Introduction
The Michigan Hand Outcomes Questionnaire (MHQ) is a pivotal, patient-reported outcome measure designed to assess hand function and quality of life. Since being developed in 1998 at the University of Michigan by Chung, Pillsbury, Walters, and Hayward, the MHQ has subsequently become a cornerstone in its field, gathering over 1,000 citations on Google Scholar. Indeed, this prominence reflects its widespread use in clinical and research settings focused on hand disorders. Furthermore, as it was specifically created for adults aged 18 and older, this comprehensive questionnaire evaluates how hand conditions affect function, pain, work, daily activities, aesthetics, and overall satisfaction. Consequently, it provides researchers and clinicians with critical, nuanced insights to enhance patient care and evaluate treatment efficacy.
This article explores the MHQ’s features, scoring methodology, applications, and limitations, offering a complete resource for orthopedic, plastic surgery, and rheumatology experts.
Key Features of the Michigan Hand Outcomes Questionnaire (MHQ)
Purpose and Use
The MHQ measures the quality-of-life impact of various hand conditions, including arthritis, trauma, and post-surgical recovery. Moreover, the MHQ is a hand-specific instrument. Consequently, this focus makes it exceptionally well-suited for clinical trials and treatment evaluations where detailed insights into hand function are paramount.
Target Population
Designed for patients aged 18 and older with hand conditions, including:
- Young Adults (18-24 years).
- Middle-Aged Adults (25-44 years).
- Older Adults (45-64 years).
- Seniors (65+ years).
However, it is not validated for pediatric populations, which ensures its specificity for adult patient care.
Structure
The MHQ is composed of 37 items organized into six distinct domains. Notably, several questions are hand-specific and are therefore asked separately for the right and left hands and the printed form therefore contains more response fields.
- Overall Hand Function (5 items): Assesses the ability to perform tasks like gripping and writing. (1 = “Very good” to 5 = “Very poor”).
- Activities of Daily Living (ADLs) (12 items): Evaluates difficulty with routine activities such as eating and dressing. (1 = “Not at all difficult” to 5 = “Very difficult”).
- Work Performance (5 items): Measures the impact of the hand condition on job-related tasks (1 = “Always” to 5 = “Never”).
- Pain (5 items): Covers the severity, frequency, and interference of hand pain. Frequency (1 = “Always” to 5 = “Never”). Severity (1 = “Very mild” to 5 = “Very severe”)
- Aesthetics (4 items): Assesses the patient’s satisfaction with the appearance of their hands. (1 = “Strongly agree” to 5 = “Strongly disagree”).
- Satisfaction (6 items): Measures overall contentment with hand function and treatment outcomes. (1 = “Very satisfied” to 5 = “Very dissatisfied”).
Scoring Method
The MHQ employs a domain-specific scoring system that transforms raw scores into a standardized scale.
- Scale Conversion: Raw scores from the 5-point Likert scales (1-5) transformed to a 0-100 scale for each domain. For more information you can see link
- Score Interpretation: For all domains except Pain, higher scores indicate better function or satisfaction. Conversely, for the Pain domain, a higher score signifies worse pain.
- Overall Score Calculation: An overall MHQ score can be obtained by summing the scores for all six scales after reversing the pain scale (pain=100-pain score) and then dividing by six.
- Hand-Specific Scoring: For the affected hand, clinicians can use either the right or left-hand score. If both hands are affected, the scores are averaged to produce a combined score. Detailed instructions are available on the official MHQ website.
- (MHQ) does not have universally established clinical cut-off scores, as it was designed primarily to track changes in individual patients rather than for diagnostic classification.
Administration Format
The MHQ takes 10-15 minutes to be completed and can be conducted efficiently through various formats:
- Paper-based forms
- Digital (Online) platforms
- Interview (In-person)
- Phone/Video call
Furthermore, its self-administered format requires no specialized training, which adds to its practicality in busy clinical environments.
Applications of the Michigan Hand Outcomes Questionnaire
The MHQ serves multiple crucial roles in orthopedics, plastic surgery, and rheumatology:
- Screening: Identifies patients with significant functional impairments due to hand conditions.
- Monitoring: Tracks changes in function and satisfaction over time, particularly in response to surgical or therapeutic interventions.
- Treatment Planning: Guides clinicians in tailoring therapies based on specific patient-reported deficits and goals.
- Research: Widely used in clinical trials to evaluate treatment efficacy, as evidenced by its extensive citations.
Languages and Availability
The MHQ is available in a wide array of languages, ensuring its utility in global research. Available translations include:
- Arabic
- English
- Mandarin Chinese
- Spanish
- French
- German
- other.
The MHQ is a copyrighted instrument held by the Regents of the University of Michigan, and therefore requires permission for use. Moreover, this proprietary license ensures proper usage and adherence to distribution guidelines
Reliability and Validity
The MHQ is recognized as a highly reliable and valid instrument for assessing hand-related outcomes. Furthermore, its robust psychometric properties are demonstrated by excellent internal consistency, with a Cronbach’s alpha ranging from 0.86 to 0.97. Moreover, it has shown strong test-retest reliability with an Intraclass Correlation Coefficient (ICC) greater than 0.80.
- Original Validation Study link.
- assessment of responsiveness to clinical change study link.
- The Michigan hand outcomes questionnaire after 15 years of field trial study link.
- Arabic Validation Study link.
- Spanish Validation Study link.
- Japanese Validation Study link.
- Italian Validation Study link.
- Turkish Validation Study link.
Limitations and Considerations
Despite its strengths, the MHQ has a few limitations:
- Length: Some patients may find the 37-item questionnaire lengthy to complete.
- Self-report: Respondents may be influenced by personal interpretation or biases.
- Cultural Bias: cultural factors may influence responses, requiring careful cross-cultural adaptation.
- Age Restrictions: The tool is not validated for use in individuals under 18 years of age.
Other Versions and Related Questionnaires
Several alternative versions of the questionnaire have been developed to suit different clinical needs, including:
- MHQ-SF (Short Form)
- bMHQ (brief MHQ)
- MHQ for specific conditions (e.g., for Carpal Tunnel Syndrome or Rheumatoid Arthritis)
Researchers should be aware of related questionnaires that can be used alongside with the MHQ such as:
- Disabilities of the Arm, Shoulder, and Hand (DASH): Assesses a broader range of upper-extremity symptoms and function.
- QuickDASH: A shortened version of the DASH for more rapid assessment.
- Boston Carpal Tunnel Questionnaire (BCTQ): Focuses specifically on symptoms and severity related to carpal tunnel syndrome.
Additional Resources
- The Original Validation Study link.
- You can access the questionnaire as a PDF through this link.
- For inquiries, contact the MHQ Research Team at the University of Michigan.
- For additional MHQ resources, consult the official MHQ website.
Frequently Asked Questions (FAQ)
- Who can use the MHQ?
Clinicians, researchers, and healthcare providers use the MHQ for patients aged 18 and older with hand disorders. - How long does it take to complete the MHQ?
Patients typically take 10 to 15 minutes to complete the MHQ, which makes it feasible for use in clinical and research settings. - How is the MHQ administered?
Healthcare teams can administer the questionnaire via paper-based, digital (online), interview (in-person), or phone/video call formats—offering flexibility in usage. - Is there any cost to using the MHQ?
The MHQ is copyrighted and requires permission for use, which can be obtained by contacting the University of Michigan.
A Word from ResRef about the Michigan Hand Outcomes Questionnaire (MHQ)
The MHQ is a robust, well-validated tool for assessing hand-related outcomes in clinical and research settings. In fact, considered a gold standard, its comprehensive structure and strong psychometric properties make it indispensable for anyone serious about measuring hand function accurately. For instance, whether you are a researcher evaluating a new surgical technique or a clinician monitoring patient recovery, the MHQ reveals critical areas that need attention. Consequently, its use leads to better outcomes and more informed treatment decisions.
References
- Chung, K. C., Pillsbury, M. S., Walters, M. R., & Hayward, R. A. (1998). Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. The Journal of Hand Surgery, 23(4), 575–587. Link
- Chung, K. C., Hamill, J. B., Walters, M. R., & Hayward, R. A. (1999). The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change. Annals of Plastic Surgery, 42(6), 619–622. Link.
- Shauver, M. J., & Chung, K. C. (2013). The Michigan hand outcomes questionnaire after 15 years of field trial. Plastic and Reconstructive Surgery, 131(5), 779e–787e. link.
- Ahmed, S. M., Abd ElRashed, N. A., Rasheed, A. N., & Kamel, N. M. (2024). Validity and Reliability of Arabic Version of Michigan Hand Outcomes Questionnaire in Assessment of Hand Function Post Burn. Egyptian Journal of Hospital Medicine, 96(1), 2763-2769. Link.
- Martínez-Fernández, M. V., Sarabia-Cobo, C. M., & Sánchez-Labraca, N. (2024). Cross-cultural adaptation, reliability, validity and responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ-Sp) in Spain. Journal of Orthopaedic Surgery and Research, 19(1), 256. Link.
- Oda, T., Abe, Y., Katsumi, Y., Ohi, H., Nakamura, T., & Inagaki, K. (2016). Reliability and Validity of the Japanese Version of the Michigan Hand Outcomes Questionnaire: A Comparison with the DASH and SF-36 Questionnaires. Journal of Hand Surgery (Asian-Pacific Volume), 21(1), 72–77. Link.
- Passiatore, M., De Vitis, R., Cilli, V., Milano, G., Saccomanno, M. F., Cotroneo, C., Brozzini, E., Vigliarolo, D., & Taccardo, G. (2021). The Italian Version of the Michigan Hand Outcomes Questionnaire (MHQ): Translation, Cross-Cultural Adaptation and Validation. Journal of Hand Surgery (Asian-Pacific Volume), 26(4), 666–683. Link.
- Öksüz, Ç., Akel, B. S., Oskay, D., Leblebicioğlu, G., & Hayran, K. M. (2011). Cross-cultural adaptation, validation, and reliability process of the Michigan Hand Outcomes Questionnaire in a Turkish population. The Journal of Hand Surgery, 36(3), 486–492. Link.
