Measurement properties of the Michigan hand outcomes questionnaire: Rasch analysis of responses from a traumatic hand injury population

Cross-Cultural Adaptation, Validation, and Reliability of the Persian Version of the Brief Michigan Hand Questionnaire

BACKGROUND

Brief Michigan Hand Questionnaire (Brief MHQ) is one of the most reliable and sensitive patient-reported outcome measures for hand and wrist disorders worldwide. This study aimed to assess the psychometric properties of the Persian version of the Brief Michigan Hand Questionnaire based on standard guidelines.

METHODS

One hundred two patients with various hand and wrist disorders filled the Persian version of Brief MHQ along with the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analogue scale (VAS) for pain. Seventy-eight participants returned to complete the Persian Brief MHQ for the second time after 4 days.

RESULTS

The analysis showed excellent internal consistency with a Cronbach's alpha ranging from 0.89 to 0.91. The Persian Brief MHQ has an excellent test-retest reliability with a 0.94 intraclass correlation coefficient (ICC). The correlation coefficient of -0.74 between Brief MHQ and the QuickDASH showed a strong correlation and confirmed its validity.

CONCLUSION

The Persian version of the Brief MHQ is a reliable and valid tool to apply to Persian individuals with hand and wrist disorders.

Validity and Reliability of the Persian Version of WOrk-Related Questionnaire for UPper Extremity Disorders (WORQ-UP)

Background: We aimed to evaluate the validity and reliability of the Persian version of the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) questionnaire in a working population with upper extremity musculoskeletal disorders. Methods: We enrolled 181 patients with upper extremity conditions to complete the Persian WORQ-UP. A total of 35 patients returned after 1 week to complete the questionnaire again. To test the construct validity, patients responded to the Persian Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) at the first visit. The correlation between Quick-DASH and the WORQ-UP was assessed using Spearman correlation coefficient. Internal consistency (IC) was tested using Cronbach's alpha, and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Results: Spearman correlation coefficient was 0.630 (p < 0.001), indicating a strong correlation between Quick-DASH and WORQ-UP. Cronbach's alpha was 0.970, which is considered excellent. ICC for the total score of the Persian WORQ-UP was 0.852 (0.691-0.927), indicating good to excellent reliability. Conclusions: Our study demonstrated that the Persian version of the WORQ-UP questionnaire has excellent reliability and IC. Construct validity showed a moderate to strong correlation between WORQ-UP and Quick-DASH, which provides a platform for the workers' population to assess the extent of disability and follow the progress along the treatment course. Level of Evidence: Level IV (Diagnostic).

A systematic review of the measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ)

This systematic review of the literature aimed to identify studies examining the measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ) in various international populations and investigate its use in various diagnoses and health conditions. The search was conducted in MEDLINE (via PubMed), SCOPUS, CINAHL and Web of Science, with no restrictions on publication date, country or patient age. Study quality and risk of bias were assessed using the COnsensus-based Standards to select the health Measurement INstruments (COSMIN) checklist. 312 publications were identified and screened; 55 studies met the inclusion criteria and were critically reviewed. These publications comprised 16 languages and 11 pathologies and mainly investigated the internal consistency, construct validity and reliability of the MHQ. In general, all the measurement properties of the instrument showed good scores. The present review shows that the MHQ is a valid patient-reported outcome measure (PROM) and can be properly used in different clinical and rehabilitative contexts. LEVEL OF EVIDENCE: 2A.

Rasch Analysis of the Michigan Hand Questionnaire

OBJECTIVES

The Michigan Hand Questionnaire (MHQ) is a commonly used evaluation for hand problems, but previous work reports conflicting evidence regarding the subscale structures. Rasch analysis uses probabilistic modeling of items and responses: if scale items can be fit to the Rasch model, it provides evidence of construct validity and interval-level measurement for precise statistical estimates. We conducted Rasch analysis on the MHQ to evaluate model fit, unidimensionality of the subscales, bias across person factors, and conversion to interval metrics.

METHODS

We conducted a secondary Rasch analysis of MHQ data from 924 persons with thumb basal joint osteoarthritis using the RUMM2030 software. Modeling was based on responses for the most affected hand and person factors including age, sex, type of work, whether the dominant side was the most affected, and surgical status. The analysis plan followed the published recommendations for examinations of person and item fit, with iterative adjustments as required.

RESULTS

A total of 11 of the 37 items required rescoring to create orderly progression of scoring thresholds. Only the overall hand function and pain subscales could be fit to the Rasch model, demonstrating unidimensionality and good reliability of fit estimates. Dividing the activities of daily living subscale into unilateral and bilateral activities also allowed unilateral activities to fit the model. Persistent misfitting in other subscales suggested local dependency and response bias across multiple person factors.

CONCLUSIONS

This Rasch analysis of the MHQ raises concerns regarding the validity and fundamental measurement properties of this widely used outcome evaluation when used as a summary score.

Determining the Minimally Important Change of the Michigan Hand outcomes Questionnaire in patients undergoing trigger finger release

INTRODUCTION

The Michigan Hand outcomes Questionnaire (MHQ) is a widely used instrument to evaluate treatment results for hand conditions. Establishing the Minimally Important Change (MIC) is essential for interpreting change in outcome that is clinically relevant.

PURPOSE OF THE STUDY

The purpose of this study was to determine the MIC of the MHQ total and subscale scores in patients undergoing trigger finger release.

STUDY DESIGN

This is a prospective cohort study conducted between December 2011 and February 2020.

METHODS

Patients completed the MHQ prior to surgery and 3 months postoperatively. The MIC of the MHQ was determined using 5 anchor-based methods (ie, 2 anchor mean change methods and 3 receiver operating characteristic methods). The median MIC value was determined to represent the triangulated MIC.

RESULTS

A total of 1814 patients were included. The MIC for the MHQ total score ranged from 7.7 to 10.9, with a triangulated estimate of 9.3. The MIC estimates for 5 of 6 of the MHQ subscales ranged from 7.7 to 20.0. No MICs could be determined for the MHQ subscale "aesthetics" due to low correlations between the anchor questions and MHQ change scores.

CONCLUSIONS

These MIC estimates can contribute to the interpretation of clinical outcomes following trigger finger release and for assessment of power in prospective trials.