Michigan Hand Outcomes Questionnaire

Original Editor - Anna Fuhrmann Top Contributors - Anna Fuhrmann, Shaimaa Eldib and Kim Jackson

Overview

The Michigan Hand Outcomes Questionnaire (MHQ) was developed in 1998 by the hand surgeon Chung and his colleagues Pillsbury, Walters, Hayward, and Arbor.[1] The process of devising the assessment was accompanied by hand therapists and hand clinic patients and has been reviewed in multiple studies over the course of the last two decades.

Objective & Intended Population

The questionnaire was developed as a standardised instrument to evaluate various health state domains that are experienced by patients with hand disorders.[1] Its strength lies in the detection and measuring of the patients' symptoms, function, aesthetics, and satisfaction of the hand function of conditions and diseases of the hand and the upper extremity. [2] The design of the assessment aims to reflect the subjective impression of the hand function.[2] The authors intended to focus on the domains that were important to the patients which are mainly function and overall well-being/quality of life, which were hard to quantify with usual measurements. [1] Most frequently, the assessment is used on patients suffering from arthritis or trauma to the upper extremity. [2]

Method of Use

The MHQ is a patient-rated questionnaire, which means the patients evaluate their health state themselves. It was developed using the psychometric principles for psychological assessments (Reliability, Validity, Standardisation, and Freedom from bias). The questionnaire consists of 37 items that can be grouped into six main categories (see Figure).[1] Special to this assessment is the inclusion of items about aesthetics, which is often regarded as very important by patients, and the separate evaluation of the left and the right side. [2] These two categories are often overlooked in other similar assessments which might e.g. focus more on the overall disability or pain experience. The questions are directed towards patients' experiences with the hand/upper extremity during the past week.

Evidence

In 2013, Shauver and Chung reviewed the published evidence on the MHQ in the 15 years since release of the first version of the assessment. The study identified 18 published papers concerning the psychometric properties and 58 clinical research papers utilising the assessment through a systematic literature review. [2] They explored both the evidence on the use and the clinometric (psychometric) properties of the tool.

Reliability

The reliability, which indicates of how susceptible to error a test is[3], was rated as high in both the original and the review paper. This indicates that the MHQ is most likely capable of capturing the subjective health state of the patient's hand when answering the questions in a measurable way.

Psychometric Properties of the MHQ - Reliability
Original paper 1998[1] Review 2013[2] Number of studies in 2013 review that evaluated the property
Re-test reliability (repeatability) Excellent (for five of the six domains >0.85 for intraclass correlation coefficient) High re-test reliability (all papers reported >0.85 for intraclass correlation coefficient (cut-off: 0.7) 3
Internal consistency Excellent (all domains had a value of >0.85 for Cronbach's alpha) High internal consistency (average of 0.89 in all papers for Cronbach's alpha with a minimum value of 0.8) 4

Validity

The validity indicates how well the patients' problems or experiences relate to the answers to the assessment. Content validity, also known as face validity, specifies how well the patients' experiences are covered by the questions asked.[3] Evaluated by a team of hand surgeons, hand therapists and patients, the model of the 6 scales was derived after extensive testing.[1] Construct validity attempts to measure the overall effectiveness of the used assessment design to reflect the patients' state.[3] This was indicated as effective since the expected correlations between related questions could be reproduced by statistical analysis.[1][2] Criterion validity implicates the ability of the assessment's predictive value for future tests.[3] Since the MHQ is a subjective measurement of the patients' perception this criterium did not apply.

Psychometric Properties of the MHQ - Validity
Original paper 1998[1] Review 2013[2] Number of studies in 2013 review that evaluated the property
Content/Face validity--- Scaling tested as valid, no further results indicatedN/A Not reported Not reported
Criterion validity --- --- ---
Construct validity "[...]predictive relationships between the scales were be proposed a priori."[1] Correlations between test scores and patients' report of improvement and other tests were high, but not always within the threshold, which points towards an influence of other criteria than function on the patients' state. 4

Responsiveness

The responsiveness of the MHQ varied greatly.[2] Responsiveness refers to the ability of the test to pick up on (subtle) changes over time. The assessment seemed to capture the short-term, easily felt changes/improvements of acute conditions (e.g. injuries, joint replacing) much more reliable than those of long term illnesses (e.g. rheumatoid arthritis).[2]

Psychometric Properties of the MHQ - Responsiveness
Original paper 1998[1] Review 2013[2] Number of studies that evaluated the property
Not reported Much higher responsiveness for acute conditions with quick changes (>0.8 standardised response mean); low responsiveness for long-term disabilities/conditions with very little changes over time (<0.2 standardised response mean) 12

Links

An online version of the assessment can be found through the following link: Michigan Hand Outcomes Questionnaire.

Please also see Rachel Lowe's article about the Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder, and Hand Questionnaire in Patients With Hand Injury on Physiospot, published March 8, 2010.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 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):575-87.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Shauver MJ, Chung KC. The Michigan hand outcomes questionnaire after 15 years of field trial. Plast Reconstr Surg. 2013;131(5):779e-87e.
  3. 3.0 3.1 3.2 3.3 Rust J. Discussion piece: The psychometric principles of assessment. Research Matters. 2007;3:25-27.