Cross-Cultural Adaptation and Validation of the Finnish Version of the Michigan Hand Outcomes Questionnaire

Systematic review of the quality of the cross-cultural adaptations and validation of Michigan Hand Outcome Questionnaire (MHQ) and meta-analysis

BACKGROUND

The Michigan Hand Questionnaire (MHQ) is a widely used patient-reported outcome measure (PROM) for assessing hand function. Cross-cultural adaptations are necessary to ensure its applicability and validity in diverse cultural contexts. However, the quality and psychometric properties of these adaptations remain unclear.

PURPOSE

This systematic review and meta-analysis aim to evaluate the psychometric properties, specifically reliability and content validity, of cross-cultural adaptations of the MHQ.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic review following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted across four electronic databases, encompassing studies published between 1998 and 2024. Quality and content validity assessment was performed using the COSMIN methodology. Random effects meta-analysis was conducted for interclass correlation coefficient (ICC) and Cronbach's alpha.

RESULTS

Twenty-one studies were included. We identified two studies with high-quality evidence for content validity and ICC, and two studies demonstrating strong internal consistency. The MHQ demonstrated strong internal consistency (Cronbach's alpha: 0.73-0.99) and moderate to high test-retest reliability (ICC: 0.91-0.93). However, significant heterogeneity was observed in Cronbach's alpha and ICC values across domains, likely due to factors beyond test-retest duration. Meta-regression analysis revealed publication bias, possibly influenced by participant and study characteristics.

CONCLUSION

This meta-analysis supports the reliability of the MHQ for assessing hand function across cultures. However, variability in ICC values suggests a need for further investigation into factors influencing reliability. While the MHQ is a valuable tool, future research should address limitations in structural validity and explore cultural factors to enhance its cross-cultural applicability.

Cross-cultural evaluation of the Michigan Hand Outcomes Questionnaire: a systematic review

This systematic review aims to provide a comprehensive synthesis and in-depth analysis of the quality of the different cross-cultural versions of the MHQ. This study was conducted using Pubmed, Web of Science, CINAHL and SCOPUS databases to identify cross-cultural validation studies of the MHQ. Methodological quality, quality of evidence and criteria for good measurement properties of these studies were applied for each psychometric property. Quality assessment and data extraction were performed independently by two reviewers according to the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) guidelines. A total of 493 articles were identified, of which 22 were included and 20 were analysed.Of the six properties analysed, responsiveness and hypothesis testing for construct validity had the highest methodological quality and quality of evidence, and met the criteria for good measurement properties. The lowest quality properties were measurement error and internal consistency. The different cross-cultural versions of the MHQ were found to be reliable, valid and able to detect clinical change. The lack of development of measurement error, formulation of an a priori hypothesis or structural validity affects the detection of small clinical changes and their discriminative capacity.

Cross-cultural adaptation, reliability, validity and responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ-Sp) in Spain

BACKGROUND

The Michigan Hand Outcomes Questionnaire (MHQ) is a self-report tool widely recognized for measuring the health status of patients with hand and wrist problems from a multidimensional perspective. The aim of this study is to translate and culturally adapt the MHQ and validate its psychometric properties of validity, reliability, and responsiveness for different hand problems in Spain.

METHODS

The MHQ was translated and culturally adapted following the recommendations of the American Association of Orthopaedic Surgeons. The validation process adhered to the current Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) group and was conducted on 262 hand patients. Reliability was assessed through internal consistency using Cronbach's alpha. The study evaluated the test-retest reliability of the measurements using the intraclass correlation coefficient (ICC). Additionally, the measurement error was calculated using the standard error of measurement (SEM) and smallest detectable change (SDC). To assess the structural validity, confirmatory factor analysis (CFA) was employed, while construct validity was evaluated using Pearson's correlation coefficient. Finally, responsiveness was assessed using effect size (ES), standardized response mean (SRM), and minimum clinically important difference (MCID).

RESULTS

The reliability of the test was confirmed through internal consistency analysis, with a good Crombach's Alpha (0.82-0.85), and test-retest analysis, with good values of ICC (0.74-0.91). The measurement error was also assessed, with low values of SEM (1.70-4.67) and SDC (4.71-12.94)). The CFA confirmed the unidimensionality of each scale with goodness of fit indices, while the MHQ showed a high and negative correlation with DASH (r = - 0.75, P < 0.001) and DASH-work (r = - 0.63, P < 0.001) and was irrelevant with EQ-5D (r = - 0.01, P > 0.005) and grip strength (r = 0.05, P > 0.005). At week 5, all 222 patients across the three diagnosed hand subgroups showed moderate to high values above 0.92 for ES and SRM, with one MCID above 6.85.

CONCLUSIONS

The MHQ-Sp was culturally adapted, and the results of this version showed good reliability and validity as well as high responsiveness for a wide range of hand conditions after surgical or conservative treatment in Spain.

Cross-Cultural Adaptation, Validation, and Reliability of the Persian Version of the Brief Michigan Hand Questionnaire

BACKGROUND

Brief Michigan Hand Questionnaire (Brief MHQ) is one of the most reliable and sensitive patient-reported outcome measures for hand and wrist disorders worldwide. This study aimed to assess the psychometric properties of the Persian version of the Brief Michigan Hand Questionnaire based on standard guidelines.

METHODS

One hundred two patients with various hand and wrist disorders filled the Persian version of Brief MHQ along with the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analogue scale (VAS) for pain. Seventy-eight participants returned to complete the Persian Brief MHQ for the second time after 4 days.

RESULTS

The analysis showed excellent internal consistency with a Cronbach's alpha ranging from 0.89 to 0.91. The Persian Brief MHQ has an excellent test-retest reliability with a 0.94 intraclass correlation coefficient (ICC). The correlation coefficient of -0.74 between Brief MHQ and the QuickDASH showed a strong correlation and confirmed its validity.

CONCLUSION

The Persian version of the Brief MHQ is a reliable and valid tool to apply to Persian individuals with hand and wrist disorders.

A systematic review of the measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ)

This systematic review of the literature aimed to identify studies examining the measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ) in various international populations and investigate its use in various diagnoses and health conditions. The search was conducted in MEDLINE (via PubMed), SCOPUS, CINAHL and Web of Science, with no restrictions on publication date, country or patient age. Study quality and risk of bias were assessed using the COnsensus-based Standards to select the health Measurement INstruments (COSMIN) checklist. 312 publications were identified and screened; 55 studies met the inclusion criteria and were critically reviewed. These publications comprised 16 languages and 11 pathologies and mainly investigated the internal consistency, construct validity and reliability of the MHQ. In general, all the measurement properties of the instrument showed good scores. The present review shows that the MHQ is a valid patient-reported outcome measure (PROM) and can be properly used in different clinical and rehabilitative contexts. LEVEL OF EVIDENCE: 2A.

Rasch Analysis of the Michigan Hand Questionnaire

OBJECTIVES

The Michigan Hand Questionnaire (MHQ) is a commonly used evaluation for hand problems, but previous work reports conflicting evidence regarding the subscale structures. Rasch analysis uses probabilistic modeling of items and responses: if scale items can be fit to the Rasch model, it provides evidence of construct validity and interval-level measurement for precise statistical estimates. We conducted Rasch analysis on the MHQ to evaluate model fit, unidimensionality of the subscales, bias across person factors, and conversion to interval metrics.

METHODS

We conducted a secondary Rasch analysis of MHQ data from 924 persons with thumb basal joint osteoarthritis using the RUMM2030 software. Modeling was based on responses for the most affected hand and person factors including age, sex, type of work, whether the dominant side was the most affected, and surgical status. The analysis plan followed the published recommendations for examinations of person and item fit, with iterative adjustments as required.

RESULTS

A total of 11 of the 37 items required rescoring to create orderly progression of scoring thresholds. Only the overall hand function and pain subscales could be fit to the Rasch model, demonstrating unidimensionality and good reliability of fit estimates. Dividing the activities of daily living subscale into unilateral and bilateral activities also allowed unilateral activities to fit the model. Persistent misfitting in other subscales suggested local dependency and response bias across multiple person factors.

CONCLUSIONS

This Rasch analysis of the MHQ raises concerns regarding the validity and fundamental measurement properties of this widely used outcome evaluation when used as a summary score.

The Michigan Hand Outcomes Questionnaire (MHQ-Swe) in patients with distal radius fractures-cross-cultural adaptation to Swedish, validation and reliability

Background

The Michigan Hand Outcomes Questionnaire—MHQ—is a well-known self-assessment questionnaire, where patients’ own perception in terms of recovery, pain and the ability to return to activities of daily living is assessed. The purpose of the study was to translate and culturally adapt the Michigan Hand Outcomes Questionnaire to Swedish and to test the validity and reliability in patients with surgically treated distal radius fractures.

Methods

The cross-cultural adaptation and the translation process were conducted according to predefined guidelines. Seventy-eight patients with surgically treated distal radius fractures completed the translated version of the questionnaire on their six-week follow-up visit.

Results

The translation and cross-cultural adaptation process revealed no major linguistic or cultural issues. The internal consistency of the MHQ-Swe ranged from 0.77 to 0.94 at test 1 and from 0.81 to 0.96 at test 2 for all subscales, which indicates good internal consistency in the subscales. The hand function subscale revealed the lowest results and work performance the highest. The ICCs showed excellent test-retest reliability, ranging from 0.77 to 0.90 on all MHQ subscales and 0.92 on total score. The highest results for the ICC were seen in the satisfaction subscale (ICC = 0.90), while the lowest were seen in the aesthetic subscale (ICC = 0.77). The correlation analysis between the MHQ-Swe, PRWE and VAS showed a generally moderate to high correlation for all the subscales.

Conclusions

The Swedish version of the MHQ, the MHQ-Swe, showed good validity and reliability and it is therefore an appropriate and relevant questionnaire for use in patients with surgically treated distal radius fractures.

Trial registration

FoU i VGR, Projectnumber: 208491, registered December 9, 2015.

A Thai version of the Michigan hand questionnaire (Thai MHQ): an investigation of the psychometric properties

Background

The Michigan Hand Questionnaire (MHQ) is widely used to assess the hand/wrist conditions. We translated the original version into Thai (Thai MHQ) and evaluated its psychometric properties.

Methods

After receiving permission, the original MHQ was translated and cross-culturally adapted to Thai following standard guidelines. Two hundred and seventeen patients who had hand/wrist injuries or disorders were included in the study. Internal consistency was evaluated using Cronbach’s alpha. Test-retest reliability was analyzed using the intraclass correlation coefficient (ICC). Spearman’s rank correlation among the subscales of Thai MHQ, Thai DASH and Thai EQ-5D-5L and also confirmatory factor analysis (CFA) were used to explore construct validity. The standardized response mean (SRM) was used to evaluate the responsiveness of the Thai MHQ.

Results

All subscales showed an acceptable Cronbach’s alpha (0.79–0.98). The test-retest reliability of each subscale was good (ICC = 0.83–0.95). In related dimensions, strong correlation was demonstrated between the Activities of daily living subscale of the Thai MHQ and the Common activities subscale in the Thai DASH (r = 0.77, P < 0.0001). For unrelated dimensions, a weak correlation was found between the Aesthetics subscale in the Thai MHQ and the Mobility subscale in the Thai EQ-5D-5L (r = − 0.13, P = 0.05). The Thai MHQ had strong correlation with Thai DASH (r = − 0.79, P < 0.0001) and Thai EQ-5D-5L (r = 0.63, P < 0.0001). CFA showed that the 6-factor model demonstrated an acceptable fit to the data. The SRM of the Thai MHQ was 0.78, indicating relatively large responsiveness. The MIC of Thai MHQ using distribution methods (SEM) was 5.2.

Conclusions

The Thai MHQ provides adequate internal consistency in all subscales as well as good construct validity and reliability for Thai patients and a relatively large standardized response mean at 2 months after treatment.