Horng Yi-Shiung, Lin Ming-Chuan, Feng Chi-Tzu, Huang Chi-Hung, Wu Hsin-Chi, Wang Jung-Der
Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan.
J Hand Surg Am. 2010 Mar;35(3):430-6. doi: 10.1016/j.jhsa.2009.11.016. Epub 2010 Feb 6.
To compare responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) with that of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in patients with hand injuries. We postulated that the MHQ may be more sensitive to functional changes in the hands, whereas the DASH questionnaire would have a closer association with days of disability.
Patients with hand injuries were consecutively recruited from 2 community hospitals. Each patient was asked to complete out the MHQ, the DASH questionnaire, the satisfaction with their health-related quality of life (Sat-HRQOL) measure, and Chinese Health Questionnaire (CHQ), which is a measure of psychological stressors. Disability days were defined as the duration of restricted activities of daily living during the previous 4 weeks. Patients repeated the same questionnaires between 2 and 9 months after enrollment (average: 4 mo).
A total of 105 patients with hand injuries were recruited, and 50 of the 105 patients returned for the second evaluation. There were no statistical differences between responders and nonresponders for age, gender, disability days, the MHQ, the DASH questionnaire, the CHQ, or the Sat-HRQOL. Responsiveness was evaluated by effect sizes and standardized response means: Those for the MHQ were 0.84 and 1.05, and those for the DASH were 0.67 and 0.86, respectively. A mixed model analysis for repeated measurements of the 50 participants showed a significant influence of psychological factors (CHQ) for both the Sat-HRQOL and disability days. After adjustment for the effects of age, gender, and the CHQ, there was an increment of one Sat-HRQOL unit for an MHQ score increment of 3.2, whereas the score decrement for the DASH questionnaire was 3.3 units.
The MHQ might be slightly more sensitive to functional changes, but the DASH questionnaire seemed more correlated with disability days. Psychological factors are the strongest determinants of the HRQOL and disability.
比较密歇根手部结果问卷（MHQ）与手臂、肩部和手部功能障碍问卷（DASH）对手部受伤患者的反应性。我们推测，MHQ可能对手部功能变化更敏感，而DASH问卷与残疾天数的关联更紧密。
从两家社区医院连续招募手部受伤患者。每位患者都要完成MHQ、DASH问卷、与健康相关生活质量满意度（Sat-HRQOL）测量以及作为心理压力源测量指标的中国健康问卷（CHQ）。残疾天数定义为前4周日常生活活动受限的持续时间。患者在入组后2至9个月（平均4个月）重复填写相同问卷。
共招募了105名手部受伤患者，其中105名患者中有50名返回进行第二次评估。在年龄、性别、残疾天数、MHQ、DASH问卷、CHQ或Sat-HRQOL方面，应答者与无应答者之间无统计学差异。通过效应量和标准化反应均值评估反应性：MHQ的效应量和标准化反应均值分别为0.84和1.05，DASH的分别为0.67和0.86。对50名参与者重复测量的混合模型分析显示，心理因素（CHQ）对Sat-HRQOL和残疾天数均有显著影响。在调整年龄、性别和CHQ的影响后，MHQ评分每增加3.2分，Sat-HRQOL单位增加1分，而DASH问卷评分减少3.3分。
MHQ可能对功能变化稍更敏感，但DASH问卷似乎与残疾天数的相关性更强。心理因素是健康相关生活质量和残疾的最强决定因素。
