Scientific/Clinical ArticleAssessment of construct validity of the Finnish versions of the Disabilities of Arm, Shoulder and Hand Instrument and the Michigan Hand Outcomes Questionnaire
Introduction
Increased interest in the outcomes of medical treatment has accelerated the development and use of patient-reported outcome (PRO) instruments as a part of clinical outcome assessment.1, 2, 3 Extensive research and validation of such instruments have shown them to be useful in evaluating and comparing treatment outcomes.4 However, the applicability of different PRO instruments may vary in diverse study samples.2 To more accurately select a proper instrument for the population under examination,5 it is beneficial to understand the measurement properties of different PRO instruments in head-to-head comparison. A systematic review of van de Ven-Stevens et al.6 reviewed the clinimetric properties of 23 instruments for assessing hand function after hand injury, including 5 PRO instruments. There were vital shortages in the reported properties of all the surveyed PRO instruments. This finding refers to insufficient understanding of the key features of these hand-specific measures.
The Disabilities of Arm, Shoulder and Hand (DASH) instrument7 and the Michigan Hand Outcomes Questionnaire (MHQ)8 are widely adopted PRO instruments for evaluating the performance and disability of upper limbs or hands.5 The clinimetric properties of the DASH have been investigated using classical test theory9 and the Rasch measurement theory,10, 11, 12 and several reports have assessed the validity of the MHQ among hand patients.8, 13, 14, 15, 16 A study by Dias et al17 compared 3 upper extremity–specific PRO instruments, the Patient Evaluation Measure, DASH, and MHQ. It found the DASH and MHQ to be valid and reliable for a sample of patients with various wrist or finger complaints, although there were shortages in construct validity of all PRO instruments measured by correlation testing between the instruments' scores and hand symptom severity.17 Nonetheless, thus far, there has been a lack of high-quality comparison of these 2 PRO instruments with a perspective of health-related quality of life (HRQoL) outcomes. Comparison of the association of the DASH and MHQ to HRQoL provides valuable information for researchers and clinicians dealing with hand and wrist problems. The results could potentially guide us to choose the right instrument for assessing the function or disability of patients.
The aim of this study was to measure and compare the scale targeting and construct validity of the Finnish versions of the DASH and MHQ and their association to HRQoL using a heterogeneous sample of patients with hand and wrist problems to better understand the clinimetrics of these 2 widely used PRO instruments.
Section snippets
Materials and methods
In 2017, 250 consecutive patients with hand and wrist problems treated at the general orthopedic outpatient clinic in Länsi-Pohja Central Hospital in Kemi, Finland, were invited in person to participate in the study. The inclusion criteria were age of 18 years or above, complete understanding of spoken and written Finnish, lack of cognitive disabilities, and the ability to give signed informed consent to participate in the study. Overall, 230 invited patients were willing to participate in the
Statistical methods
The scores of all the instruments were converted to scale from 0 to 100. To obtain a parallel effect direction, the scores of the EQ-5D-3L index, EQ-VAS, and MHQ were inverted by subtracting the score from 100. After conversion, lower scores indicated better outcomes in all scales, and higher scores indicated worse outcomes. Clinical, demographic, and questionnaire data are presented as means with standard deviations, 95% CI, or counts with percentages. Scale targeting was assessed by
Results
Table 1 presents the sociodemographic and clinical data of the participants. We observed no floor or ceiling effects in either PRO instrument, although 6 (3.1%) participants scored the minimum score in the DASH. Figure 1 shows the distributions of the DASH and MHQ scores. The distribution of the MHQ scores followed normal distribution, whereas the DASH score distribution was skewed toward lower disability. However, the DASH scores covered the scale more comprehensively than the MHQ scores. In
Discussion
The main finding of this study was that both the DASH and MHQ instruments' scores strongly correlated with each other, as well as with the generic HRQoL instrument scores. Both instruments had comparable measurement properties when the outcomes of various hand complaints were evaluated (Table 3). However, in terms of its strong relationship with HRQoL, the DASH instrument seemed to have more suitable measurement properties for the study sample than the MHQ when evaluating HRQoL-related outcomes
Conclusion
The scores of the DASH and MHQ were highly correlated. The DASH scores had a stronger relationship with the HRQoL outcomes. Thus, the DASH instrument appeared to be superior to the MHQ in evaluating the outcomes from a perspective of HRQoL among patients with heterogeneous hand and wrist complaints. On the other hand, the MHQ might be a more specific instrument when measuring performance of the affected hand.
Quiz: # 722
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.
Good targeting was noted for the
- a.
DASH
- b.
MHQ
- c.
both a and b above
- d.
neither a nor b above
- a.
- # 2.
Overall scores were
- a.
higher for females
- b.
higher for males
- c.
equal for male and female
- d.
inconclusive
- a.
- # 3.
Participants completed the
- a.
MHQ
- b.
EQ-5D-3L
- c.
DASH
- d.
all of the above
- a.
- # 4.
Comparing the MHQ and the DASH there was
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