The demographic characteristics of the study sample are detailed in . This study sample consisted of 422 patients, of whom 132 patients had suffered distal radius fractures, 97 patients had CTS, 162 patients had RA, and 31 patients with CMC arthritis. The average age of the patient sample was approximately 55 years, and 69.7% were women. Approximately 33% had a college education or higher.
Descriptive statistics of the study population. (n=422)
The results of the item reduction of the MHQ are described in . In all of the domains, except satisfaction, the two survey items for each domain that were most strongly associated with the summary MHQ score were retained in the final version of the brief-MHQ for a total of 12 items. Within the function domain, the following two items “Overall, how well did your hand work?” (R2=0.41) and “How was the sensation in your hand?” (R2=0.21) were most correlated with the summary MHQ, and were retained in the brief-MHQ survey. Within the ADL domain, two items “How difficult was it for you to hold a frying pan?” (R2=0.16) and “How difficult was it for you to button a shirt/blouse?” (R2=0.17) were most strongly correlated with the summary MHQ score, and were retained in the brief-MHQ. The items within the work domain that were most strongly correlated with the summary MHQ score included “How often were you unable to do your work in the last week because of your hands/wrists?” (R2=0.25) and “How often did you take longer to do tasks in your work because of problems with your hands/wrists?” (R2=0.34). The items within the pain domain that were selected for the brief-MHQ included “Describe the pain in your hands/wrists” (R2=0.18) and “How often did the pain in your hands/wrists interfere with your daily activities?” (R2=0.39). Within the aesthetic domain, two items “I am satisfied with the look of my hands” (R2=0.33) and “The appearance of my hand interferes with my normal daily activities” (R2=0.32) were most strongly correlated with the summary MHQ score, and were retained in the brief-MHQ. Finally, the two items related to satisfaction that were retained included “Satisfaction with the motion of your fingers” (R2=0.14) and “Satisfaction with the motion of your wrist” (R2=0.19). These items were selected for inclusion in the brief-MHQ over others with higher correlation coefficients because these items contained concepts that were not represented in other portions of the survey. After these 12 items were selected for inclusion in the final brief-MHQ survey, regression analysis revealed that these survey items explained 97.8% of the variance of the original summary MHQ scores.
The Correlation Between Individual Items of MHQ with the Summary MHQ Score (Items Retained for the Brief MHQ are Indicated in Bold Print).
details the reliability of the brief-MHQ. The reliability of the brief MHQ was examined by measuring the test-retest correlation over a 6 month period among a subset of 68 rheumatoid arthritis patients who did not undergo surgical intervention and had both baseline and 6 months measurements available. The correlation and ICC values between the brief-MHQ scores between each time period was high (r=0.78, rI=0.91), and the mean difference between the two scores was not statistically significant (0.22, p=0.87). Similar findings were noted for the original MHQ scores. This indicates excellent test-retest reliability of the brief MHQ in this subset of patients.
Test-Retest Correlation Comparing Baseline and 6-month Follow Up Scores for the Brief MHQ score (n=68 RA Control Patients Who Did Not Undergo Surgical Intervention).
shows the adjusted means of the brief-MHQ summary score and the original MHQ summary score, stratified by disease type and adjusted for age, gender, and education. We hypothesize that the relative hand health status by the different disease types shown using the original MHQ will also be shown using the brief-MHQ scores. We observed that patients with DRF had the highest summary MHQ score (77.8 ± 1.60), and patients with RA had the lowest summary MHQ scores (51.7 ± 1.38). Similarly, patients with DRF had the highest brief MHQ score (77.8 ± 1.42) and patient with RA had the lowest brief MHQ scores (47.6 ± 1.34). Of note, DRF patients were surveyed postoperatively, and have significantly better hand outcomes than each of the other three conditions.
The comparison between the adjusted mean summary scores of the brief MHQ and the original MHQ, stratified by disease type. Adjusted for age, gender and education level.
details the responsiveness of the brief-MHQ to clinical change among patients who underwent surgical intervention by disease type. Overall, the responsiveness of the brief MHQ was high for all disease types, even in the DRF patients whose measurements reflect the improvements between 3 and 6 months post VLPS, and similar to that of the original MHQ. Responsiveness was highest among RA patients who have undergone SMPA, and was similar for the brief-MHQ (SRM=1.28) and the original MHQ (SRM=1.36).
Responsiveness of the Brief MHQ and Original MHQ Summary Score to Clinical Change, Stratified by Disease Type.*
compares the changes in scores between the two time periods and responsiveness to clinical change for the brief MHQ, the original MHQ, grip and pinch strength, and Jebsen-Taylor test score. All analyses were adjusted for disease type, and CTS patients were admitted from this portion of the analysis as they did not complete these parameters. Responsiveness to clinical change was highest for the brief MHQ (SRM=4.15), followed by the original MHQ (SRM=3.30), Jebsen-Taylor test score (SRM=1.26), and pinch strength (SRM=1.60). Responsiveness was lowest for grip strength (SRM=0.36).
Comparison of responsiveness of the Brief MHQ score and objective function measures, controlling for disease type.*††
describes the correlation between the brief MHQ and objective measures of hand function, specifically grip and pinch strength, and Jebsen-Taylor test score. The brief MHQ was moderately correlated with each of these measures, after adjusting for disease type, age, gender, and education level. The correlation values were highest for grip strength (r=0.38), followed by pinch strength (r=0.35), and Jebsen-Taylor test (r=0.35). Similar trends were identified in the correlation of the full MHQ with these parameters.
The correlation between the brief MHQ and objective measures of function, including grip and pinch strength, and Jebsen-Taylor test score, adjusted for disease type
describes the correlation between the brief MHQ and patient-reported hand function among a subset of the patient sample. Rheumatoid arthritis patients completed the AIMS2 survey, and responses to each domain were compared with brief MHQ score, after controlling for age, gender, and education level. The brief MHQ score was most highly correlated with function (r=0.68) and least correlated with social interaction (r=0.15). Brief MHQ score was moderately correlated with affect (r=0.36) and disease symptoms (r=0.53). Similar trends were identified in the correlation of the full MHQ with each of these domains.
The correlation between the brief MHQ and patient self-assessment of function using the AIMS2 survey among RA patients