The Single Assessment Numeric Evaluation (SANE), PROMIS-UE, and QuickDASH for Carpal Tunnel Release Surgery and Trigger Finger Release Surgery

Gabrielle Notorgiacomo, UCCOM MS21 (Medical student); Phillip Ross, MD1,2 (PI); Peter Stern, MD1,2 (Co-Investigator) 

1 University of Cincinnati College of Medicine, Cincinnati, USA 

2 Department of Orthopaedics & Sports Medicine, UC Health, Cincinnati, USA 

Presenting Author Contact: Gabrielle Notorgiacomo, notorgga@mail.uc.edu, (859) 609-3329 

Category:  Clinical Surgical

Subcategory:  Orthopedic Surgery

Introduction:  Validated patient-reported outcome measures (PROMs) provide insight into condition-specific clinical outcomes, but they place a considerable time burden on patients, clinicians, and staff. Efforts have been made to validate single-question surveys, such as the Single Assessment Numeric Evaluation (SANE) questionnaire, across orthopedic conditions, but few prospective studies have evaluated SANE for hand conditions. The purpose of this study was to validate the use of SANE in patients undergoing routine elective hand surgeries. We hypothesized that SANE scores would strongly correlate with other validated upper extremity PROMs.

Methods:  Eligible patients scheduled for carpal tunnel release and trigger finger release from the UC Orthopaedics and Sports Medicine practice completed three PROMs (SANE, the Patient-Reported Outcomes Measurement Information System Upper Extremity item bank (PROMIS-UE), and the shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH)) during a preoperative clinical encounter (within 90 days before scheduled surgery) and at two postoperative time points: 14 and 90 days after surgery. Based on an a priori power calculation and values from previous studies, a minimum sample of 82 patients was needed to achieve 80% power to detect a change after treatment of the minimal clinically important difference (MCID) or greater on the QuickDASH with a 2-sided level of significance of .025. 

Results:  To date, 25 of the 71 enrolled patients had completed both the preoperative surveys and the 2-week follow-up surveys. On average, patients reported a 23% (± 39%) increase between pre- and post-operative SANE scores. The change in SANE scores strongly negatively correlated with changes in QuickDASH scores (p=0.018). There was not a significant correlation between changes in SANE scores and changes in PROMIS-UE. Eight patients (32%) who met the QuickDASH MCID at 2 weeks reported significantly worse SANE scores (p=0.002) compared to those who did not meet the MCID (17 patients, 68%). There was no difference in SANE scores between patients who met the PROMIS-UE MCID (6 patients, 24%) and those who did not (19 patients, 76%) (p>0.05).

Conclusions:  Our study is ongoing, and our preliminary data suggest that SANE does not accurately capture appropriate information in the early postoperative period.  The strong negative correlation between SANE and QuickDASH is likely due to the fact that at 2 weeks after surgery, most patients cannot perform many of the tasks included in QuickDASH yet. Their response to the SANE question, “Considering all aspects of your hand (including how it functions, how it looks, and how it feels), on a scale of 0% to 100% (where 0% is completely abnormal and 100% is completely normal), how normal would you say your hand is currently?” may be more reflective of how their hand feels and looks rather than functions. 

Key Words:  SANE, PROMIS-UE, QuickDASH, PROMs, carpal tunnel release, trigger finger release