Orthopedics and Physical Medicine

brief Michigan Hand Outcomes Questionnaire (briefMHQ): A Full Guide for Researchers and Clinicians

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Introduction

Hand disorders significantly impact daily life, making accurate assessment critical for effective treatment. Consequently, the brief Michigan Hand Outcomes Questionnaire (briefMHQ), a 12-item patient-reported outcome measure, offers a streamlined solution for evaluating hand-specific outcomes. Developed by Jennifer F. Waljee and colleagues in 2011, this tool, derived from the original 37-item Michigan Hand Questionnaire (MHQ), has garnered over 160 citations on Google Scholar, reflecting its widespread adoption. With its robust psychometric properties and concise format, the briefMHQ is invaluable for researchers and clinicians in hand surgery and rehabilitation.

This article explores its structure, applications, and clinical value, providing actionable insights for improving patient outcomes.

Key Features of the brief Michigan Hand Outcomes Questionnaire

Purpose and Use of the brief Michigan Hand Outcomes Questionnaire

The briefMHQ is designed to assess patient-perceived hand function and symptoms in individuals with hand and wrist conditions. Specifically, it evaluates six key domains: hand function, activities of daily living (ADLs), work performance, pain, aesthetics, and satisfaction. Unlike broader musculoskeletal tools, its targeted focus ensures relevance for patients with conditions like Dupuytren contracture or carpal tunnel syndrome, making it a vital instrument in clinical and research settings.

Target Population

The briefMHQ is designed for adults aged 18 and older with hand and wrist conditions, including:

Young adults (18–24 years)
Middle-aged adults (25–44 years)
Older adults (45–64 years)
Seniors (65+ years)

Its versatility suits diverse clinical settings, such as orthopedics and rehabilitation, but it is not validated for pediatric or non-hand-related conditions.

Structure

The briefMHQ comprises 12 items, with two items per domain, ensuring comprehensive yet efficient assessment. Each item uses a 5-point Likert scale, covering 6 domains:

Overall Hand Function: Ability to perform tasks like gripping or lifting.
Activities of Daily Living (ADLs): Ease of performing daily tasks.
Work Performance: Impact of hand issues on professional tasks.
Pain: Severity and frequency of hand pain.
Aesthetics: Satisfaction with hand appearance.
Satisfaction: Overall contentment with hand function.

This structure allows clinicians to pinpoint specific areas of concern, such as pain or work limitations, for tailored interventions.

Scoring Method of the brief Michigan Hand Outcomes Questionnaire

The briefMHQ uses a 5-point Likert scale (1–5) for each of its 12 items. Notably, eight items (1, 2, 3, 4, 8, 9, 11, and 12) require reverse scoring (1=5, 2=4, 3=3, 4=2, 5=1) to align responses. The 12 raw scores are summed (range: 12–60), then averaged across the number of items (range 1-5) and normalized to generate a score that is scaled from 0 (poorest function) to 100 (ideal function) using the formula: 100 x (brief MHQ raw score – 1)/4

Respondents must answer every question in order to calculate the brief MHQ summary score. Higher scores indicate better hand function, with a minimal clinically important difference (MCID) of approximately 7 points, indicating meaningful improvement post-intervention (Wehrli et al. (2016)). However, MCID may vary by condition and study. While no universal cut-off scores exist for diagnosis, clinicians can use domain-specific scores to identify areas like pain or aesthetics for targeted treatment.

Administration Format and Time

The briefMHQ can be administered via:

Paper-based forms
Digital (online) platforms
Mobile apps
In-person interviews
Phone or video calls

This adaptability ensures accessibility in various clinical and research environments. It is highly flexible, taking less than 5 minutes to complete. No training is required as it is Self-administered. The shortened version of the Michigan Hand Questionnaire is a more attractive research instrument for population studies because it is more time-efficient, reduces responder burden, and can therefore minimize missing data.

Applications of the brief Michigan Hand Outcomes Questionnaire

The briefMHQ offers versatile applications for researchers and clinicians:

Screening: Identifies patients with significant hand function impairments.
Monitoring: Tracks changes in hand function over time or post-intervention.
Treatment Planning: Guides tailored interventions based on domain-specific scores.
Research: Supports studies on hand surgery outcomes and rehabilitation efficacy.

For example, a high pain score may prompt analgesic interventions, while a low aesthetics score could indicate a need for counseling on body image.

Languages and Availability

To support global use, the briefMHQ is available in multiple languages, including:

English
French
German
Portuguese
Mandarin Chinese
Persian
As well as Greek, Polish and Turkish

This multilingual availability enhances its applicability across diverse populations. The briefMHQ is copyrighted by the Regents of the University of Michigan, requiring completion of a license for use. While it is copyrighted, it is available for use without charge for non-commercial purposes. For inquiries contact the university at innovationpartnerships@umich.edu or visit the research team website.

Reliability and Validity

The briefMHQ boasts strong psychometric properties, with a Cronbach’s alpha of 0.85–0.91, indicating high internal consistency. Additionally, its test-retest intraclass correlation coefficient (ICC) ranges from 0.87–0.97, demonstrating excellent reliability (Waljee et al., 2011). Validation studies, such as Wehrli et al. (2016), confirm its sensitivity to changes in hand function, making it a robust tool for monitoring treatment outcomes.

Other validation studies include:

Validation of the Frensh version.
Validation of the Portuguese version.
Validation of the Persian version.
Validation of the Turkish version.

Limitations and Considerations

Despite its strengths, the briefMHQ has a few limitations:

Self-Report: Responses may be influenced by social desirability bias or personal interpretation.
Narrow Focus: It does not distinguish between laterality of hand symptoms, limiting specificity.

Additional Resources

For more information on the briefMHQ, explore these resources:

Original Validation Study
Another Validation Study.
Validation studies of other languages: French, Portuguese, Persian, Turkish.
Access the Questionnaire as a PDF.
For inquiries contact the university at innovationpartnerships@umich.edu or visit the research team website.
For additional resources, visit the University of Michigan MHQ website.

Frequently Asked Questions (FAQ)

Who can use the briefMHQ?
Clinicians, researchers, and healthcare providers use the briefMHQ for adults aged 18 and older with hand and wrist conditions.
How long does it take to complete the briefMHQ?
Patients typically complete it in less than 5 minutes, ideal for busy clinical settings.
How is the briefMHQ administered?
It can be administered via paper, digital, mobile app, or interview formats, offering flexibility.
Is there any cost to using the briefMHQ?
The briefMHQ is free for non-commercial use, but a license is required for commercial or funded academic projects.

A word from ResRef about the brief Michigan Hand Outcomes Questionnaire

The brief Michigan Hand Outcomes Questionnaire (briefMHQ) is a validated, 12-item patient-reported outcome measure derived from the original 37-item MHQ. It efficiently assesses hand-specific outcomes across six key domains: overall hand function, activities of daily living (ADLs), work performance, pain, aesthetics, and satisfaction. It provides a comprehensive yet rapid evaluation, scoring each domain and generating a total score (0-100, higher scores indicating better outcomes). The briefMHQ demonstrates strong reliability, validity, and responsiveness, making it a practical and psychometrically robust tool for evaluating treatment effectiveness and patient experiences in both clinical practice and research settings.

References

Waljee JF, Kim HM, Burns PB, Chung KC. Development of a brief, 12-item version of the Michigan Hand Questionnaire. Plast Reconstr Surg. 2011 Jul;128(1):208-220. doi: 10.1097/PRS.0b013e318218fc51. PMID: 21701336; PMCID: PMC3124660. Study link.
Wehrli M, Hensler S, Schindele S, Herren DB, Marks M. Measurement Properties of the Brief Michigan Hand Outcomes Questionnaire in Patients With Dupuytren Contracture. J Hand Surg Am. 2016 Sep;41(9):896-902. doi: 10.1016/j.jhsa.2016.06.009. Epub 2016 Jul 26. PMID: 27469936. Study link.
Efanov JI, Shine JJ, Darwich R, Besner Morin C, Arsenault J, Harris PG, Danino AM, Izadpanah A. French translation and cross-cultural adaptation of the Michigan Hand Outcomes Questionnaire and the Brief Michigan Hand Outcomes Questionnaire. Hand Surg Rehabil. 2018 Apr;37(2):86-90. doi: 10.1016/j.hansur.2017.12.003. Epub 2018 Jan 17. PMID: 29373241. Study link.
Fernandes CH, Neto JR, Meirelles LM, Pereira CN, Dos Santos JB, Faloppa F. Translation and cultural adaptation of the Brief Michigan Hand Questionnaire to Brazilian Portuguese language. Hand (N Y). 2014 Sep;9(3):370-4. doi: 10.1007/s11552-013-9595-5. PMID: 25191170; PMCID: PMC4152426. Study link.
Shariatzadeh H, Najd Mazhar F, Fathi Choghadeh M, Kachooei AR. Cross-Cultural Adaptation, Validation, and Reliability of the Persian Version of the Brief Michigan Hand Questionnaire. Hand (N Y). 2024 Mar;19(2):311-315. doi: 10.1177/15589447221109628. Epub 2022 Jul 25. PMID: 35876280; PMCID: PMC10953514. Study link.
Ergen Hİ, Yiğit S, Maden T, Keskinbıçkı MV. The Turkish version of the brief Michigan hand outcomes questionnaire: cross-cultural adaptation, validity, and reliability testing. Acta Orthop Traumatol Turc. 2024 Nov 8;58(5):286-289. doi: 10.5152/j.aott.2024.23104. PMID: 39560813; PMCID: PMC11583941. Study link.