Scientific Article|Articles in Press

Responsiveness of the Brief Michigan Hand Outcomes Questionnaire and Patient-Reported Outcomes Measurement Information System Pain Interference in the Context of Patient Mental Health

Published:August 05, 2022DOI:


      A patient-reported outcomes measure (PROM) is responsive if it is sensitive to clinical status changes. The minimal clinically important difference (MCID) is used to indicate meaningful change, helpful in designing studies and adding context to some study results, and is related to instrument responsiveness. Our purpose was to provide MCID estimates for the brief Michigan Hand Outcomes Questionnaire (bMHQ) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) in a hand and upper extremity surgery cohort within the context of varying patient-reported mental health.


      Data were analyzed from 1,262 adult patients who received surgical care at a single center between January 1, 2018, and December 31, 2019. Patients completed PROMIS PI, PROMIS Global Health (including global mental health [GMH] component), bMHQ, and a pain-focused anchor question before each clinic visit. Data were collected 8 ± 2 weeks before and after surgery. A distribution-based MCID then was calculated for the general patient population, lowest 10th percentile of GMH scores, and top 10th percentile of GMH scores.


      Minimal clinically important difference estimates were 10.4 for the bMHQ and 4.3 for PROMIS PI. Analysis of MCID across different GMH score groups showed a mean score of 11.5 for bMHQ for the lowest 10th percentile of GMH, 9.6 for bMHQ for the top 10th percentile, 4.5 for PI for the lowest 10th percentile, and 4.9 for PI for the top 10th percentile.


      Analysis of subgroups stratified by preoperative patient-reported mental health condition found that preoperative mental health status, as indicated by GMH score, does not have a meaningful impact on responsiveness of bMHQ or PROMIS PI.

      Clinical Relevance

      A patient’s reported mental health condition does not meaningfully change how these common PRO instruments reflect the patient condition after hand and upper extremity surgery.

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


        • Giladi A.M.
        • Chung K.C.
        Measuring outcomes in hand surgery.
        Clin Plast Surg. 2013; 40: 313-322
        • Brodke D.J.
        • Saltzman C.L.
        • Brodke D.S.
        PROMIS for Orthopaedic outcomes measurement.
        J Am Acad Orthop Surg. 2016; 24: 744-749
        • Beckmann J.T.
        • Hung M.
        • Voss M.W.
        • Crum A.B.
        • Bounsanga J.
        • Tyser A.R.
        Evaluation of the patient-reported outcomes measurement information system upper extremity computer adaptive test.
        J Hand Surg Am. 2016; 41: 739-744 e4
        • Tyser A.R.
        • Beckmann J.
        • Franklin J.D.
        • et al.
        Evaluation of the PROMIS physical function computer adaptive test in the upper extremity.
        J Hand Surg Am. 2014; 39: 2047-2051 e4
        • Doring A.C.
        • Nota S.P.
        • Hageman M.G.
        • Ring D.C.
        Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System.
        J Hand Surg Am. 2014; 39: 1160-1165
        • Beleckas C.M.
        • Padovano A.
        • Guattery J.
        • Chamberlain A.M.
        • Keener J.D.
        • Calfee R.P.
        Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) versus physical function (PF) Computer adaptive tests (CATs) in upper extremity clinics.
        J Hand Surg Am. 2017; 42: 867-874
        • Stoop N.
        • Menendez M.E.
        • Mellema J.J.
        • Ring D.
        The PROMIS Global Health Questionnaire correlates with the QuickDASH in patients with upper extremity illness.
        Hand (N Y). 2018; 13: 118-121
        • Smith M.V.
        • Calfee R.P.
        • Baumgarten K.M.
        • Brophy R.H.
        • Wright R.W.
        Upper extremity-specific measures of disability and outcomes in orthopaedic surgery.
        J Bone Joint Surg Am. 2012; 94: 277-285
        • Hsu J.E.
        • Nacke E.
        • Park M.J.
        • Sennett B.J.
        • Huffman G.R.
        The Disabilities of the arm, shoulder, and hand questionnaire in intercollegiate athletes: validity limited by ceiling effect.
        J Shoulder Elbow Surg. 2010; 19: 349-354
        • Revicki D.A.
        • Cella D.
        • Hays R.D.
        • Sloan J.A.
        • Lenderking W.R.
        • Aaronson N.K.
        Responsiveness and minimal important differences for patient reported outcomes.
        Health Qual Life Outcomes. 2006; 4: 70
        • Jaeschke R.
        • Singer J.
        • Guyatt G.H.
        Measurement of health status. Ascertaining the minimal clinically important difference.
        Control Clin Trials. 1989; 10: 407-415
        • Bernstein D.N.
        • Houck J.R.
        • Mahmood B.
        • Hammert W.C.
        Minimal clinically important differences for PROMIS physical function, upper extremity, and pain interference in carpal tunnel release using region- and condition-specific PROM tools.
        J Hand Surg Am. 2019; 44: 635-640
        • Kazmers N.H.
        • Hung M.
        • Bounsanga J.
        • Voss M.W.
        • Howenstein A.
        • Tyser A.R.
        Minimal clinically important difference after carpal tunnel release using the PROMIS platform.
        J Hand Surg Am. 2019; 44: 947-953 e1
        • Hung M.
        • Tyser A.
        • Saltzman C.L.
        • Voss M.W.
        • Bounsanga J.
        • Kazmers N.H.
        Establishing the minimal clinically important difference for the PROMIS and qDASH: Level 1 Evidence.
        J Hand Surg. 2018; 43: S22
        • Hollenberg A.M.
        • Hammert W.C.
        Minimal clinically important difference for PROMIS physical function and pain interference in patients following surgical treatment of distal radius fracture.
        J Hand Surg Am. 2022; 47: 137-144
        • Darrith B.
        • Khalil L.S.
        • Franovic S.
        • et al.
        Preoperative patient-reported outcomes measurement information system global health scores predict patients achieving the minimal clinically important difference in the early postoperative time period after total knee arthroplasty.
        J Am Acad Orthop Surg. 2021; 29: e1417-e1426
        • Abdurrob A.
        • Smith J.T.
        The effect of health insurance coverage on orthopaedic patient-reported outcome measures.
        J Am Acad Orthop Surg. 2020; 28: e729-e734
        • Ho B.
        • Houck J.R.
        • Flemister A.S.
        • et al.
        Preoperative PROMIS Scores predict postoperative success in foot and ankle patients.
        Foot Ankle Int. 2016; 37: 911-918
        • Amtmann D.
        • Kim J.
        • Chung H.
        • Askew R.L.
        • Park R.
        • Cook K.F.
        Minimally important differences for Patient reported outcomes measurement information system pain interference for individuals with back pain.
        J Pain Res. 2016; 9: 251-255
        • Okoroafor U.C.
        • Gerull W.
        • Wright M.
        • Guattery J.
        • Sandvall B.
        • Calfee R.P.
        The impact of social deprivation on pediatric PROMIS health scores after upper extremity fracture.
        J Hand Surg Am. 2018; 43: 897-902
        • Wright M.A.
        • Beleckas C.M.
        • Calfee R.P.
        Mental and physical health disparities in patients with carpal tunnel syndrome living with high levels of social deprivation.
        J Hand Surg Am. 2019; 44: 335 e1-335 e9
        • Wright M.A.
        • Adelani M.
        • Dy C.
        • O'Keefe R.
        • Calfee R.P.
        What is the impact of social deprivation on physical and mental health in orthopaedic patients?.
        Clin Orthop Relat Res. 2019; 477: 1825-1835
        • Talaei-Khoei M.
        • Fischerauer S.F.
        • Jha R.
        • Ring D.
        • Chen N.
        • Vranceanu A.M.
        Bidirectional mediation of depression and pain intensity on their associations with upper extremity physical function.
        J Behav Med. 2018; 41: 309-317
        • Vranceanu A.M.
        • Bachoura A.
        • Weening A.
        • Vrahas M.
        • Smith R.M.
        • Ring D.
        Psychological factors predict disability and pain intensity after skeletal trauma.
        J Bone Joint Surg Am. 2014; 96e20
        • Vranceanu A.M.
        • Barsky A.
        • Ring D.
        Psychosocial aspects of disabling musculoskeletal pain.
        J Bone Joint Surg Am. 2009; 91: 2014-2018
        • Hays R.D.
        • Bjorner J.B.
        • Revicki D.A.
        • Spritzer K.L.
        • Cella D.
        Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items.
        Qual Life Res. 2009; 18: 873-880
        • Hays R.D.
        • Spritzer K.L.
        • Schalet B.D.
        • Cella D.
        PROMIS-29 v2.0 profile physical and mental health summary scores.
        Qual Life Res. 2018; 27: 1885-1891
        • 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
        • Kazmers N.H.
        • Qiu Y.
        • Yoo M.
        • Stephens A.R.
        • Tyser A.R.
        • Zhang Y.
        The minimal clinically important difference of the PROMIS and QuickDASH instruments in a nonshoulder hand and upper extremity patient population.
        J Hand Surg Am. 2020; 45: 399-407 e6
        • Bernstein D.N.
        • Houck J.R.
        • Gonzalez R.M.
        • et al.
        Preoperative PROMIS scores predict postoperative PROMIS score improvement for patients undergoing hand surgery.
        Hand (N Y). 2020; 15: 185-193
        • Chen R.E.
        • Papuga M.O.
        • Nicandri G.T.
        • Miller R.J.
        • Voloshin I.
        Preoperative patient-reported outcomes measurement information system (PROMIS) scores predict postoperative outcome in total shoulder arthroplasty patients.
        J Shoulder Elbow Surg. 2019; 28: 547-554
      1. Patient Reported Outcome Measures. Centers for Medicare & Medicaid Services.
        (Available at:)
        • Yost K.J.
        • Eton D.T.
        • Garcia S.F.
        • Cella D.
        Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients.
        J Clin Epidemiol. 2011; 64: 507-516
        • Puzia M.E.
        • Huberty J.
        • Eckert R.
        • Larkey L.
        • Mesa R.
        Associations between global mental health and response to an app-based meditation intervention in myeloproliferative neoplasm patients.
        Integr Cancer Ther. 2020; 191534735420927780
        • 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
        • London D.A.
        • Stepan J.G.
        • Calfee R.P.
        Determining the Michigan hand outcomes questionnaire minimal clinically important difference by means of three methods.
        Plast Reconstr Surg. 2014; 133: 616-625
        • Becher S.
        • Smith M.
        • Ziran B.
        Orthopaedic trauma patients and depression: a prospective cohort.
        J Orthop Trauma. Oct. 2014; 28: e242-e246
        • Bennett D.
        • Hill J.
        • Beverland D.
        • Kee F.
        The influence of area level social deprivation on preoperative disease severity and postoperative outcomes following unicompartmental knee joint replacement.
        Knee. 2015; 22: 653-658
        • Urwin M.
        • Symmons D.
        • Allison T.
        • et al.
        Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation.
        Ann Rheum Dis. 1998; 57: 649-655
        • London D.A.
        • Stepan J.G.
        • Boyer M.I.
        • Calfee R.P.
        The impact of depression and pain catastrophization on initial presentation and treatment outcomes for atraumatic hand conditions.
        J Bone Joint Surg Am. 2014; 96: 806-814
        • Lozano Calderon S.A.
        • Paiva A.
        • Ring D.
        Patient satisfaction after open carpal tunnel release correlates with depression.
        J Hand Surg Am. 2008; 33: 303-307
        • Utrillas-Compaired A.
        • De la Torre-Escuredo B.J.
        • Tebar-Martinez A.J.
        • Asunsolo-Del Barco A.
        Does preoperative psychologic distress influence pain, function, and quality of life after TKA?.
        Clin Orthop Relat Res. 2014; 472: 2457-2465
        • Copay A.G.
        • Subach B.R.
        • Glassman S.D.
        • Polly Jr., D.W.
        • Schuler T.C.
        Understanding the minimum clinically important difference: a review of concepts and methods.
        Spine J. 2007; 7: 541-546