agreement after CTR and capture distinct aspects of postoperative recovery. Reliance on MCID alone may underestimate patient-perceived success, particularly in patients with milder baseline symptoms. Incorporating both state-based and change-based measures may provide a more patient-centered assessment of surgical outcomes after CTR.