7 Essential Questionnaires for Hand, Wrist and Finger Injuries | Hand Therapy
Clinical questionnaires and scales serve as excellent tools that enable us to facilitate a critical aspect of treating wrist, hand, and finger pathologies or injuries: monitoring and assessing progress and clinical outcomes.
Constantly monitoring and objectively assessing the progression of injuries and pathologies such as distal radius fracture, carpal tunnel syndrome, thumb basal joint arthritis, or recently operated Dupuytren’s contracture enables us to optimize our treatment and make clinical decisions in Hand Therapy, or even consider Hand Surgery.
Currently, it exist hundreds of clinical questionnaires and scales available, but only a few have been validated through scientific studies and designed by experts in the field. The fact that seasoned professionals in Hand Surgery and Hand Therapy have developed these scales allows us to enhance our patient interviews and assessments.
Furthermore, these scales can be used not only in paper form but are also available in digital formats on digital platforms to streamline processing and transmission. This is where telemedicine and telerehabilitation come into play, simplifying monitoring using just a laptop or computer.
Did you know that proper patient progress monitoring promotes treatment adherence? 👇
For all of this, we’ve condensed in this post the 7️⃣ most commonly used Clinical Questionnaires in scientific literature for hand therapy and rehabilitation.
1️⃣ Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire
Among the most commonly used questionnaires in scientific literature is the DASH questionnaire. This scale is a patient self-administered questionnaire widely utilized in musculoskeletal disorders of the upper limb. Specifically, it assesses the function of the upper limb and any clinical changes associated with an intervention in the past week.
It consists of a total of 6 subscales comprising a total of 30 questions:
1) Activities of Daily Living (21 items)
2) Social Activities (1 item)
3) Work Activities (1 item)
4) Symptoms (5 items)
5) Sleep (1 item)
6) Confidence (1 item)
Additionally, it has a total of 2 optional modules: 1) Sports/Hobbies (4 items) and 2) Work (4 items).
There are 5 response options for each item, ranging from 1 (no difficulty, no symptoms, or no impact) to 5 (unable to perform, very severe symptoms, or high impact), and the overall score ranges from 0-100.
The DASH questionnaire is one of the most extensively studied, with notable psychometric values.
Based on a 2014 study, a MCID (Minimal Clinically Important Difference) of 10.83 points was calculated for a moderate improvement in the DASH questionnaire (Franchignoni F et al 2014).
I´’m leaving you the link to the original article of the DASH scale.
2️⃣ QuickDASH Questionnaire
The QuickDASH questionnaire is a shortened version of the DASH questionnaire.
It includes a total of 5 subscales comprising a total of 11 items:
1) Activities of Daily Living (5 items)
2) Social and Work Activities (2 items)
3) Recreational Activities (1 item)
4) Severity of Symptoms (2 items)
5) Sleep (1 item)
It also has a total of 2 optional modules: 1) Sports/Hobbies (4 items) and 2) Work (4 items).
It employs the same 5-point Likert scale (1-5) to yield a final score of 0-100, where a higher score corresponds to greater functional limitation. To obtain the final raw score, a minimum of 10 out of 11 items must be answered.
Based on a 2014 study, a Minimal Clinically Important Difference (MCID) of 15.91 points was calculated for a moderate improvement in the QuickDASH (Franchignoni F et al 2014).
I’m leaving you the link to the original article of the QuicKDASH Questionnaire.
3️⃣ Michigan Hand Outcome Questionnaire (MHQ)
The Michigan Hand Questionnaire (MHQ) assesses the self-perception of the hands in terms of function, appearance, pain, and satisfaction. It is designed for patients who have hand and wrist injuries and conditions, including arthritis.
The MHQ consists of a total of 6 subscales with 37 items:
1) Function (5 items)
2) Activities of Daily Living (5 items for unilateral evaluation or 7 for bilateral)
3) Work (5 items)
4) Pain (5 items)
5) Aesthetics (4 items)
6) Satisfaction (6 items)
Each item is rated on a scale of 1 to 5. The scale yields normalized scores ranging from 0-100 for each subscale, where a higher score implies a better condition, except in the pain subscale, where a higher score is associated with more pain.
A Minimal Clinically Important Difference (MCID) of 13 points on the global MHQ scale has been defined (London DA et al 2014).
Although it is a comprehensive questionnaire, one of the challenges is that it takes approximately 15-20 minutes to complete.
I’m leaving you the link to the original article of the MHQ Questionnaire.
4️⃣ Patient Rated Wrist Evaluation (PRWE) Questionnaire
The Patient-Rated Wrist Evaluation (PRWE) is a self-reported scale designed to assess wrist pain and disability over the past week in pathologies such as Radius Fractures, Carpal Fractures (scaphoid fractures, triquetrum fractures, etc.).
It consists of 15 items grouped into 2 subscales:
1) Pain (5 questions)
2) Function (divided into Specific Activities, 6 questions, and Routine Activities, 4 questions).
Responses range from 0 to 10, and the values from both subscales are combined to provide an overall score. A lower score indicates a better functional status of the hand.
Walenkamp M and colleagues (2015) conducted an analysis in patients with distal radius fractures using the PRWE scale, and they obtained a Minimal Clinically Important Difference (MCID) value of 11.5 points.
I’m leaving you the link to the original article of the PRWE Questionnaire.
5️⃣ Boston Carpal Tunnel Questionnaire (BCTQ)
The Boston Carpal Tunnel Questionnaire (BCTQ) is a patient self-administered questionnaire specifically designed for patients with Carpal Tunnel Syndrome or patients with Median Nerve disfunction.
It includes two subscales with a total of 19 items: 1)
1) Functional Status (total of 40 points)
2) Symptom Severity, divided into Pain (25 points), Tingling (20 points), and Weakness (10 points)
Responses to the questions range from 1-5, with lower scores indicating better symptom and functional status.
The Boston questionnaire for carpal tunnel syndrome was validated several years ago and is recommended for use by the 2019 Clinical Practice Guidelines for this condition.
6️⃣ FIHOA Questionnaire (Functional Index for Hand Osteoarthritis)
The FIHOA scale is a patient self-reported or healthcare professional-administered scale specifically designed for osteoarthritis or arthrosis in the hands, evaluating the functional status of the segment (Dreiser RL et al 1995)
It consists of 10 questions about tasks such as using a key, cutting different objects, lifting objects, buttoning, using tools, writing, and shaking hands.
Responses range from 0 (possible without difficulty) to 3 (impossible), resulting in a final score between 0-30, where lower values indicate a better functional state of the hand.
There is a website where you can obtain the scale score automatically: FIHOA Web ✅
💡Interested in Hand Osteoarthritis? Check out our New Blog on 10 Must-Have Tips for Hand & Thumb Osteoarthritis Assessment
7️⃣ Fugl-Meyer Upper Limb Questionnaire
The Fugl-Meyer scale is a healthcare professional-reported scale designed to assess the motor function of the upper limb with neurological impairment after stroke.
It comprises a total of 33 items in 4 subscales:
1) Upper Extremity (36 points)
2) Wrist (10 points)
3) Hand (14 points)
4) Coordination/Speed (6 points)
Each item has response options of 0 (unable to perform), 1 (partially performs), or 2 (performs completely), resulting in a final score ranging from 0 to 66 points, where a higher score indicates better motor function.
According to the study by Page S. and colleagues (2012), the FM-MS scale had a mean Minimal Clinically Important Difference (MCID) estimated at 5.25 points. However, the value could range from 4.25 points to 7.25 points depending on the type of stroke the patient has.
The Fugl-Meyer Scale was developed in 1975.
💡What more? Learn 12 Clinical Questionnaires recommended by international Clinical Practice Guidelines in Upper Limb Stroke Rehabilitation.
Download the 7️⃣ most commonly used questionnaires in Hand Therapy and Surgery for FREE!
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As we’ve seen, the use of validated scales or questionnaires allows us to enhance patient care and improve our decision-making process. However, at times, using these paper-based questionnaires in the clinic can be cumbersome (time-consuming, result calculations, material organization, etc.).
It’s much simpler to have them filled out digitally and conveniently at the patient’s home. This way, time in the clinic would be saved, and comprehension would be facilitated. This is one of the benefits offered by the Telerehabilitation ReHand System.
ReHand and the Monitoring System with Scales and Questionnaires to Your Smartphone or Tablet
In a glance, ReHand is the result of the joint work of a team of hand therapists, hand surgeons and engineers after two multicenter clinical trials involving more than 600 patients.
ReHand’s technology combines the latest scientific evidence in sensorimotor system approach with artificial intelligence to facilitate the prescription of exercise programmes and optimize your patients’ health outcomes.
ReHand is more than an app, is a tool for us, the healthcare professionals, which consists of three systems:
A) Prescription system (Dashboard): allows us to prescribe a tailored exercise programmes to our patient according to his or her pathology.
B) Treatment system (ReHand App): allows our patient to access their exercise programme anywhere with an app.
C) Monitoring system (Reports): allow us to receive weekly objective information about the adherence to treatment and evolution of our patient.
Are you interested in sending questionnaires to your patient’s mobile device? Do you want closer patient monitoring?
References
Lloyd-Hughes H, Geoghegan L, Rodrigues J, Peters M, Beard D, Price A, et al. Systematic Review of the Use of Patient Reported Outcome Measures in Studies of Electively-Managed Hand Conditions. J hand Surg Asian-Pacific Vol. 2019;24(3):329–41.
Hammond A, Prior Y, Tyson S. Linguistic validation, validity and reliability of the British English versions of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and QuickDASH in people with rheumatoid arthritis. BMC Musculoskelet Disord. 2018;19(1):1–11.
Poole JL. Measures of hand function: Arthritis Hand Function Test (AHFT), Australian Canadian Osteoarthritis Hand Index (AUSCAN), Cochin Hand Function Scale, Functional Index for Hand Osteoarthritis (FIHOA), Grip Ability Test (GAT), Jebsen Hand Function Test (JHFT). Arthritis Care Res. 2011;63(SUPPL. 11).
Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties. Neurorehabil Neural Repair. 2002;16(3):232–40.
Pablo Rodríguez Sánchez-Laulhé
PhD Candidate | PT & eHealth Researcher
