Validating the Michigan Hand Outcomes Questionnaire in patients with rheumatoid arthritis using Rasch analysis

Jayaram, Mayank; Wang, Chang; Wang, Lu; Chung, Kevin C.

doi:10.1371/journal.pone.0254984

Cited by 5 publications

(3 citation statements)

References 29 publications

(32 reference statements)

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“…It is possible that appearance can limit hand function as that both relate to joint deformities. In this case, the 37-item MHQ may be a better option for assessing hand disability in patients with thumb OA because the aesthetics subscale was found to have acceptable fit to the Rasch model in a sample of patients with hand and wrist conditions [ 10 ] and in a sample of patients with rheumatoid arthritis [ 34 ] after modifications were made. Future research would be needed to assess the correlations between the reduced item brief MHQ and the 37-item MHQ in a sample of individuals with thumb OA.…”

Section: Discussionmentioning

confidence: 99%

“…In another Rasch analysis of the 37-item MHQ, three subscales (overall hand function, pain and unilateral activities subscales) were found to be unidimensional and to fit the Rasch model [ 9 ]. On the other hand, a study by Jayaram et al found that with some modifications to the items, the MHQ and all 6 of the subscales fit well to the Rasch model [ 34 ]. When comparing the Rasch analysis findings of the 37-item MHQ [ 9 , 10 , 34 ] and the brief-MHQ, the 37-item MHQ would be more valid and useful for clinicians because the subscale scores would provide valid measures of hand disability.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a study by Jayaram et al found that with some modifications to the items, the MHQ and all 6 of the subscales fit well to the Rasch model [ 34 ]. When comparing the Rasch analysis findings of the 37-item MHQ [ 9 , 10 , 34 ] and the brief-MHQ, the 37-item MHQ would be more valid and useful for clinicians because the subscale scores would provide valid measures of hand disability. Moreover, in this Rasch analysis of the brief MHQ identified local dependence for two sets of items: the items “Difficulty buttoning shirt” and “Wrist motion”, and for the items “Feeling in hands” and “Pain during daily activities”.…”

Section: Discussionmentioning

confidence: 99%

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Rasch analysis of the brief Michigan Hand Questionnaire in patients with thumb osteoarthritis

Killip

MacDermid

Wouters

et al. 2022

BMC Musculoskelet Disord

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Background The brief Michigan Hand Questionnaire (brief MHQ) is a 12-item self-reported measure of hand function for patients with hand disorders which has been validated using Classical Test Theory. Rasch analysis can provide more detailed psychometric information. The purpose of this Rasch analysis is to assess the psychometric properties of the brief MHQ for patients with thumb osteoarthritis, and to make recommendations for improvements to the questionnaire if needed. Methods The Michigan Hand Questionnaire and demographic data were collected from 923 thumb osteoarthritis patients treated in specialized clinics for hand surgery and therapy in the Netherlands. Rasch analysis was performed on the 12 items of the brief MHQ using RUMM 2030 to assess the fit of the brief MHQ to the Rasch model. To determine fit, analysis of fit summary statistics, individual person fit and individual item fit were assessed. Threshold distributions were assessed to identify if any items required rescoring. The Person Separation Index was calculated to measure reliability of the questionnaire. Differential item functioning was assessed to identify item bias, and Principal Component Analysis was performed to identify unidimensionality and local dependence. Results The brief MHQ showed misfit (χ2 = 1312.5, p < 0.0001) with 6 items having disordered thresholds and 9 items requiring rescoring. After deleting 3 of the rescored items due to significant item fit residuals, the brief MHQ had an acceptable reliability (Cronbach’s alpha = 0.79). Misfit to the model (χ2 = 49.6, p = 0.0001), multidimensionality (10.2% of t-tests were significant), and item bias from non-uniform differential item functioning for 7 items across many person variables were still found. Conclusion Although no satisfactory solutions were found to correct the misfit to the Rasch model, it is recommended that the response options of the brief MHQ be rescored, and that items 6, 9 and 10 be removed. The lack of unidimensionality indicates that the items do not represent the singular construct of hand disability and that totalling the scores of the brief MHQ does not provide a valid measure of hand disability for people with thumb osteoarthritis. The 37-item Michigan Hand Questionnaire may provide a better assessment of hand disability for patients with thumb osteoarthritis.

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Section: Discussionmentioning

confidence: 99%