Item Reduction of the Boston Carpal Tunnel Questionnaire Using Decision Tree Modeling
Objective: To produce an electronic decision tree version of the Boston Carpal Tunnel Questionnaire (DT-BCTQ) using the chi-squared automatic interaction detection (CHAID) algorithm to reduce questionnaire length of the Boston Carpal Tunnel Questionnaire (BCTQ) while minimizing the loss of measurement properties. Design: Criterion standard study. All BCTQs completed between January 2012 and September 2016 by patients who were treated for carpal tunnel syndrome (CTS) were randomly divided into a development and a validation dataset at a 3-to-1 ratio. Optimization of the CHAID algorithm was performed in the development dataset to determine the most optimal DT-BCTQ. Setting: Private hand clinic providing both surgical and nonsurgical (orthosis and exercise therapy) treatment for hand and wrist disorders. Participants: Patients with CTS (N=4470) completed a total of 10,055 BCTQs. Interventions: Not applicable. Main Outcome Measures: The intraclass correlation coefficient (ICC) was calculated between the original BCTQ scores and the scores predicted by the DT-BCTQ in the validation dataset. Bland-Altman plots visualized the agreement between the BCTQ and the DT-BCTQ. Results: The DT-BCTQ reduced the number of questions needed to ask a patient from 11 to a maximum of 3 for the symptom severity scale domain and from 8 to maximum of 3 for the functional status scale domain. The ICC between the original BCTQ and DT-BCTQ was 0.94. The mean difference between the BCTQ and DT-BCTQ was 0.05 on the 0-5 scale (95% confidence interval [CI], -0.48 to 0.57) for the symptom severity scale; 0.02 (95% CI, -0.45 to 0.49) for the functional status scale; and 0.04 (95% CI, -0.31 to 0.39) for the total BCTQ score. Conclusion: By creating the DT-BCTQ, we diminished the number of questions needed to ask a patient from 18 to a maximum of 6 questions (3 for each subscore) when administering the BCTQ while maintaining an ICC of 0.94 with the original BCTQ.
|Keywords||Carpal tunnel syndrome, Decision trees, Rehabilitation, Surveys and questionnaires|
|Persistent URL||dx.doi.org/10.1016/j.apmr.2019.04.021, hdl.handle.net/1765/118074|
|Journal||Archives of Physical Medicine and Rehabilitation|
Jansen, M.C. (Miguel C.), van der Oest, M.J. (Mark J.), Slijper, H.P, Porsius, J.T. (Jarry T.), & Selles, R.W. (2019). Item Reduction of the Boston Carpal Tunnel Questionnaire Using Decision Tree Modeling. Archives of Physical Medicine and Rehabilitation. doi:10.1016/j.apmr.2019.04.021