Validity and Responsiveness of the Michigan Hand Questionnaire in Patients With Rheumatoid Arthritis: A Multicenter, International Study

Article (PDF Available) · November 2010with31 Reads
DOI: 10.1002/acr.20274 · Source: PubMed
Millions of patients experience the disabling hand manifestations of rheumatoid arthritis (RA), yet few hand-specific instruments are validated in this population. Our objective was to assess the reliability, validity, and responsiveness of the Michigan Hand Questionnaire (MHQ) in patients with RA. At enrollment and at 6 months, 128 RA patients with severe subluxation of the metacarpophalangeal joints completed the MHQ, a 37-item questionnaire with 6 domains: function, activities of daily living (ADL), pain, work, aesthetics, and satisfaction. Reliability was measured using Spearman's correlation coefficients between time periods. Internal consistency was measured using Cronbach's alpha. Construct validity was measured by correlating MHQ responses with the Arthritis Impact Measurement Scales 2 (AIMS2). Responsiveness was measured by calculating standardized response means (SRMs) between time periods. The MHQ demonstrated good test-retest reliability (r = 0.66, P < 0.001). Cronbach's alpha scores were high for ADL (α = 0.90), function (α = 0.87), aesthetics (α = 0.79), and satisfaction (α = 0.89), indicating redundancy. The MHQ correlated well with AIMS2 responses. Function (r = -0.63), ADL (r = -0.77), work (r = -0.64), pain (r = 0.59), and summary score (r = -0.74) were correlated with the physical domain. Affect was correlated with ADL (r = -0.47), work (r = -0.47), pain (r = 0.48), and summary score (r = -0.53). Responsiveness was excellent among arthroplasty patients in function (SRM 1.42), ADL (SRM 0.89), aesthetics (SRM 1.23), satisfaction (SRM 1.76), and summary score (SRM 1.61). The MHQ is easily administered, reliable, and valid to measure rheumatoid hand function, and can be used to measure outcomes in rheumatic hand disease.


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Available from: David Fox, Jan 27, 2015
    • "Our patients in remission did not achieve " control norms " when they were evaluated according to the MHQ. The MHQ is a patient-oriented questionnaire that covers HF problems, and it is particularly suitable for evaluating the rheumatoid hand [14]. We recommend that it be included in the RA patient evaluation because it may identify HF impairment in individuals who otherwise achieve population norms for health-related quality-of-life outcomes. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: In 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA). Hand function was incorporated into evaluations from 2014 onward. The objectives were to examine hand function in our cohort, compare hand function with function in healthy controls and determine the factors associated with impaired function. Methods: From February 2014 to June 2015, 139 patients (97.2 % of the cohort) had disease activity scored (28 joints, [DAS28]); the Michigan Hand Outcome Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) were completed, and the tip-, key- and palmar-pinch and grip strengths were measured. Sixty-nine healthy controls underwent the same evaluations. Ninety-nine patients underwent a second evaluation one year after their baseline. Descriptive statistics and linear regression models were used. Patients and controls signed informed consent. Results: Patients were primarily middle-aged females with a median disease duration of 7 years; 91 patients had DAS28-remission, and 16, 23, and 9 patients had low, moderate and high disease activity, respectively. Controls scored better than did patients with (any) disease activity level; remission patients had similar DASH and key pinch function as did controls with poorer MHQ and both tip and palmar pinch and grip strength. DAS28 was consistently associated with impaired hand function. Among the patients with a one-year re-assessment, changes in DAS28 correlated (rho = 0.34 to 0.63) with changes in hand function (p ≤ 0.01 for all comparisons), but there was no correlation with palmar pinch strength. Conclusions: Disease activity was associated with hand function impairment in RA patients with variable follow-up. MHQ discriminated poorer hand function in remission patients who otherwise had similar DASH scores as the controls did.
    Article · Dec 2016
    • "A recent report indicated that arthritis in the wrist and finger joints (metacarpophalangeal and proximal interphalangeal joints) is more common in patients with inflammatory myopathies than previously described (≈20%) (Klein et al., 2013). Arthritis in the hands is known to lead to deformities, dysfunction and reduced ROM (Heine et al., 2012; Waljee et al., 2010). In the current study, PM and DM patients with arthritis or other comorbid diseases that could affect the hand were excluded. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives To develop a 12-week hand exercise intervention for patients with polymyositis (PM) and dermatomyositis (DM) and evaluate adherence, patients opinion of program design and overall feasibility and the effect on hand function and activity limitation after the intervention. Methods A pilot, hand exercise intervention was conducted on a convenience sample of 15 patients with reduced handgrip strength and established, inactive PM and DM. Acceptable adherence was set at 75%. The program was evaluated based on patients' opinions regarding exertion, the movements and over all feasibility. Hand- and pinch-grip strength, grip ability, dexterity and activity limitation were assessed. Results Eleven of 15 patients completed the intervention with acceptable adherence of 78–100%. Measures of handgrip strength, dexterity and activity limitation were reduced at baseline. Throughout the intervention, exertion was rated between “moderate” and “somewhat strong”. Finger abduction and adduction were excluded from the program because they were not feasible. Repetitions increased continuously to a maximum of 30 repetitions per movement. Patients regarded this as too time-consuming and suggested 10 repetitions daily or 10–20 repetitions 2–4 times per week. There were some individual, clinically meaningful improvements in hand function and activity limitation. After the intervention, three-jaw pinch grip strength (left hand) had improved. Conclusions A hand exercise program was feasible to perform by patients with established PM or DM. The effect was limited with few individual improvements in hand function and activity limitation, indicating a need to increase the resistance in the movements and to limit the time spent. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2230
    Full-text · Article · Sep 2014
    • "The questionnaire assesses a patient’s perception to function, pain, satisfaction, and aesthetic appearance. The original MHQ has been used with almost all types of hand disorders, and its reliability, validity, and responsiveness has been validated for a range of upper extremity conditions, such as carpal tunnel syndrome, distal radius fractures, and rheumatoid arthritis (Chatterjee and Price, 2009; Kotsis et al., 2007; Roh et al., 2011; Waljee et al., 2010). The questionnaire itself consists of 57 items, and distinguishes between left and right hands over six domains, including overall hand function, activities of daily living, pain, work performance, aesthetics, and patient satisfaction with function. "
    [Show abstract] [Hide abstract] ABSTRACT: Musculoskeletal disorders substantially impacts physical activity, mental state, and quality of life (QOL). Generally, comprehensive assessment of upper limb function requires measures of impairment or disability as well as health-related quality of life. A growing number of outcome instrument have been introduced to evaluate upper limb function and disability, and these measures can be categorized as patient- or clinician-based, and as condition specific or general health-related QOL evaluations. The upper limb outcome instruments reviewed in this article assess different aspect of upper limb conditions, and the measures are affected by differences in cultural, psychological, and gender aspect of illness perception and behavior. Therefore, physician should select/interpret the outcome instruments addressing their primary purpose of research. Information about regional instruments for upper limb condition and health-related QOL in upper limb disorder may help us in decision-making for treatment priority or in interpretation of the treatment outcomes.
    Full-text · Article · Aug 2013
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