Advertisement
Scientific article| Volume 34, ISSUE 3, P509-514, March 2009

Download started.

Ok

The Minimal Clinically Important Difference of the Michigan Hand Outcomes Questionnaire

      Purpose

      To determine the change in score required in various domains of the Michigan Hand Outcomes Questionnaire (MHQ) to indicate meaningful patient improvement, or the minimal clinically important difference (MCID), for 3 common hand conditions: rheumatoid arthritis (RA), carpal tunnel syndrome (CTS) and distal radius fracture (DRF).

      Methods

      The MHQ was administered to patients at 2 time points. Patient satisfaction was defined as a satisfaction score ≥80% of the standard deviation of that patient sample. The minimal change in score in specific MHQ domains that corresponded with patient satisfaction was determined using receiver operating characteristic curves.

      Results

      For CTS patients, MCIDs of 23, 13, and 8 were identified for the pain, function, and work domains, respectively. For RA patients, pain and function were also identified as having discriminative ability, with MCIDs of 11 and 13, respectively. An MCID of 3 was identified for the activities of daily living domain. For DRF patients, no MHQ domains showed discriminative ability because of the ceiling effect at the 3-month assessment period.

      Conclusions

      Individual domains of the MHQ can be used to discriminate between patients who are satisfied and those who are not after either carpal tunnel release or silicone arthroplasty of the metacarpophalangeal joints for RA. Pain and function are the domains of the MHQ that are best able to discriminate between patients who are satisfied and those who are not. The identical function MCID for both RA patients and CTS patients, despite markedly different preoperative values, indicates that a standard amount of functional change may indicate patient satisfaction. High postoperative satisfaction, even only 3 months after surgery, prevented any domains from showing discriminative ability for the DRF patients.

      Type of study/level of evidence

      Diagnostic III.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ozyurekoglu T.
        • McCabe S.J.
        • Goldsmith L.J.
        • LaJoie A.S.
        The minimal clinically important difference of the Carpal Tunnel Syndrome Symptom Severity Scale.
        J Hand Surg. 2006; 31A: 733-738
        • Redelmeier D.A.
        • Guyatt G.H.
        • Goldstein R.S.
        Assessing the minimal important difference in symptoms: a comparison of two techniques.
        J Clin Epidemiol. 1996; 49: 1215-1219
        • Davis Sears E.
        • Burns P.B.
        • Chung K.C.
        The outcomes of outcome studies in plastic surgery: a systematic review of 17 years of plastic surgery research.
        Plast Reconstr Surg. 2007; 120: 2059-2065
        • Chung K.C.
        • Kotsis S.V.
        • Kim H.M.
        A prospective outcomes study of Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand.
        J Hand Surg. 2004; 29A: 646-653
        • Kotsis S.V.
        • Chung K.C.
        Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire in carpal tunnel surgery.
        J Hand Surg. 2005; 30A: 81-86
        • 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. 2007; 32A: 84-90
        • Klein R.D.
        • Kotsis S.V.
        • Chung K.C.
        Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients.
        Plast Reconstr Surg. 2003; 111: 1616-1622
        • Chung K.C.
        • Watt A.J.
        • Kotsis S.V.
        • Margaliot Z.
        • Haase S.C.
        • Kim H.M.
        Treatment of unstable distal radial fractures with the volar locking plating system.
        J Bone Joint Surg. 2006; 88A: 2687-2694
        • 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. 1998; 23A: 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
        • Chung K.C.
        • Kotsis S.V.
        • Kim H.M.
        Predictors of functional outcomes after surgical treatment of distal radius fractures.
        J Hand Surg. 2007; 32A: 76-83
        • Dawson J.
        • Doll H.
        • Coffey J.
        • Jenkinson C.
        Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus.
        Osteoarthritis Cartilage. 2007; 15: 918-931
        • Salaffi F.
        • Stancati A.
        • Silvestri C.A.
        • Ciapetti A.
        • Grassi W.
        Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
      1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988: 8-14
        • Zweig M.H.
        • Campbell G.
        Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine.
        Clin Chem. 1993; 39: 561-577
        • Metz C.E.
        Basic principles of ROC analysis.
        Semin Nucl Med. 1978; 8: 283-298
        • Chung K.C.
        Commentary: the minimal clinically important difference of the carpal tunnel syndrome symptom severity scale.
        J Hand Surg. 2006; 31A: 739-740
        • Fan J.
        • Upadhye S.
        • Worster A.
        Understanding receiver operating characteristic (ROC) curves.
        CJEM. 2006; 8: 19-20
        • Beaton D.E.
        • Katz J.N.
        • Fossel A.H.
        • Wright J.G.
        • Tarasuk V.
        • Bombardier C.
        Measuring the whole or the parts?.
        J Hand Ther. 2001; 14: 128-146
        • Smith D.M.
        • Brown S.L.
        • Ubel P.A.
        Mispredictions and misrecollections: challenges for subjective outcome measurement.
        Disabil Rehabil. 2008; 30: 418-424