Responsiveness of the Korean Version of the Michigan Hand Outcomes Questionnaire after Carpal Tunnel Release

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Abstract

Background

The Korean version of the Michigan Hand Outcomes Questionnaire (K-MHQ) was recently validated; however, the questionnaire's responsiveness as well as the degree to which the instrument is sensitive to change has not been thoroughly evaluated in a specific condition in Koreans. We evaluated the responsiveness of the K-MHQ in a homogenous cohort of patients with carpal tunnel syndrome (CTS) and we compared it with that of the Korean version of the Disability of the Arm, Shoulder, and Hand Questionnaire (K-DASH), which was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS.

Methods

Thirty-seven patients with CTS prospectively completed the K-MHQ and the K-DASH before and 6 months after surgery. The responsiveness statistics were assessed for both the K-MHQ and the K-DASH by using the standardized response mean (SRM), which was defined as the mean change of the original scores after surgery divided by the standard deviation of the change.

Results

All domains of the K-MHQ significantly improved after carpal tunnel release ( p < 0.001). The SRM for all scales but one (the aesthetics scale) showed large responsiveness of ≥ 0.8. The aesthetics scale showed medium responsiveness of 0.6. The combined function/symptom scale of the K-DASH significantly improved after surgery ( p < 0.001). The SRM of the K-DASH revealed large responsiveness of 0.9.

Conclusions

The K-MHQ was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS, which is comparable not only to the K-DASH, but also to the original version of the MHQ. The region-specific K-MHQ can be useful for outcomes research related to carpal tunnel surgery, especially for research comparing CTS with various other hand and wrist health conditions.

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Most cited references 22

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Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.

K C Chung, M S Pillsbury, M R Walters … (1998)

In this study, psychometric principles were used to develop an outcomes questionnaire capable of measuring health state domains important to patients with hand disorders. These domains were hypothesized to include (1) overall hand function, (2) activities of daily living (ADL), (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. An initial pool of 100 questions was pilot-tested for clarity in 20 patients; following factor analysis, the number of questions was reduced to a 37-item Michigan Hand Outcomes Questionnaire (MHQ). The MHQ, along with the Short Form-12, a generic health status outcomes questionnaire, was then administered to 200 consecutive patients at a university-based hand surgery clinic and was subjected to reliability and validity testing. The mean time required to complete the questionnaire was 10 minutes (range, 7-20 minutes). Factor analysis supported the 6 hypothesized scales. Test-retest reliability using Spearman's correlation demonstrated substantial agreement, ranging from 0.81 for the aesthetics scale to 0.97 for the ADL scale. In testing for internal consistency, Cronbach's alphas ranged from 0.86 for the pain scale to 0.97 for the ADL scale (values >0.7 for Cronbach's alpha are considered a good internal consistency). Correlation between scales gave evidence of construct validity. In comparing similar scales in the MHQ and the Short Form-12, a moderate correlation (range, 0.54-0.79) for the ADL, work performance, and pain scales was found. In evaluating the discriminate validity of the aesthetics scale, a significant difference (p = .0012) was found between the aesthetics scores for patients with carpal tunnel syndrome and patients with rheumatoid arthritis. The MHQ is a reliable and valid instrument for measuring hand outcomes. It can be used in a clinic setting with minimal burden to patients. The questions in the MHQ have undergone rigorous psychometric testing, and the MHQ is a promising instrument for evaluation of outcomes following hand surgery.

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A neurophysiological grading scale for carpal tunnel syndrome.

J D Bland (2000)

Different ways of expressing the severity of carpal tunnel syndrome (CTS) are found in the existing literature and in clinical records. This paper documents the distribution of patients on a scale based upon the nerve conduction study findings, which are largely independent of the exact normal values used in any given laboratory and demonstrate a highly significant linear relationship between the neurophysiological grading and a numerical score derived from the clinical history. Patients with more characteristic stories of CTS generally have higher neurophysiological grades. The scale is as follows: normal (grade 0); very mild (grade 1), CTS demonstrable only with most sensitive tests; mild (grade 2), sensory nerve conduction velocity slow on finger/wrist measurement, normal terminal motor latency; moderate (grade 3), sensory potential preserved with motor slowing, distal motor latency to abductor pollicis brevis (APB) 6.5 ms; extremely severe (grade 6), sensory and motor potentials effectively unrecordable (surface motor potential from APB < 0.2 mV amplitude). Copyright 2000 John Wiley & Sons, Inc.

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Incidence of common compressive neuropathies in primary care.

R Latinovic, M C Gulliford, R A C Hughes (2006)

Apart from carpal tunnel syndrome, there are no population based studies of the epidemiology of compressive neuropathies. To provide this information, new presentations of compressive neuropathies among patients registered with 253 general practices in the UK General Practice Research Database with 1.83 million patient years at risk in 2000 were analysed. The study revealed that in 2000 the annual age standardised rates per 100 000 of new presentations in primary care were: carpal tunnel syndrome, men 87.8/women 192.8; Morton's metatarsalgia, men 50.2/women 87.5; ulnar neuropathy, men 25.2/women 18.9; meralgia paraesthetica, men 10.7/women 13.2; and radial neuropathy, men 2.97/women 1.42. New presentations were most frequent at ages 55-64 years except for carpal tunnel syndrome, which was most frequent in women aged 45-54 years, and radial nerve palsy, which was most frequent in men aged 75-84 years. In 2000, operative treatment was undertaken for 31% of new presentations of carpal tunnel syndrome, 3% of Morton's metatarsalgia, and 30% of ulnar neuropathy.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Orthop Surg

Journal ID (iso-abbrev): Clin Orthop Surg

Journal ID (publisher-id): CIOS

Title: Clinics in Orthopedic Surgery

Publisher: The Korean Orthopaedic Association

ISSN (Print): 2005-291X

ISSN (Electronic): 2005-4408

Publication date (Print): June 2014

Publication date (Electronic): 16 May 2014

Volume: 6

Issue: 2

Pages: 203-207

Affiliations

Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

[* ]Department of Orthopedic Surgery, Gachon University Hospital, Incheon, Korea.

[† ]Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Author notes

Correspondence to: Hyun Sik Gong, MD. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-31-787-7198, Fax: +82-31-787-4056, hsgong@ 123456snu.ac.kr

Article

DOI: 10.4055/cios.2014.6.2.203

PMC ID: 4040382

PubMed ID: 24900903

SO-VID: 839828e4-ed82-4972-a134-517fcf6a4421

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Responsiveness of the Korean Version of the Michigan Hand Outcomes Questionnaire after Carpal Tunnel Release

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Abstract

Background

Methods

Results

Conclusions

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 22

Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.

A neurophysiological grading scale for carpal tunnel syndrome.

Incidence of common compressive neuropathies in primary care.

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