JMIR Publications

ABSTRACT

Background:

The Michigan Hand Outcomes Questionnaire (MHQ) is a key instrument for assessing hand and wrist conditions, but a validated version for European Portuguese speakers is unavailable. Furthermore, the potential of an electronic version to improve data collection and clinical workflows has not been formally evaluated.

Objective:

This study aimed to translate and culturally adapt the MHQ for European Portuguese and to evaluate the measurement properties and comparability of its paper and electronic versions.

Methods:

An observational study was conducted in three phases: 1 - translation and expert review; 2 - content validation through cognitive interviews; 3 - psychometric evaluation in a cohort of 81 adult patients with hand conditions. For structural validity, confirmatory factor analysis (CFA) was planned, followed by a post-hoc exploratory factor analysis (EFA) in case of model misfit or non-convergence. Further analysis included internal consistency (Cronbach’s alpha [α], McDonald’s omega [ω]), measurement error (Standard Error of Measurement [SEM]), relative and absolute reliability (intraclass correlation coefficient [ICC], Spearman’s correlation coefficient [ρ], Bland-Altman analysis). The electronic version’s usability was assessed with the System Usability Scale (SUS).

Results:

The European Portuguese MHQ demonstrated excellent internal consistency (α = 0.85-0.98; ω = 0.88-0.99), but the original six-factor structure could not be confirmed due to model non-convergence, prompting an exploratory analysis. While group-level relative reliability between formats was strong (ρ = 0.68–0.91; ICC = 0.76–0.95), individual-level absolute reliability was poor, with wide 95% limits of agreement spanning a 32.83-point interval. The electronic version was the preferred format (58.1%), showed acceptable usability (median SUS score = 70 [66-88]), and demonstrated superior metric precision with a lower SEM in key domains like pain and overall function.

Conclusions:

The European Portuguese MHQ is a reliable instrument suitable for group-level assessment in clinical research, though its factor structure requires further investigation. Due to significant random error between formats, a single version must be used consistently for longitudinal patient monitoring. Given its superior precision and user preference, the electronic version is recommended as the primary tool for clinical and research applications.