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Rasch Analysis of the Michigan Hand Questionnaire

  • Tara Packham
    Correspondence
    Correspondence: Tara Packham, PhD, Institute for Applied Health Sciences, School of Rehabilitation Sciences, McMaster University, Rm 403, 1400 Main St West, Hamilton, ON L8S 1C7, Canada.
    Affiliations
    School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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  • Joy C. MacDermid
    Affiliations
    School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada

    School of Physiotherapy, Western University, London, Ontario, Canada
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  • Ruud W. Selles
    Affiliations
    Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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  • Harm P. Slijper
    Affiliations
    Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands

    Hand and Wrist Center, Xpert Clinic and Handtherapie Nederland, Rotterdam, The Netherlands
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  • Robbert Wouters
    Affiliations
    Department of Rehabilitation Medicine and Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands

    Hand and Wrist Center, Xpert Clinic and Handtherapie Nederland, Rotterdam, The Netherlands
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Published:October 26, 2021DOI:https://doi.org/10.1016/j.jval.2021.09.015

      Highlights

      • Summary scores based on (1) items using ordinal scaling and (2) multiple subscales such as the Michigan Hand Questionnaire may add error or bias to statistical analyses for effect or prediction. Rasch analysis is a strategy that can address these concerns in existing scales or while designing new evaluations.
      • Rasch analysis of the Michigan Hand Questionnaire suggests only the overall hand function and pain subscales, and unilateral activities from the activities of daily living subscale provide valid metrics for statistical calculations. Caution is warranted in using the summary scores as an outcome in clinical trials.

      Abstract

      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.

      Keywords

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      References

        • Chung K.C.
        • Pillsbury M.S.
        • Walters M.R.
        • Hayward R.A.
        Reliability and validity testing of the Michigan hand outcomes questionnaire.
        J Hand Surg Am. 1998; 23: 575-587
        • Chung K.C.
        • Hamill J.B.
        • Walters M.R.
        • Hayward R.A.
        The Michigan hand outcomes questionnaire (MHQ): assessment of responsiveness to clinical change.
        Ann Plast Surg. 1999; 42: 619-622
        • Shauver M.J.
        • Chung K.C.
        The minimal clinically important difference of the Michigan hand outcomes questionnaire.
        J Hand Surg Am. 2009; 34: 509-514
        • Waljee J.F.
        • Chung K.C.
        • Kim H.M.
        • et al.
        Validity and responsiveness of the Michigan Hand Questionnaire in patients with rheumatoid arthritis: a multicenter [international study].
        Arthritis Care Res (Hoboken). 2010; 62: 1569-1577
        • Kotsis S.V.
        • Lau F.H.
        • Chung K.C.
        Responsiveness of the Michigan hand outcomes questionnaire and physical measurements in outcome studies of distal radius fracture treatment.
        J Hand Surg Am. 2007; 32: 84-90
      1. Koopman JE, van Kooij YE, Selles RW, et al. Determining the Minimally Important Change of the Michigan Hand outcomes Questionnaire in patients undergoing trigger finger release [published online July 24, 2021. J Hand Ther. https://doi.org/10.1016/j.jht.2021.06.003.

        • Nolte M.T.
        • Shauver M.J.
        • Chung K.C.
        Normative values of the Michigan hand outcomes questionnaire for patients with and without hand conditions.
        Plast Reconstr Surg. 2017; 140: 425e-433e
        • Chung B.T.
        • Morris S.F.
        Confirmatory factor analysis of the Michigan Hand Questionnaire.
        Ann Plast Surg. 2015; 74: 176-181
      2. Farzad M, Lu Z, MacDermid JC, Kachooei AR, Shafiee E. Measurement properties of the Michigan hand outcomes questionnaire: Rasch analysis of responses from a traumatic hand injury population [published online March 8, 2021]. Disabil Rehabil. https://doi.org/10.1080/09638288.2021.1894246.

        • Jayaram M.
        • Wang C.
        • Wang L.
        • Chung K.C.
        Validating the Michigan Hand Outcomes Questionnaire in patients with rheumatoid arthritis using Rasch analysis.
        PLoS One. 2021; 16e0254984
        • Oda T.
        • Abe Y.
        • Katsumi Y.
        • Ohi H.
        • Nakamura T.
        • Inagaki K.
        Reliability and validity of the Japanese version of the Michigan hand outcomes questionnaire: a comparison with the DASH and SF-36 questionnaires.
        J Hand Surg Asian Pac Vol. 2016; 21: 72-77
        • Meireles S.M.
        • Natour J.
        • Batista D.A.
        • Lopes M.
        • Skare T.L.
        Cross-cultural adaptation and validation of the Michigan Hand Outcomes Questionnaire (MHQ) for Brazil: validation study.
        S Paulo Med J. 2014; 132: 339-347
        • Huijsmans R.
        • Sluiter H.
        • Aufdemkampe G.
        Michigan Hand Outcomes Questionnaire-Dutch Language Version; een vragenlijst voor Patienten met handfunctieproblemen.
        Fysiopraxis. 2001; 9 (A questionnaire for patients with hand function problems): 38-41
        • van der Giesen F.J.
        • Nelissen R.G.
        • Arendzen J.H.
        • de Jong Z.
        • Wolterbeek R.
        • Vliet Vlieland T.P.
        Responsiveness of the Michigan hand outcomes questionnaire-Dutch language version in patients with rheumatoid arthritis.
        Arch Phys Med Rehabil. 2008; 89: 1121-1126
        • Fernandes C.H.
        • Neto J.R.
        • Meirelles L.M.
        • Pereira C.N.M.
        • Dos Santos J.B.G.
        • Faloppa F.
        Translation and cultural adaptation of the Brief Michigan Hand Questionnaire to Brazilian Portuguese language.
        Hand (N Y). 2014; 9: 370-374
        • Atthakomol P.
        • Manosroi W.
        • Sanguanrungsirikul S.
        • et al.
        A Thai version of the Michigan Hand Questionnaire (Thai MHQ): an investigation of the psychometric properties.
        Health Qual Life Outcomes. 2020; 18: 313
        • Efanov J.I.
        • Shine J.J.
        • Darwich R.
        • et al.
        French translation and cross-cultural adaptation of the Michigan Hand Outcomes Questionnaire and the Brief Michigan Hand Outcomes Questionnaire.
        Hand Surg Rehabil. 2018; 37: 86-90
        • Dhippayom J.P.
        • Trevittaya P.
        • Cheng A.S.K.
        Cross-cultural adaptation, validity, and reliability of the patient-rated Michigan hand outcomes questionnaire for Thai patients.
        Occup Ther Int. 2018; 20188319875
        • Knobloch K.
        • Kuehn M.
        • Papst S.
        • Kraemer R.
        • Vogt P.M.
        German standardized translation of the Michigan Hand Outcomes Questionnaire for patient-related outcome measurement in Dupuytren disease.
        Plast Reconstr Surg. 2011; 128: 39e-40e
        • Hulkkonen S.
        • Repo J.P.
        • Hakkinen A.
        • Karppinen J.
        • Ryhanen J.
        Cross-cultural adaptation and validation of the Finnish version of the Michigan hand outcomes questionnaire.
        Scand J Surg. 2020; 109: 159-165
        • Oksuz C.
        • Akel B.S.
        • Oskay D.
        • Leblebicioglu G.
        • Hayran K.M.
        Cross-cultural adaptation, validation, and reliability process of the Michigan Hand Outcomes Questionnaire in a Turkish population.
        J Hand Surg Am. 2011; 36: 486-492
        • Czarnecki P.
        • Wawrzyniak-Bieleda A.
        • Romanowski L.
        Polish adaptation of wrist evaluation questionnaires.
        Ortop Traumatol Rehabil. 2015; 17: 241-248
        • Tennant A.
        • Conaghan P.G.
        The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch.
        Arthritis Rheum. 2007; 57: 1358-1362
        • Tennant A.
        • Horton M.
        • Pallant J.F.
        Introductory Rasch Analysis: A Workbook.
        Department of Rehabilitation Medicine, University of Leeds, Leeds, United Kingdom2011
        • Horton M.
        • Tennant A.
        Patient Reported Outcomes: misinference from ordinal scales?.
        Trials. 2011; 12: A65
        • Hagquist C.
        • Bruce M.
        • Gustavsson J.P.
        Using the Rasch model in nursing research: an introduction and illustrative example.
        Int J Nurs Stud. 2009; 46: 380-393
        • Selles R.W.
        • Wouters R.M.
        • Poelstra R.
        • et al.
        Routine health outcome measurement: development, design, and implementation of the Hand and Wrist Cohort.
        Plast Reconstr Surg. 2020; 146: 343-354
        • Sullivan M.J.L.
        • Bishop S.
        • Pivik J.
        The Pain Catastrophizing Scale: development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Oh Y.
        • Drijkoningen T.
        • Menendez M.E.
        • Claessen F.M.A.P.
        • Ring D.
        The influence of psychological factors on the Michigan Hand Questionnaire.
        Hand. 2017; 12: 197-201
        • London D.
        • Stepan J.
        • Boyer M.
        • Calfee R.P.
        The impact of depression and pain catastrophization on initial presentation and treatment outcomes for atraumatic hand conditions.
        J Bone Jt Surg Am Vol. 2014; 96: 806-814
        • Broadbent E.
        • Petrie K.J.
        • Main J.
        • Weinman J.
        The Brief Illness Perception Questionnaire.
        J Psychosom Res. 2006; 60: 631-637
        • Lundgren Nilsson A.
        • Tennant A.
        Past and present issues in Rasch analysis: the Functional Independence Measure (FIMTM) revisited.
        J Rehabil Med. 2011; 43: 884-891
        • Linacre J.M.
        Investigating rating scale category utility.
        J Outcome Meas. 1999; 3: 103-122
        • Bond T.G.
        • Fox C.M.
        Applying the Rasch Model: Fundamental Measurement in the Human Sciences.
        3rd ed. Routledge, New York, NY2015
        • Kersten P.
        • White P.J.
        • Tennant A.
        Is the pain visual analogue scale linear and responsive to change? An exploration using rasch analysis.
        PLoS One. 2014; 9e99485
        • Wright B.
        Fundamental measurement for outcome evaluation.
        Phys Med Rehabil State Art Rev. 1997; 11: 261-288
        • Fisher Jr., W.
        Reliability, separation, strata statistics.
        Rasch Meas Trans. 1992; 6: 238
        • Svensson E.
        Guidelines to statistical evaluation of data from rating scales and questionnaires.
        J Rehabil Med. 2001; 33: 47-48
        • Wright B.D.
        • Linacre J.M.
        Observations are always ordinal; measurements, however, must be interval.
        Arch Phys Med Rehabil. 1989; 70: 857-860
        • Tourangeau R.
        Cognitive sciences and survey methods.
        in: Jabine T. Straf M. Tanur J. Tourangeau R. Cognitive Aspects of Survey Methodology: Building a Bridge Between Disciplines. National Academies Press, Washington, DC1984: 73-101
        • Ojanen V.
        • Gogates G.
        A briefing on cognitive debriefing.
        Good Clin Pract. 2006; 13: 25-29
        • Dabbagh A.
        • MacDermid J.C.
        • Packham T.L.
        • Macedo L.G.
        Content validation of the Kamath and Stothard questionnaire for carpal tunnel syndrome diagnosis: a cognitive interviewing study.
        Health Qual Life Outcomes. 2020; 18: 1-14
        • Chung K.C.
        • Kotsis S.V.
        • Burns P.B.
        • et al.
        Seven-year outcomes of the silicone arthroplasty in rheumatoid arthritis prospective cohort study.
        Arthritis Care Res. 2017; 69: 973-981
        • Pallant J.F.
        • Tennant A.
        An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS).
        Br J Clin Psychol. 2007; 46: 1-18
        • Tennant A.
        • Pallant J.F.
        Unidimensionality matters! (A tale of two Smiths?).
        Rasch Meas Trans. 2006; 20: 1048-1051
        • Mokkink L.B.
        • Terwee C.B.
        • Knol D.L.
        • et al.
        The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content.
        BMC Med Res Methodol. 2010; 10: 22
        • Chung B.T.
        • Morris S.F.
        Reliability and internal validity of the Michigan Hand Questionnaire.
        Ann Plast Surg. 2014; 73: 385-389
        • Waljee J.F.
        • Kim H.M.
        • Burns P.B.
        • Chung K.C.
        Development of a brief, 12-item version of the Michigan Hand Questionnaire.
        Plast Reconstr Surg. 2011; 128: 208-220
      3. Hand and wrist conditions: the standard set. International Consortium for Health Outcomes Measurement.