German Standardized Translation of the Michigan Hand Outcomes Questionnaire for Patient-Related Outcome Measurement in Dupuytren Disease

Abstract

Sir: As highlighted in a recent article in the Journal, patient satisfaction outcomes in plastic and hand surgery are rare and often unvalidated,1 with a need for further refinement in the future. In hand surgery, the Disabilities of the Arm, Shoulder and Hand outcome measure has been used in a number of clinical trials.2 The Disabilities of the Arm, Shoulder and Hand questionnaire has good validity with the quality of life subscale of the Medical Outcomes Study 36-Item Short Form Health Survey.3 However, side differences of the hand are often not adequately displayed because the “better” hand often scores higher than the “impaired” hand. As such, Disabilities of the Arm, Shoulder and Hand values for Dupuytren disease can be reported as good despite limited range of motion.4 Another study of 46 patients undergoing selective aponeurectomy reported a baseline Disabilities of the Arm, Shoulder and Hand score of 12 ± 13 and 7 ± 9 at 10 months postoperatively.5 The Michigan Hand Outcomes Questionnaire was implemented in 1998 by Kevin C. Chung to provide a patient-related outcome measure.6 It is responsive to clinical change7 and has been used in a number of hand disorders such as in Dupuytren disease. One feature of the Michigan Hand Outcomes Questionnaire are side-specific questions (i.e., left hand, right hand, both hands), which is of special consideration especially in Dupuytren disease, where often one hand is involved to a more severe degree. A surgical trial demonstrated an improvement in the Michigan Hand Outcomes Questionnaire score from 58 ± 16 to 75 ± 16 at 3 months following selective aponeurectomy and to 87 ± 12 at 14 months following selective aponeurectomy.8 Because language adaptation is key to use of the Michigan Hand Outcomes Questionnaire in a different lingual environment, we sought to translate the Michigan Hand Outcomes Questionnaire to German as an additional patient-related outcome measure. To date, validated translations of the Michigan Hand Outcomes Questionnaire have been posted in Dutch, Spanish, Chinese, and Japanese. The Michigan Hand Outcomes Questionnaire was translated using a team of translators fluent in both English and the desired language (German). The translation process consisted of the following components: Forward translation: Two translators independently translated the Michigan Hand Outcomes Questionnaire from English to German. The translators then met to evaluate both translations and arrive at a consensus version. Backward translation: Two other translators independently translated the new version of the Michigan Hand Outcomes Questionnaire from German into English. The backward translation version was compared with the original English version. All four translators then met to discuss and resolve any discrepancies. See Document, Supplemental Digital Content 1, for the validated German version of the Michigan Hand Outcomes Questionnaire, which we plan to use prospectively in Dupuytren disease trials as an additional valuable patient-reported outcome measure, https://links.lww.com/PRS/A347. Karsten Knobloch, M.D. Marie Kuehn Stephan Papst, M.D. Robert Kraemer Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany