German Version of the Brief Michigan Hand Outcomes Questionnaire

Abstract

Sir:FigureAssessment of quality of health care is paramount. As such, patient-oriented outcome measures have found their way into clinical practice in our broad specialty of plastic, hand, and reconstructive surgery. However, implementation issues in the real world are hampered by questionnaires, which are time-consuming and thus create a responder burden, limiting the validity of such questionnaires.1 Because language adaptation is key when using such patient-oriented questionnaires, we performed a four-step standardized translation process from an English to a German brief version of the Michigan Hand Outcomes Questionnaire, with forward and backward translation and consensus conferences. (See Document, Supplemental Digital Content 1, which shows the Kurzer Michigan Hand Outcome Questionnaire, https://links.lww.com/PRS/A490.) When Dupuytren disease in considered, recent refinements in the operative technique2 and in the minimally invasive approach using either collagenase injections or needle fasciotomy with or without additional fat grafting3 have been highlighted. However, the quality-of-life perspective is nonetheless somewhat neglected. Previously, we have reported on the validation and language-adaptation of the conventional long version of the Michigan Hand Outcomes Questionnaire in the Journal.4 Applying both, the validated Disabilities of the Arm, Shoulder, and Hand questionnaire and the German-validated Michigan Hand Outcomes Questionnaire long version to a cohort of 113 patients who underwent selective fasciectomy at a mean 27 months previously, Disabilities of the Arm, Shoulder, and Hand scores of 17 ± 20 (95 percent confidence interval, 13.3 to 20.7) and Michigan Hand Outcomes Questionnaire scores of 76 ± 19 (95 percent confidence interval, 72.5 to 79.5) were noted.5 Since May of 2011, collagenase has been approved in Germany. One of our first patients was a 63-year-old woman following radiotherapy with a Dupuytren contracture. Before the collagenase injection, her Disabilities of the Arm, Shoulder, and Hand score was 24 and her brief Michigan Hand Outcomes Questionnaire score was 70 (Fig. 1). After a single collagenase injection in the cord and manual distraction the day after, she improved in the questionnaires 3 weeks after the intervention (Disabilities of the Arm, Shoulder, and Hand score, 16; brief Michigan Hand Outcomes Questionnaire score, 78). At 8-week follow-up, her Disabilities of the Arm, Shoulder, and Hand score had improved to 6 and her brief Michigan Hand Outcomes Questionnaire score had improved to 85 (Fig. 2). Thus, this case illustrates the potential early response to a minimally invasive procedure as a measure for improving quality-of-life in Dupuytren disease.Fig. 1: A 63-year-old female patient with Dupuytren contracture is shown before collagenase injection enzymatic fasciotomy. Her Disabilities of the Arm, Shoulder, and Hand score was 24 of 100, and her brief Michigan Hand Outcomes Questionnaire score was 70 of 100.Fig. 2: Photograph obtained at 8-week follow-up after collagenase injection of the same woman with a treated fourth ray on the patient's left hand (unringed), with a Disabilities of the Arm, Shoulder, and Hand score of 6 and a brief Michigan Hand Outcomes Questionnaire score of 85.Karsten Knobloch, M.D., Ph.D. Robert Kraemer, M.D. Stephan Papst, M.D. Heiko Sorg, M.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Hannover, Germany DISCLOSURE No author received any internal or external funding that might have impacted the results presented herein.