CHAPTER 75: MICHIGAN HAND OUTCOMES QUESTIONNAIRE (MHQ)

Description

The Michigan Hand Outcomes Questionnaire (MHQ) is a self-report questionnaire designed to assess a person’s general hand function as well as change over time and when used by the clinician, it can help to portray an overall sense of what the client feels their strengths and weaknesses are as it relates to their injured extremity. The MHQ has 72 items comprising 6 categories: (1) overall hand function, (2) activities of daily living (ADLs), (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. There is also a demographic section that purveys information relating to age, background, and education. The battery uses several numerical value scoring systems that range from (1) not difficult to (5) very difficult, (1) always to (5) never, and (1) strongly disagree to (5) strongly agree. A Brief MHQ (bMHQ) is also available that contains 12 items scored 1 to 5 along a Likert scale and is designed for clinical, rather than research, functions and includes such items as “In the past week, how satisfied are you with the motion of your fingers?” and “How was the sensation (feeling) in your hand(s) during the past week?” The MHQ can be completed in 15 minutes and the bMHQ in less than 5 minutes. Both assessments employ unique scoring algorithms giving the clinician several ways to assess results.

Psychometrics

An early study of the MHQ using 200 consecutive patients at a university-based hand surgery clinic found that test-retest reliabilities of the subscales demonstrated substantial agreement, ranging from r = 0.81 for the aesthetics scale to 0.97 for the ADL scale (Chung, Pillsbury, Walters, & Hayward, 1998). Among a diabetic population Poole, Gonzales, and Tedesco (2010) found that test–retest reliability ranged from r = 0.58 to 0.94, whereas a study by Impens et al. (n.d.) showed overall test-retest reliability to be r = 0.84)with subscales ranging from 0.61 (aesthetic) to 0.86 (ADLs) among subjects with systemic sclerosis. The same study found the internal consistency results of each subscale were greater than α = > 0.80, except for aesthetics, which was 0.62. Another study of 116 and 77 using 2 administrations of the MHQ found that reliabilities ranged from r = 0.84 to 0.95 for the MHQ subscales and correlation coefficients ranged from 0.71 to 0.84 (Chung & Morris, 2014). Horng et al. (2010) found that strong associations existed between the MHQ and the DASH (Disabilities of the Arm, Shoulder and Hand) scale at r = 0.89 and further results confirmed the MHQ to be more sensitive to functional changes, whereas the DASH was more sensitive to disability days. When comparing the MHQ, DASH, and the Patient-Rated Wrist/Hand Evaluation (PRWHE), 45% considered the PRWHE as easiest to complete, followed by the DASH (28%), and the MHQ (27%). However, 49% selected the MHQ as best reflecting current ability to use their hand, followed by the DASH (36%), and the PRWHE (15%) (Weinstock-Zlotnick, Page, Wolff, & Ghomwari, 2012)

Advantages

There is a good amount of research evidence in support of its use in clinical practice and no special training or certifications are needed to administer the assessment. It has also shown to be relatively sensitive in detecting the client’s perceived changes in hand function over time, highlighting its usefulness in developing an occupational profile of a client’s self-perceived strengths and weaknesses as well as determine client-centered treatment goals. The MHQ is free to use in clinical practice and can be completed in 15 minutes. Finally, the University of Michigan maintains a website devoted to the measure where it can be downloaded along with support material.

Disadvantages

The MHQ has separate questions for the right and left hand in 4 of 6 domains, excluding pain and work, therefore, scores in these domains could potentially be affected by latent symptoms in the unoperated hand of carpal tunnel syndrome, for example (Chatterjee & Price, 2009).

Administration

The MHQ, when downloaded, includes both versions where each has detailed instructions as well as scoring interpretations. Administered as a self-report questionnaire, the subject is asked to consider each question relative to the function of his or her hand(s)/wrist(s) during the past week by selecting the appropriate descriptive scoring choice (1 to 5). A raw scale score for each of the six scales is generated, as is the sum of responses of each scale item. The raw score can then be converted to an overall score ranging from 0 to 100 using a unique algorithm that requires some items to be reversed and recoded. A higher score on the pain scale is suggestive of more pain, whereas on the other five scales, higher scores indicate better hand performance. The end result is typically a score for the affected hand; however, if both hands are affected (i.e., rheumatoid arthritis), the right and left hand scores are averaged (Ames, 2014).

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