Advertisement

Validity of the Michigan Hand Outcomes Questionnaire in Patients With Stroke

Published:October 08, 2015DOI:https://doi.org/10.1016/j.apmr.2015.09.018

      Abstract

      Objective

      To investigate the measurement properties of the Dutch version of the Michigan Hand Outcomes Questionnaire (MHQ) in patients with stroke.

      Design

      Validation study.

      Setting

      Outpatient rehabilitation clinic.

      Participants

      Consecutive patients with stroke (N=51; mean age, 60±11y; 16 women [31%]).

      Interventions

      Patients were asked to complete the MHQ (57 items) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Additional assessments included the Barthel Index and performance tests for hand function (Action Research Arm Test, Nine Hole Peg Test, Frenchay Arm Test, Motricity Index).

      Main Outcome Measures

      Associations between the MHQ and other outcome measures were determined using Spearman correlation coefficients and the internal consistency of the MHQ using Cronbach α. Floor or ceiling effects were present if >15% of the patients scored minimal or maximal scores, respectively. Test-retest reliability was established by the intraclass correlation coefficient.

      Results

      The mean MHQ total score was 70.0±22.4, with Cronbach α being .97. The MHQ total score correlated significantly with the physical component summary of the SF-36, the Barthel Index, and all hand function performance tests (P<.01). The MHQ total score showed no floor or ceiling effects. The test-retest intraclass correlation coefficient was .97.

      Conclusions

      This study provides preliminary evidence that the MHQ is an internally consistent, valid, and reliable hand function questionnaire in outpatients after stroke, although these results need to be further confirmed.

      Keywords

      List of abbreviations:

      ARAT (Action Research Arm Test), ICF (International Classification of Functioning, Disability and Health), FAT (Frenchay Arm Test), MCS (mental component summary), MHQ (Michigan Hand Outcomes Questionnaire), MI (Motricity Index), NHPT (Nine Hole Peg Test), PCS (physical component summary), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organization. Cardiovascular diseases. Available at: http://www.who.int/cardiovascular_diseases/en. Accessed October 22, 2015.

        • Nakayama H.
        • Jørgensen H.S.
        • Raaschou H.O.
        • Olsen T.S.
        Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study.
        Arch Phys Med Rehabil. 1994; 75: 394-398
        • Kwakkel G.
        • Kollen B.J.
        • van der Grond J.
        • Prevo A.J.
        Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke.
        Stroke. 2003; 34: 2181-2186
        • Geyh S.
        • Cieza A.
        • Schouten J.
        • et al.
        ICF core sets for stroke.
        J Rehabil Med. 2004; 44: 135-141
        • Mathiowetz M.
        • Weber K.
        • Kashman N.
        • Volland G.
        Adult norms for Nine Hole Peg Test of finger dexterity.
        Occup Ther J Res. 1985; 5: 24-38
        • Heller A.
        • Wade D.T.
        • Wood V.A.
        • Sunderland A.
        • Hewer R.L.
        • Ward E.
        Arm function after stroke: measurement and recovery over the first three months.
        J Neurol Neurosurg Psychiatr. 1987; 50: 714-719
        • Lyle R.C.
        A performance test for assessment of upper limb function in physical rehabilitation treatment and research.
        Int J Rehabil Res. 1981; 4: 483-492
        • van Delden A.L.
        • Peper C.L.
        • Beek P.J.
        • Kwakkel G.
        Match and mismatch between objective and subjective improvements in upper limb function after stroke.
        Disabil Rehabil. 2013; 35: 1961-1967
        • Ashford S.
        • Slade M.
        • Malaprade F.
        • Turner-Stokes L.
        Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review.
        J Rehabil Med. 2008; 40: 787-795
        • Lemmens R.J.
        • Timmermans A.A.
        • Janssen-Potten Y.J.
        • Smeets R.J.
        • Seelen H.A.
        Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review.
        BMC Neurol. 2012; 12: 21
        • Duncan P.W.
        • Wallace D.
        • Lai S.M.
        • Johnson D.
        • Embretson S.
        • Laster L.J.
        The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change.
        Stroke. 1999; 30: 2131-2140
        • Penta M.
        • Thonnard J.L.
        • Tesio L.
        ABILHAND: a Rasch-built measure of manual ability.
        Arch Phys Med Rehabil. 1998; 79: 1038-1042
        • Chung K.C.
        • Pillsbury M.S.
        • Walters M.R.
        • Hayward R.A.
        Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.
        J Hand Surg Am. 1998; 23: 575-587
        • Shauver M.J.
        • Chung K.C.
        The Michigan Hand Outcomes Questionnaire after 15 years of field trial.
        Plast Reconstr Surg. 2013; 131: 779e-787e
        • Horng Y.S.
        • Lin M.C.
        • Feng C.T.
        • Huang C.H.
        • Wu H.C.
        • Wang J.D.
        Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire in patients with hand injury.
        J Hand Surg Am. 2010; 35: 430-436
        • Kotsis S.V.
        • Lau F.H.
        • Chung K.C.
        Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment.
        J Hand Surg Am. 2007; 32: 84-90
        • Hoang-Kim A.
        • Pegreffi F.
        • Moroni A.
        • Ladd A.
        Measuring wrist and hand function: common scales and checklists.
        Injury. 2011; 42: 253-258
        • Shauver M.J.
        • Chang K.W.
        • Chung K.C.
        Contribution of functional parameters to patient-rated outcomes after surgical treatment of distal radius fractures.
        J Hand Surg Am. 2014; 39: 436-442
        • Ebrahimzadeh M.H.
        • Mashhadinejad H.
        • Moradi A.
        • Kachooei A.R.
        Carpal tunnel release in diabetic and non-diabetic patients.
        Arch Bone Jt Surg. 2013; 1: 23-27
        • Barden H.L.
        • Baguley I.J.
        • Nott M.T.
        • Chapparo C.
        Measuring spasticity and fine motor control (pinch) change in the hand after botulinum toxin-A injection using dynamic computerized hand dynamometry.
        Arch Phys Med Rehabil. 2014; 95: 2402-2409
        • World Medical Association
        World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
        JAMA. 2013; 310: 2191-2194
      2. Dutch Society of Neurology. Stroke: diagnostics, therapy and care after stroke [Dutch]. Available at: http://www.diliguide.nl/document/230/beroerte-diagnostiek-behandelingen-zorg-voor-patienten-met-een-beroerte.html. Accessed October 22, 2015.

      3. University of Michigan. The Michigan Hand Outcomes Questionnaire (MHQ). Available at: http://mhq.lab.medicine.umich.edu/. Accessed October 22, 2015.

        • van der Giesen F.J.
        • Nelissen R.G.
        • Arendzen J.H.
        • de Jong Z.
        • Wolterbeek R.
        • Vliet Vlieland T.P.
        Responsiveness of the Michigan Hand Outcomes Questionnaire—Dutch language version in patients with rheumatoid arthritis.
        Arch Phys Med Rehabil. 2008; 89: 1121-1126
        • Collin C.
        • Wade D.T.
        • Davies S.
        • Horne V.
        The Barthel ADL Index: a reliability study.
        Int Disabil Stud. 1988; 10: 61-63
        • Aaronson N.K.
        • Muller M.
        • Cohen P.D.
        • et al.
        Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations.
        J Clin Epidemiol. 1998; 51: 1055-1068
        • Collin C.
        • Wade D.
        Assessing motor impairment after stroke: a pilot reliability study.
        J Neurol Neurosurg Psychiatry. 1990; 53: 576-579
        • Terwee C.B.
        • Bot S.D.
        • de Boer M.R.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Waljee J.F.
        • Chung K.C.
        • Kim H.M.
        • et al.
        Validity and responsiveness of the Michigan Hand Questionnaire in patients with rheumatoid arthritis: a multicenter, international study.
        Arthritis Care Res (Hoboken). 2010; 62: 1569-1577
        • Massy-Westropp N.
        • Krishnan J.
        • Ahern M.
        Comparing the AUSCAN Osteoarthritis Hand Index, Michigan Hand Outcomes Questionnaire, and Sequential Occupational Dexterity Assessment for patients with rheumatoid arthritis.
        J Rheumatol. 2004; 31: 1996-2001
        • Lin J.H.
        • Hsu M.J.
        • Sheu C.F.
        • et al.
        Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke.
        Phys Ther. 2009; 89: 840-850
        • Shauver M.J.
        • Chung K.C.
        The minimal clinically important difference of the Michigan hand outcomes questionnaire.
        J Hand Surg Am. 2009; 34: 509-514