Michigan Hand Outcomes Questionnaire – Spanish Version

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Abstract

patient-reported outcome measures (PROMs) have become a cornerstone of modern clinical assessment, shifting the focus from purely objective clinical metrics to the patient's subjective experience of their health. The Michigan Hand Outcomes Questionnaire (MHQ) is a premier instrument in this domain, specifically engineered to evaluate the multidimensional impact of hand and wrist conditions. Unlike many generic upper-extremity tools, the MHQ distinguishes itself by assessing the left and right hands independently and incorporating unique psychosocial dimensions such as aesthetics and patient satisfaction.

The recent adaptation and validation of the Spanish version (MHQ-Sp) represents a significant advancement for cross-cultural psychometrics and orthopedic rehabilitation in Spain. By subjecting the translated instrument to rigorous validation protocols—including those outlined by the COSMIN group—researchers have ensured that the MHQ-Sp retains the robust psychometric properties of the original 1998 English version. This adaptation provides Spanish-speaking clinicians and researchers with a highly reliable, structurally sound, and culturally congruent tool to track patient recovery trajectories following surgical or conservative interventions.

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Keywords
patient-reported outcome measures
hand injuries
psychometrics
Cross-cultural adaptation
orthopedics
rehabilitation
Health-Related Quality of Life

📊 Psychometric Scorecard

Items Count
37
Structure
Multidimensional
Cronbach's α
0.82
Validation Country
📍 Spain

Translation Method: Forward-Backward Translation
Clinical Cut-off Scores: MCID > 6.85

Authors

👤 María Visitación Martínez-Fernández

👤 Carmen María Sarabia-Cobo
✉ [email protected]
🏛 University of Cantabria

👤 Nuria Sánchez-Labraca

Purpose

In the realm of orthopedic and rehabilitative medicine, hand and wrist injuries represent a massive proportion of clinical caseloads and occupational accidents. Historically, clinicians relied heavily on objective physical measurements, such as range of motion or dynamometer-based grip strength, to gauge recovery. However, these physiological markers often fail to capture the true functional disability or psychosocial distress experienced by the patient. There is a critical need for standardized tools that quantify the lived experience of hand impairment, particularly in specific cultural contexts where the functional demands and subjective valuation of hand utility may vary.

The MHQ-Sp was developed to bridge this exact gap within the Spanish healthcare system. By providing a culturally adapted and psychometrically validated version of one of the world's most respected hand-specific PROMs, it equips practitioners with a sensitive metric to evaluate treatment efficacy. Whether a patient is recovering from a distal radius fracture, managing carpal tunnel syndrome, or undergoing physiotherapy, the MHQ-Sp allows clinicians to detect clinically meaningful changes over time, thereby facilitating evidence-based, patient-centered care.

Construct

The psychological and functional construct measured by the MHQ-Sp is the comprehensive health status and Health-Related Quality of Life specific to hand and wrist functionality. Rather than treating hand function as a single, monolithic variable, the instrument's theoretical framework deconstructs it into six distinct but interacting domains. This multidimensional approach acknowledges that a hand injury is a biopsychosocial event.

The core functional dimensions evaluate overall hand utility, the ability to perform activities of daily living (ADLs), and occupational performance. These are complemented by a symptom-focused domain measuring pain severity. Crucially, the construct also integrates subjective psychological appraisals through its aesthetics and satisfaction subscales. By measuring how a patient perceives the appearance of their hand and their overall contentment with its function, the scale captures the psychological distress and body-image alterations that frequently accompany traumatic injuries or deforming conditions like osteoarthritis.

Validity

Establishing validity is paramount when adapting an instrument across cultures, as it ensures the translated tool measures the intended psychological and functional constructs. The researchers demonstrated excellent convergent validity by comparing the MHQ-Sp to the widely used DASH questionnaire. As theoretically predicted, the MHQ-Sp exhibited a strong negative correlation with the DASH (r = -0.75) and the DASH-work module (r = -0.63). This inverse relationship makes perfect sense, as the MHQ measures functional ability (higher is better) while the DASH measures disability (higher is worse).

Equally important was the evidence for discriminant validity, which proves the scale is not accidentally measuring unrelated constructs. The MHQ-Sp showed virtually no correlation with the generic EQ-5D quality of life measure (r = -0.01) or with objective grip strength (r = 0.05). This is a fascinating psychometric finding for graduate students to note: it highlights that a patient's subjective perception of their hand function is a highly specific construct that cannot be inferred simply by measuring their raw physical strength or their general, systemic health status.

Convergent & Discriminant Validation Correlations

Reference Instrument Correlation Coefficient (r)
Disabilities of the Arm, Shoulder and Hand (DASH) r=-0.75
DASH-work module r=-0.63

Reliability

The reliability profile of the MHQ-Sp demonstrates exceptional stability and internal consistency, aligning perfectly with stringent psychometric standards. Internal consistency, which evaluates how well items within the same subscale correlate with one another, yielded Cronbach's alpha values ranging from 0.82 to 0.85. This is an optimal range; it is well above the 0.70 threshold required for adequate reliability, yet below the 0.90 mark that often indicates item redundancy or bloat.

Furthermore, the instrument's temporal stability was confirmed through rigorous test-retest reliability analysis. When administered to patients twice over a 10 to 15-day interval—a period during which their clinical status was expected to remain unchanged—the Intraclass Correlation Coefficients (ICC) ranged from 0.74 to 0.91. Coupled with low Standard Error of Measurement (SEM) values between 1.70 and 4.67, these metrics assure clinicians that score fluctuations on the MHQ-Sp reflect genuine clinical changes rather than random measurement error.

Factor Analysis

To verify the structural validity of the Spanish adaptation, the research team utilized both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). In cross-cultural psychometrics, CFA is a critical step to ensure that the translated items still map onto the original theoretical framework designed by the scale's creators.

The CFA was specifically deployed to test the unidimensionality of each of the six individual subscales. By examining various goodness-of-fit indices—such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and the Root Mean Square Error of Approximation (RMSEA)—the researchers confirmed that the items within each domain successfully loaded onto their intended latent factors. This structural confirmation indicates that the translation process preserved the conceptual integrity of the original English MHQ, ensuring that the Spanish version measures the exact same dimensional constructs.

Subscales

Subscale Items Description
Overall hand function Evaluates the general functional capacity and utility of the hand.
Activities of daily living (ADL) Assesses the patient's ability to perform routine daily tasks and self-care.
Work performance Measures the impact of the hand condition on the patient's occupational duties and work efficiency.
Pain Quantifies the severity, frequency, and impact of pain in the affected hand or wrist.
Aesthetics Captures the patient's subjective perception of and psychological reaction to the physical appearance of their hand.
Satisfaction with hand function Evaluates the patient's overall contentment with the current state and capabilities of their hand.

Instrument

Test Type Self-report questionnaire
Format 37 items, 5-point Likert scale
Scoring Raw scores for each domain are converted to a 0-100 scale. The pain domain is reverse-scored. The total score is calculated by summing the six domain scores and dividing by six. Higher scores indicate better hand function.
Language Spanish
Population Medical patients
Age Group 18-65 years
Administration Self-administered (paper or online electronic means)

Scoring & Interpretation Guidelines

Scoring Instructions Raw scores are converted to a 0-100 scale. The pain domain is inverted so that higher scores across all domains consistently indicate better health status.
Cut-off Scores MCID > 6.85

Sample

The validation sample consisted of 262 patients (63.74% male, 36.26% female) aged 18 to 65 years, recruited from the Mutua Montañesa Hospital in Santander, Spain. Participants presented with various acute traumas or neuromusculoskeletal conditions of the hand or wrist, including distal radius fractures, tendon injuries, and carpal tunnel syndrome.

Permissions & Test Year

Permission to translate and validate the instrument was requested and obtained from the original authors (MHQ IR code #3372).

Test Year: 2024

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Cite This Paper

María Visitación Martínez-Fernández, Carmen María Sarabia-Cobo, Nuria Sánchez-Labraca (2024). Michigan Hand Outcomes Questionnaire – Spanish Version. Journal of orthopaedic surgery and research. https://doi.org/10.1186/s13018-024-04723-x

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References
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Michigan Hand Outcomes Questionnaire – Spanish Version Items

✉ Items are not yet available

The scale author has been contacted to obtain permission to share the items. This section will be updated once the items are provided.

Cite this article

Mohammed looti (2026). Michigan Hand Outcomes Questionnaire – Spanish Version. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/michigan-hand-outcomes-questionnaire-spanish-version/

Mohammed looti. "Michigan Hand Outcomes Questionnaire – Spanish Version." PSYCHOLOGICAL SCALES, 12 Aug. 2026, https://scales.arabpsychology.com/s/michigan-hand-outcomes-questionnaire-spanish-version/.

Mohammed looti. "Michigan Hand Outcomes Questionnaire – Spanish Version." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/michigan-hand-outcomes-questionnaire-spanish-version/.

Mohammed looti (2026) 'Michigan Hand Outcomes Questionnaire – Spanish Version', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/michigan-hand-outcomes-questionnaire-spanish-version/.

[1] Mohammed looti, "Michigan Hand Outcomes Questionnaire – Spanish Version," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.

Mohammed looti. Michigan Hand Outcomes Questionnaire – Spanish Version. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.

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