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Original Article Clinics in Orthopedic Surgery 20

3-207 http://dx.doi.org/10.4055/cios.2014.6.2.203 Responsiveness of the Korean Version of the Michigan Hand Outcomes Questionnaire after Carpal Tunnel Release Seung Myung Wi, MD, Hyun Sik Gong, MD,

Seongnam, *Department of Orthopedic Surgery, Gachon University Hospital, Incheon, Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine,

1 Original Article Clinics in Orthopedic Surgery 2014;6: Responsiveness of the Korean Version of the Michigan Hand Outcomes Questionnaire after Carpal Tunnel Release Seung Myung Wi, MD, Hyun Sik Gong, MD, Kee Jeong Bae, MD, Young Hak Roh, MD*, Young Ho Lee, MD, Goo Hyun Baek, MD Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, *Department of Orthopedic Surgery, Gachon University Hospital, Incheon, Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Background: The Korean version of the Michigan Hand Outcomes Questionnaire (K-MHQ) was recently validated; however, the questionnaire s responsiveness as well as the degree to which the instrument is sensitive to change has not been thoroughly evaluated in a specific condition in Koreans. We evaluated the responsiveness of the K-MHQ in a homogenous cohort of patients with carpal tunnel syndrome (CTS) and we compared it with that of the Korean version of the Disability of the Arm, Shoulder, and Hand Questionnaire (K-DASH), which was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS. Methods: Thirty-seven patients with CTS prospectively completed the K-MHQ and the K-DASH before and 6 months after surgery. The responsiveness statistics were assessed for both the K-MHQ and the K-DASH by using the standardized response mean (SRM), which was defined as the mean change of the original scores after surgery divided by the standard deviation of the change. Results: All domains of the K-MHQ significantly improved after carpal tunnel release (p < 0.001). The SRM for all scales but one (the aesthetics scale) showed large responsiveness of 0.8. The aesthetics scale showed medium responsiveness of 0.6. The combined function/symptom scale of the K-DASH significantly improved after surgery (p < 0.001). The SRM of the K-DASH revealed large responsiveness of 0.9. Conclusions: The K-MHQ was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS, which is comparable not only to the K-DASH, but also to the original version of the MHQ. The region-specific K-MHQ can be useful for outcomes research related to carpal tunnel surgery, especially for research comparing CTS with various other hand and wrist health conditions. Keywords: Responsiveness, K-MHQ, K-DASH, Carpal tunnel syndrome Health and functional status questionnaires have been increasingly used to assess the effectiveness of medical treatment or surgery. In hand surgery, physicians have used Received January 14, 2013; Accepted August 12, 2013 Correspondence to: Hyun Sik Gong, MD Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam , Korea Tel: , Fax: hsgong@snu.ac.kr these instruments to evaluate patient outcomes for specific hand conditions such as carpal tunnel syndrome (CTS), distal radius fracture, and rheumatoid arthritis. 1,2) The Michigan Hand Outcomes Questionnaire (MHQ) is one of the most widely used hand-specific surveys that measures health status relevant to patients with hand disorders. 3) The MHQ assesses the patient s perception for six different scales, including function, activities, pain, work, satisfaction, and asthetics. 4) The validity, reliability, and responsiveness of the MHQ have been Copyright 2014 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinics in Orthopedic Surgery pissn X eissn

2 204 reported for a variety of upper extremity conditions such as CTS, distal radius fracture, and rheumatoid arthritis. 5-7) The MHQ has also been translated into Korean: the validity and reliability of the Korean version of MHQ (K-MHQ) were recently assessed for arm, shoulder, and hand musculoskeletal conditions. 8) However, the responsiveness of K- MHQ, and the degree to which the instrument is sensitive to change, has not been thoroughly evaluated for a specific medical condition in Koreans. CTS is the most common compressive neuropathy in the upper extremity. 9) The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a wellknown and frequently used tool that was developed for the assessment of patients with upper extremity conditions. The Korean version of DASH (K-DASH) has been validated for the assessment of upper extremity conditions; it was also found to be responsive to carpal tunnel release. 10,11) The purpose of this study was to evaluate the responsiveness of the K-MHQ to carpel tunnel release, and to compare the results with those of the K-DASH in a homogenous cohort of patients with CTS. METHODS Subjects Eighty-four consecutive patients with CTS scheduled for surgery at our institution (an urban tertiary referral hospital) were prospectively recruited for the study between June 2011 and February All patients were referred by primary care physicians, general orthopaedic surgeons, neurologists, or rehabilitation physicians. We excluded those from the study with any other upper extremity problem besides CTS, such as a history of forearm fracture or malunion, cervical radiculopathy, and cubital tunnel syndrome. We also excluded those from the study with systemic comorbidities, such as rheumatoid arthritis, diabetes mellitus, thyroid disease, and chronic renal failure. Concurrent disorders and loss of follow-up led to a total of forty-seven patients being excluded from the final data analysis. Therefore, data analysis was performed for the remaining thirty-seven patients. The patients included consisted of 1 man and 36 women; their ages ranged from 28 years old to 73 years old (average, 53.5 years old). This study was approved by the Institutional Review Board of the authors hospital; informed consent was obtained from all patients. CTS was diagnosed based on clinical symptoms, such as tingling sensation of the hand. Electrophysiologic studies were conducted for all patients to confirm the diagnosis; only those with positive findings were included for analysis. We used the classification developed by Bland 12) : the classification consists of 7 grades from grade 0 (normal) to grade 6 (extremely severe) based on conduction time and amplitude. All patients underwent either unilateral or simultaneous bilateral open carpal tunnel release by a single surgeon (HSG) under local anesthesia. K-MHQ and K-DASH Evaluations using the K-MHQ and K-DASH were performed preoperatively and six months postoperatively. The six-month interval period was chosen due to findings from a previous study: the study found that patients who have carpal tunnel release tend to plateau in functional and symptom improvement six months after surgery when assessed via questionnaire. 13) The K-MHQ is a 57-item hand-specific outcomes questionnaire that contains 6 domains: (1) function, (2) activities of daily living, (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction. Patients are asked to answer each question for the relevant domain using a scale of 1 to 5. Each domain is assessed on a score from 0 to 100. All scales except for work and pain assess each hand separately and are scored according to the affected hand or as an average for bilaterally affected hands. There is no scoring adjustment for hand dominance. The K-MHQ was translated by two of the authors (HSG and YHR), approved by the original developer (Kevin Chung, University of Michigan, USA), and was validated for its reliability and cross-cultural adaptation for common hand disorders. The instrument is presented in the Appendix 1. 8) The K-DASH questionnaire primarily consists of a 30 item scale concerning the patient s health status for the preceding week. The items ask about the following issues: degree of difficulty in performing various physical activities because of an arm; shoulder or hand problem (21 items); the severity of each symptom of pain, activityrelated pain, tingling, weakness, and stiffness (5 items); the problem s effect on social activities, work and sleep; and its psychological impact (4 items). Each item has five response options, ranging from 1 to 5. If at least 27 of the 30 items are completed, then a score ranging from 0 (no disability) to 100 (the most severe disability) can be calculated. The two optional scales of K-DASH (sport/music and work) were excluded from this study. Data Analysis Statistical analysis was performed using IBM SPSS ver (IBM Co., Armonk, NY, USA). Paired t-tests were used when comparing the preoperative versus postoperative scores. Two-sample Student t-tests were performed

3 205 when comparing scores for patients who had unilateral carpal tunnel release versus patients who had simultaneous bilateral carpal tunnel release and comparing scores for the mild (Bland grade 1 2) group versus moderate to severe (Bland grade 3 5) group. The level of significance chosen for the analysis was p = The responsiveness of each questionnaire was evaluated in this study using a distribution-based methodology: This was performed by calculating the standardized response mean (SRM). 14) The SRM was defined as the mean change between pre- and postoperative scores divided by the standard deviation of the total change. The higher the SRM, the greater the level of responsiveness is. Values 0.5, between 0.5 and 0.8, and 0.8 were considered to represent small, moderate, and large degrees of responsiveness, respectively. 15) For the sample size calculation, we needed a total of 56 patients to achieve 90% power. We initially recruited 84 patients for this study. However, due to concurrent disorders and a loss of follow-up, data analysis was performed for only 37 patients. However, as the study results were positive, retrospective power analysis indicated that the statistical power was adequate. RESULTS Comparison of Pre- and Postoperative Scores All domains of the K-MHQ (function, activities of daily living, work, pain, aesthetics, and satisfaction) revealed significant postoperative improvement (p < 0.001) (Table Table 1. Preoperative vs. 6-month Postoperative K-MHQ Scores Scale* Preoperative Postoperative p-value SRM Function 47.1 ± ± 18.8 < Activities of daily living 59.7 ± ± 16.2 < Work 42.0 ± ± 19.1 < Pain 67.8 ± ± 14.3 < Aesthetics 71.1 ± ± 19.9 < Satisfaction 51.1 ± ± 25.7 < Values are presented as mean ± SD. K-MHQ: Korean version of the Michigan Hand Outcomes Questionnaire, SRM: standardized response mean. *All of the K-MHQ scales are based on a score from 0 to 100. For all of the scales except pain, a higher score translates into better performance for the patient s hand. For the pain scale, the relationship is inverse: the lower the score, the less pain the patient experiences, which signifies a better outcome. Mean difference between preoperative and postoperative scores/standard deviation of mean difference. An SRM of 0.2 is considered small, 0.5 is considered medium, and 0.8 is considered large. 1). Comparing the unilateral and bilateral surgery group, there were no statistically significant differences preoperatively and postoperatively in mean function scores (p = 0.71 and 0.53, respectively), and in mean pain scores (p = 0.85 and 0.96, respectively). Comparing the mild (Bland grade 1 2) and moderate to severe (Bland grade 3 5) group, there were no significant differences in mean preoperative and postoperative K-MHQ scores (function: p = 0.33 and 0.51; pain: p = 0.59 and 0.25, respectively). K-DASH scores decreased by 19 points, revealing a significant postoperative improvement (p < 0.001) (Table 2). There were no significant differences between unilateral and bilateral patients in mean preoperative and postoperative K-DASH scores (p = 0.82 and 0.54, respectively). There were no significant differences between mild and moderate to severe group in mean preoperative or postoperative K-DASH scores, either (p = 0.22 and 0.35, respectively). Responsiveness of Outcome Scores The SRM for the K-MHQ ranged from medium (0.6) for the aesthetics scales, to large ( ) for the pain, satisfaction, activities of daily living, work, and function scales. For patients who had unilateral surgery, the SRMs for the work and pain scales were 0.8 and 0.9, respectively. For patients who had bilateral surgery. the SRMs for the work and pain scales were 1.0 and 1.1, respectively. The SRM for K-DASH was 0.9. For patients who had unilateral surgery, the SRM for the K-DASH was 0.8. For patients who had bilateral surgery, the SRM for the K- DASH was 1.1. DISCUSSION In this study, we evaluated the responsiveness of the K- MHQ for CTS and compared it with that of the K-DASH. We found that the K-MHQ had a level of responsiveness similar to that of the K-DASH in the assessment of CTS outcomes. Table 2. Preoperative vs. 6-month Postoperative Scores of the K-DASH Questionnaire Scale* Preoperative Postoperative p-value SRM Function/symptom 39.6 ± ± 15.8 < Values are presented as mean ± SD. K-DASH: Korean version of the Disability of the Arm, Shoulder, and Hand Questionnaire, SRM: standardized response mean. *The K-DASH is based on a score from 0 to 100. A lower score indicates less disability.

4 206 Table 3. The Responsiveness of Various Studies of the MHQ after Carpal Tunnel Release Scale Standardized response mean Chatterjee and Price 7) Kotsis and Chung 16) Present study Function Activities of daily living Work Pain Aesthetics 0.8 Not reported 0.6 Satisfaction MHQ: Michigan Hand Outcomes Questionnaire. Several previous studies have evaluated the responsiveness of the MHQ for CTS patients. Kotsis and Chung 16) reported that the SRM varied from 0.5 to 0.6 for the activity subscale and from 0.9 to 1.1 for the pain and satisfaction scales. The study by Chatterjee and Price 7) showed the SRM varied from 0.78 to 1.30 for the pain, aesthetics, and function scales and from 0.79 to 0.80 for the satisfaction, activity, and work scales (Table 3). Compared with these studies, the K-MHQ was found to have a sufficient degree of responsiveness for assessing and comparing outcomes for Korean patients with CTS. Previous studies found that the pain domain seemed to be the most responsive for the MHQ, but as shown in Table 3, our study found that the function domain appeared to be the most responsive. The reason for this difference is presumed that the high proportion (83.8%) of moderate to severe patients (Bland grade 3 5) who had a sensory or motor deficit would experience comprehensive improvement in hand functioning. The aesthetics domain may not be pertinent to carpal tunnel release. 17) In addition, aesthetics outcomes may worsen because of the scar after open carpal tunnel release. In this study, however, there was a significant improvement in the aesthetic domain after surgery, which concurs with previous study by the Chatterjee and Price. 7) They suggested that patients may have improved their self-image secondary to better function following carpal tunnel release and their perception of their hand aesthetics therefore improved. In the present study, we compared scores between the K-DASH and-mhq. The K-DASH is a more general questionnaire with questions that assess the collective arm, shoulder, and hand conditions. The combined function/ symptom scale of the K-DASH limits the measurement of symptom and function improvement after carpal tunnel surgery because symptoms are quicker to improve than functional outcomes ) Furthermore, the K-DASH outcomes are not scored separately for each hand; thus, it is difficult to interpret the K-DASH outcome in conditions that often involve both hands, such as CTS. Compared with the K-DASH, the K-MHQ contains multiple domains, each of which can be scored individually. All domains (except for work and pain) assess the right and left hand separately, making it possible to assess both hands separately, and also allowing for scores of the affected hand to be compared with an unaffected control hand if only one hand is affected. In addition, the K-MHQ is more region-specific than the K-DASH in that it has questions relating to the hand only. Our study has several limitations that require consideration. First, our study did not have a balanced sex ratio: the study had an overabundance of female patients (97.3%). This limits the generalizability of our results to the population, but it is not likely to affect the conclusions of our study because outcomes of CTS were not found to vary by gender. 13) Furthermore, similar demographics have been used in other prospective CTS studies. 18) Second, we lacked other general health measurement questionnaires that can be used for comparison; we also did not analyze any clinical factors such as physical findings that may influence the responsiveness of each score. Third, we did not compare the K-MHQ with the Boston carpal tunnel scores, which is a disease specific scale and is known to have a greater responsiveness than K-DASH in CTS. 11) In conclusion, the K-MHQ was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS, which is comparable not only to the K-DASH, but also to the original version of the MHQ. The region-specific K-MHQ can be used for outcomes research related to carpal tunnel surgery, especially for research comparing CTS with various other hand and wrist conditions. CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

5 207 REFERENCES 1. Chung KC, Hamill JB, Walters MR, Hayward RA. The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change. Ann Plast Surg. 1999;42(6): Pincus T, Yazici Y, Bergman MJ. Patient questionnaires in rheumatoid arthritis: advantages and limitations as a quantitative, standardized scientific medical history. Rheum Dis Clin North Am. 2009;35(4): Waljee JF, Kim HM, Burns PB, Chung KC. Development of a brief, 12-item version of the Michigan Hand Questionnaire. Plast Reconstr Surg. 2011;128(1): Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4): Chung KC, Kotsis SV. Outcomes of multiple microvascular toe transfers for reconstruction in 2 patients with digitless hands: 2- and 4-year follow-up case reports. J Hand Surg Am. 2002;27(4): Kotsis SV, Lau FH, Chung KC. Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment. J Hand Surg Am. 2007;32(1): Chatterjee JS, Price PE. Comparative responsiveness of the Michigan Hand Outcomes Questionnaire and the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Am. 2009;34(2): Roh YH, Yang BK, Noh JH, Baek GH, Song CH, Gong HS. Cross-cultural adaptation and validation of the Korean version of the Michigan hand questionnaire. J Hand Surg Am. 2011;36(9): Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77(2): Lee JY, Lim JY, Oh JH, Ko YM. Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K- DASH). J Shoulder Elbow Surg. 2008;17(4): Korean version of the disabilities of the arm, shoulder and hand questionnaire (K-DASH) after carpal tunnel release. Clin Orthop Surg. 2011;3(2): Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 2000;23(8): Katz JN, Losina E, Amick BC 3rd, Fossel AH, Bessette L, Keller RB. Predictors of outcomes of carpal tunnel release. Arthritis Rheum. 2001;44(5): Hays RD, Hadorn D. Responsiveness to change: an aspect of validity, not a separate dimension. Qual Life Res. 1992;1(1): Atroshi I, Johnsson R, Sprinchorn A. Self-administered outcome instrument in carpal tunnel syndrome: reliability, validity and responsiveness evaluated in 102 patients. Acta Orthop Scand. 1998;69(1): Kotsis SV, Chung KC. Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire in carpal tunnel surgery. J Hand Surg Am. 2005;30(1): Weber RA, Rude MJ. Clinical outcomes of carpal tunnel release in patients 65 and older. J Hand Surg Am. 2005;30(1): Katz JN, Fossel KK, Simmons BP, Swartz RA, Fossel AH, Koris MJ. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg Am. 1995;20(4): Reale F, Ginanneschi F, Sicurelli F, Mondelli M. Protocol of outcome evaluation for surgical release of carpal tunnel syndrome. Neurosurgery. 2003;53(2): Brown RA, Gelberman RH, Seiler JG 3rd, et al. Carpal tunnel release: a prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg Am. 1993;75(9): Gellman H, Kan D, Gee V, Kuschner SH, Botte MJ. Analysis of pinch and grip strength after carpal tunnel release. J Hand Surg Am. 1989;14(5): Jeon SH, Lee JH, Chung MS, et al. Responsiveness of the

6 e1 Appendix 1. Korean version of the Michigan Hand Outcomes Questionnaire (K-MHQ) 이설문지는환자분의손과건강에관한것입니다. 여기서얻어지는정보는의료진에게환자분이어떻게느끼고, 일상생활을얼마나잘할수있는가에대한정보를제공합니다. 해당되는모든문항에동그라미로표시하시고, 만약완전이일치하는것이없을경우가장근접한대답을선택하시면됩니다. I. 다음질문은지난한주동안, 환자분의손 / 손목의기능에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) A. 다음질문은환자분의우측손 / 손목에관한것입니다. 매우잘한다 잘한다 보통이다 나쁘다 아주나쁘다 우측손으로얼마나일을잘할수있습니까? 우측손가락은얼마나잘움직입니까? 우측손목은얼마나잘움직입니까? 우측손의근력은어느정도입니까? 우측손의감각은어느정도입니까? B. 다음질문은환자분의좌측손 / 손목에관한것입니다. 매우잘한다 잘한다 보통이다 나쁘다 아주나쁘다 좌측손으로얼마나일을잘할수있습니까? 좌측손가락은얼마나잘움직입니까? 좌측손목은얼마나잘움직입니까? 좌측손의근력은어느정도입니까? 좌측손의감각은어느정도입니까? II. 다음질문은지난한주동안, 환자분이특정일을하는데있어손의능력에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) A. 우측손으로다음과같은행동을하는것이얼마나어려웠습니까? 전혀어렵지않다약간어렵다중간정도어렵다상당히어렵다극히어렵다 문손잡이돌리기 동전줍기 물잔들기 열쇠로문잠그기 프라이팬잡기 B. 좌측손으로다음과같은행동을하는것이얼마나어려웠습니까? 전혀어렵지않다 약간어렵다 중간정도어렵다 상당히어렵다 극히어렵다 문손잡이돌리기 동전줍기 물잔들기 열쇠로문잠그기 프라이팬잡기

7 e2 C. 양손으로다음과같은행동을하는것이얼마나어려웠습니까? 전혀어렵지않다 약간어렵다 중간정도어렵다 상당히어렵다 극히어렵다 병따기 셔츠 / 브라우스의단추잠그기 숫가락 / 젓가락으로먹기 식료품가방들기 접시씻기 머리감기 구두끈 / 리본묶기 III. 다음질문은지난 4 주동안, 환자분이일을하는데있어어느정도의제약이있었는가에대한것입니다. 가사일, 학교생활포함 ( 각질문의해당되는곳에동그라미로표시하십시오 ) 항상자주가끔드물다없다 손 / 손목의문제로얼마나자주일을할수없었습니까? 손 / 손목의문제로얼마나자주일하다조퇴를하였습니까? 손 / 손목의문제로얼마나자주일을하다중간에쉬어야하였습니까? 손 / 손목의문제로얼마나자주일의양을줄여야하였습니까? 손 / 손목의문제로얼마나자주업무시간을늘여야하였습니까? IV. 다음질문은지난한주동안, 환자분이손 / 손목에느낀통증에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) 1. 얼마나자주손 / 손목에통증을느꼈습니까? 1) 항상 2) 자주 3) 가끔 4) 드물다 5) 없다 만약위의대답이 없다 인경우, 2 번의문항은답하지마시고, V 번문항으로바로가십시오. 2. 손 / 손목의통증강도에대해답해주십시오 1) 아주경미하다 2) 경미하다 3) 중간정도이다 4) 심하다 5) 아주심하다 항상 자주 가끔 드물다 없다 3. 손 / 손의통증으로얼마나자주잠을잘자지못했습니까? 손 / 손의통증으로얼마나자주일상생활에지장이있었습니까? ( 식사, 목욕 ) 손 / 손의통증으로얼마나자주우울하였습니까? V. A. 다음질문은지난한주동안환자분의우측손의모양에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) 완전일치 동의 그저그렇다 불일치 완전불일치 우측손모습에만족한다 우측손모습때문에종종공공장소에서불편하다 우측손모습때문에우울하다 우측손모습때문에사회생활에제약이있다

8 e3 B. 다음질문은지난한주동안환자분의좌측손의모양에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) 완전일치 동의 그저그렇다 불일치 완전불일치 좌측손모습에만족한다 좌측손모습때문에종종공공장소에서불편하다 좌측손모습때문에우울하다 좌측손모습때문에사회생활에제약이있다 VI. A. 다음질문은지난한주동안환자분의우측손 / 손목에대한만족정도에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) 매우만족한다대체로만족한다그저그렇다다소실망이다매우실망이다 우측손의전체적기능 우측손가락의움직임 우측손목의움직임 우측손의근력 우측손의통증 우측손의감각 B. 다음질문은지난한주동안환자분의좌측손 / 손목에대한만족정도에관한것입니다. ( 각질문의해당되는곳에동그라미로표시하십시오 ) 매우만족한다대체로만족한다그저그렇다다소실망이다매우실망이다 좌측손의전체적기능 좌측손가락의움직임 좌측손목의움직임 좌측손의근력 좌측손의통증 좌측손의감각

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar