to detect appreciable clinical change, and longer followup
may be needed to understand the responsiveness to
change of the MHQ in patients who have not undergone
surgery. However, we were able to demonstrate excellent
responsiveness among patients who underwent surgical
intervention. Finally, our sample size prevented us from
stratifying our results based on disease severity and effects
of medical and occupational therapies, which may have
inﬂuenced our results. Our current data are limited by a
lack of information regarding disease characteristics and
medical therapies, such as laboratory values (e.g.,
C-reactive protein level) or the use of corticosteroids. Fu-
ture studies will include such variables and will allow us
to evaluate the performance of the MHQ in the context of
Nonetheless, this study demonstrates that the MHQ is an
essential instrument to understand the extent of disability
of rheumatic hand disease. The MHQ offers clinicians a
systematic approach to deﬁning patient disability. Addi-
tionally, the MHQ can be incorporated into future studies
regarding the effectiveness of RA therapies because it of-
fers a comprehensive assessment of hand functioning and
patient-centered outcomes. In conclusion, the MHQ is an
easily administered, reliable, valid tool to measure rheu-
matoid hand function, and an essential instrument to sys-
tematically guide clinical decision making and assess the
quality of care of rheumatic hand disease.
All authors were involved in drafting the article or revising it
critically for important intellectual content, and all authors ap-
proved the ﬁnal version to be submitted for publication. Dr.
Chung had full access to all of the data in the study and takes
responsibility for the integrity of the data and the accuracy of the
Study conception and design. Chung, Burke, Wilgis, Fox.
Acquisition of data. Chung, Burns, Burke, Wilgis.
Analysis and interpretation of data. Waljee, Chung, Kim, Burke,
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