Comprehensive Hand Evaluation Form: Feasibility of Merging the Most Common Hand-Specific Patient-Reported Outcome Measures.

Background and

Objectives

Patient-reported outcome measures (PROMs) are essential for evaluating outcomes in hand surgery, but the broad range of available instruments complicates selection and increases patient burden due to overlapping content. The Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) are the most frequently used PROMs. This study aimed to develop a merged instrument, the Comprehensive Hand Evaluation Form (CHEF), and to test whether CHEF-derived scores are equivalent to the original questionnaires. A secondary objective was to assess equivalence between pain ratings using an 11-item numeric rating scale (NRS) and a visual analogue scale (VAS). Materials and

Methods

In this prospective study, adults with chronic atraumatic hand or wrist conditions completed the CHEF in the outpatient clinic and, three days later, the original DASH-G, MHQ-G, and PRWHE-G by mail. Equivalence was evaluated using two one-sided tests with margins set at half the minimal clinically important difference. Completion times were recorded.

Results

Of the 100 patients, 57 could be included in the final analysis. Equivalence between CHEF-derived and original scores was demonstrated for PRWHE-G (mean difference -2.0; 90% CI -4.4 to 0.4 within ±7). Equivalence was not demonstrated for DASH-G (mean difference -3.5; 90% CI -5.7 to -1.3; margin ±5) or MHQ-G (mean difference 13.3; 90% CI 10.6 to 15.9; margin ±4.5). Thus, equivalence was achieved for one of three instruments. CHEF completion time was significantly shorter than the combined original questionnaires (median 10 vs. 15 min; p < 0.0001). For pain assessment, equivalence between the numeric rating scale and the visual analogue scale was observed at rest but not during activity.

Conclusions

CHEF reduced completion time but achieved score equivalence only for PRWHE-G. These findings suggest that integrated PROM approaches may reduce burden, but do not consistently preserve equivalence across instruments.