Which outcome measure is the best? Evaluating responsiveness of the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Michigan Hand Questionnaire and the Patient-Specific Functional Scale following hand and wrist surgery

Abstract

The purpose of this study was to determine and compare the responsiveness of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Michigan Hand Questionnaire (MHQ), and the Patient-Specific Functional Scale (PSFS) in patients with carpal tunnel syndrome, wrist pain, finger contracture, or tumor. Eighty-one subjects prospectively completed each questionnaire shortly before and 3 and 6 months after surgery. Data were analyzed using one-way analysis of variance and Newman-Keuls multiple comparison tests. Responsiveness to clinical change was calculated using standardized response means. The DASH was responsive for those with carpal tunnel syndrome (0.77), wrist pain (0.61), and tumor (0.55); the MHQ was responsive for those with carpal tunnel syndrome (1.04), wrist pain (0.87), and finger contracture (0.62); and the PSFS was responsive for those with carpal tunnel syndrome (0.65) and finger contracture (0.64). The interval during which the highest responsiveness occurred for the carpal tunnel, wrist pain, and finger contracture groups was the preoperative to 6-month period. The tumor group experienced the highest responsiveness during the preoperative to 3-month period. Our results indicate that one or more of the instruments evaluated are suitable for outcomes research related to surgery to treat carpal tunnel syndrome, wrist pain, finger contracture, and tumor.

Figures

Figure 1

DASH, MHQ, and PSFS mean preoperative, 3-month postoperative, and 6-month postoperative scores. a Whole sample (n = 81); b carpal tunnel group (n = 20); c wrist pain group (n = 21); d finger contracture group (n = 34); e tumor group (n = 6). *Three-month mean score significantly differs from respective preoperative mean score. ‡Six-month mean score significantly differs from respective 3-month mean score. DASH scores are reversed so that a higher score reflects less disability. Error bars represent standard deviation.

Figure 2

Standardized response means (SRM) for all questionnaires and all groups from preoperative to 3-month, preoperative to 6-month, and 3- to 6-month periods. a Whole sample (n = 81); b carpal tunnel group (n = 20); c wrist pain group (n = 21); d finger contracture group (n = 34); e tumor group (n = 6).

Figure 3

Standardized response means (SRM) for all questionnaires for the preoperative to 3-month period including subjects who completed at least baseline and 3-month questionnaires. a Carpal tunnel group (n = 46); b wrist pain group (n = 33); c finger contracture group (n = 61); d tumor group (n = 13).