Rasch Analysis of the Michigan Hand Questionnaire

Tara Packham*, Joy C. MacDermid, Ruud W. Selles, Harm P. Slijper, Robbert Wouters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


Objectives: The Michigan Hand Questionnaire (MHQ) is a commonly used evaluation for hand problems, but previous work reports conflicting evidence regarding the subscale structures. Rasch analysis uses probabilistic modeling of items and responses: if scale items can be fit to the Rasch model, it provides evidence of construct validity and interval-level measurement for precise statistical estimates. We conducted Rasch analysis on the MHQ to evaluate model fit, unidimensionality of the subscales, bias across person factors, and conversion to interval metrics. 

Methods: We conducted a secondary Rasch analysis of MHQ data from 924 persons with thumb basal joint osteoarthritis using the RUMM2030 software. Modeling was based on responses for the most affected hand and person factors including age, sex, type of work, whether the dominant side was the most affected, and surgical status. The analysis plan followed the published recommendations for examinations of person and item fit, with iterative adjustments as required. 

Results: A total of 11 of the 37 items required rescoring to create orderly progression of scoring thresholds. Only the overall hand function and pain subscales could be fit to the Rasch model, demonstrating unidimensionality and good reliability of fit estimates. Dividing the activities of daily living subscale into unilateral and bilateral activities also allowed unilateral activities to fit the model. Persistent misfitting in other subscales suggested local dependency and response bias across multiple person factors. 

Conclusions: This Rasch analysis of the MHQ raises concerns regarding the validity and fundamental measurement properties of this widely used outcome evaluation when used as a summary score.

Original languageEnglish
Pages (from-to)638-646
Number of pages9
JournalValue in Health
Issue number4
Early online date26 Oct 2021
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
Conflict of Interest Disclosures: Dr MacDermid reported a Canada Research Chair that provided unrestricted funds paid to her institution from the Canadian Institutes of Health Research to support specific projects (eg, funding postdoctoral fellows, pilot studies), project grants from the Canadian Institutes of Health Research for specific research proposals unrelated to this work, research grants that funded attendance to present research findings not related to this work, being on the board of the Orthopedic Research Society, and being a member of multiple research groups. Dr Wouters reported receiving a grant from The Netherlands Organisation for Health and Research Development to perform research. No other disclosures were reported.

Funding Information:
The authors thank all patients who have filled out questionnaires as part of their clinical care and have agreed that their data could be anonymously used for this study. In addition, we acknowledge the members of the Hand-Wrist Study Group, caregivers and personnel of Xpert Clinic and Handtherapie Nederland, and Equipe Zorgbedrijven for assisting in the routine outcome measurements that are the basis for this manuscript. The collaborators of the Hand-Wrist Study Group are R.A.M. Blomme, B.J.R. Sluijter, D.J.J.C. van der Avoort, A. Kroeze, J. Smit, J. Debeij, E.T. Walbeehm, G.M. van Couwelaar, G.M. Vermeulen, J.P. de Schipper, J.F.M. Temming, J.H. van Uchelen, H.L. de Boer, K.P. de Haas, K. Harmsen, O.T. Z?phel, R. Feitz, J.S. Souer, R. Koch, S.E.R. Hovius, T.M. Moojen, X. Smit, R. van Huis, P.Y. Pennehouat, K. Schoneveld, Y.E. van Kooij, J.J. Veltkamp, A. Fink, W.A. de Ridder, H.P. Slijper, R.W. Selles, J.T. Porsius, R.M. Wouters, J. Tsehaie, R. Poelstra, M.C. Jansen, M.J.W. van der Oest, L. Hoogendam, J.S. Teunissen, J. Dekker, M. Jansen-Landheer, M. ter Stege, J.M. Zuidam, C.A. van Nieuwenhoven, L.S. Duraku, C. Hundepool, B. van der Heijden, and J.W. Colaris.

Publisher Copyright:
© 2021


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