Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder, and Hand Questionnaire in Patients With Hand Injury

Purpose: To compare responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) with that of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in patients with hand injuries. We postulated that the MHQ may be more sensitive to functional changes in the hands, whereas the DASH questionnaire would have a closer association with days of disability. Methods: Patients with hand injuries were consecutively recruited from 2 community hospitals. Each patient was asked to complete out the MHQ, the DASH questionnaire, the satisfaction with their health-related quality of life (Sat-HRQOL) measure, and Chinese Health Questionnaire (CHQ), which is a measure of psychological stressors. Disability days were defined as the duration of restricted activities of daily living during the previous 4 weeks. Patients repeated the same questionnaires between 2 and 9 months after enrollment (average: 4 mo). Results: A total of 105 patients with hand injuries were recruited, and 50 of the 105 patients returned for the second evaluation. There were no statistical differences between responders and nonresponders for age, gender, disability days, the MHQ, the DASH questionnaire, the CHQ, or the Sat-HRQOL. Responsiveness was evaluated by effect sizes and standardized response means: Those for the MHQ were 0.84 and 1.05, and those for the DASH were 0.67 and 0.86, respectively. A mixed model analysis for repeated measurements of the 50 participants showed a significant influence of psychological factors (CHQ) for both the Sat-HRQOL and disability days. After adjustment for the effects of age, gender, and the CHQ, there was an increment of one Sat-HRQOL unit for an MHQ score increment of 3.2, whereas the score decrement for the DASH questionnaire was 3.3 units. Conclusions: The MHQ might be slightly more sensitive to functional changes, but the DASH questionnaire seemed more correlated with disability days. Psychological factors are the strongest determinants of the HRQOL and disability.