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Reliability and validity of the modified McGowan grade in patients with cubital tunnel syndrome

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Abstract

Introduction

This study aimed to assess the reliability and validity of the modified McGowan grading system and to determine its ability to distinguish the severity of cubital tunnel syndrome (CuTS) between the different grades.

Materials and methods

We prospectively enrolled 39 consecutive patients with CuTS from March 2018 to December 2020. Inter- and intra-observer reliability was assessed by two orthopaedic surgeons with a minimum 2-week interval using Cohen kappa coefficients. Validity was assessed by Spearman’s correlation with objective clinical outcomes (grip strength, Semmes–Weinstein monofilament test [SWMT], static two-point discrimination [2PD], and motor conduction velocity [MCV]). In addition, the relationship between the grading system and patient-reported outcomes (Disabilities of the Arm, Shoulder and Hand score and Boston Questionnaire) was evaluated using Spearman’s correlation. The ability to distinguish the severity between the different grades was assessed using the Kruskal–Wallis analysis.

Results

The inter-observer kappa value was 0.54 and intra-observer kappa value was 0.59, which imply a moderate reliability. The modified McGowan grade had a moderate correlation with objective clinical outcomes (grip strength [r = – 0.350, p = 0.029], SWMT [r = 0.552, p < 0.001], 2PD [r = 0.456, p = 0.004], and MCV [r = – 0.394, p = 0.021]). However, patient-reported outcomes did not correlate with this grading system. Kruskal–Wallis analysis revealed significant differences between grades in terms of SWMT, 2PD, grip strength, and Boston Questionnaire functional score (p = 0.006, 0.025, 0.014, and 0.043, respectively); however, these differences were statistically significant only for a limited number of parts.

Conclusions

The modified McGowan grade has a moderate inter- and intra-observer reliability. This grading system moderately correlates with objective sensory-motor functions and MCV of patients with CuTS. However, the modified McGowan grade does not reflect the patient’s perceived disabilities and has a weakness in distinguishing the severity of patients’ conditions among the different grades.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

    Shin Woo Choi & Joo-Yul Bae

  2. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Young Ho Shin, Sung Ho Moon & Jae Kwang Kim

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  1. Shin Woo Choi
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Correspondence to Jae Kwang Kim.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical review committee statement

This study was approved by the institutional review board of the Asan Medical Center (project no.: 2018–0434).

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Written informed consent was obtained from all patients willing to participate.

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Choi, S.W., Bae, JY., Shin, Y.H. et al. Reliability and validity of the modified McGowan grade in patients with cubital tunnel syndrome. Arch Orthop Trauma Surg 142, 1697–1703 (2022). https://doi.org/10.1007/s00402-022-04367-8

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  • DOI: https://doi.org/10.1007/s00402-022-04367-8

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