Hands are complex limbs that consist of bones, nerves, muscles, tendons, ligaments, arteries, and veins [
The study was approved by the ethical committee of the Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
The permission to translate the MHQ was given by the developer, the Department of Plastic Surgery, University of Michigan School of Medicine. The study followed the Beaton protocol for the cross-cultural adaptation of self-reporting measures [
Initial translation. The questionnaire was translated from English to Thai by bilingual translators whose mother tongue was Thai [
Merge translation. The two translations were merged into a single translation. Then, the differences between the two translations were discussed and addressed by the authors. The merged version was called the MHQ-T12.
Back translation. The merged translation (MHQ-T12) was translated back into English. Then, without being given any information on the original version, two native English speakers were asked to produce two independent English versions (MHQ-BT1 and MHQ-BT2). This step was to ensure that the translated version reflected the same item content as the original version.
Expert committee. A panel of experts, including an occupational therapist, a language professional, and four translators, discussed MHQ-BT1 and MHQ-BT2 in order to produce a prefinal version of the questionnaire for field testing. The aim of the discussion was to achieve semantic, idiomatic, experiential, and conceptual equivalence.
Testing of the prefinal version. Before field testing, content validity of the prefinal version was evaluated. Three occupational therapists, who had been working with patients with hand injuries for more than five years, were asked to score each item for the degree to which it measured the specific objective listed by the test developer. The scoring system for each questionnaire item was as follows:
+1 = clearly measuring 0 = unclear −1 = clearly not measuring
The item-objective congruence (IOC) value for each item was calculated using the summation of scores from each occupational therapist, divided by the number of occupational therapists.
For further confirmation, the prefinal version was tested on ten patients who had hand injuries due to orthopedic conditions. They were asked to rate how fully they could understand the items and how easily they could answer the questionnaire.
Submission of documentation to the developers. In the last step, all the reports and forms were submitted to the developers to allow them to keep track of the translated version.
The content and construct validity, internal consistency, and test-retest reliability were examined. The number of participants of 30 was the minimum sample size suggested by many statisticians [
The gathered data were analyzed using SPSS for Windows version 17. The patients’ characteristics, MHQ scores, and distribution of the scores were calculated. The content validity was assessed using the item-objective congruence (IOC) value. An IOC value of 0.5 or more was considered satisfactory [
Even though both of the forward translation versions (MHQ-T1 and MHQ-T2) differed in style with regard to sentence composition, the meaning was found to be the same. After discussion, the MHQ-T12 was finalized. Then, back translation was carried out and two back translated versions were produced. Both were confirmed to have retained the questionnaire’s original meaning. Turning to the process undertaken by the expert committee, the meaning of the word “job” in Thai, in the section on demographic data, was discussed, and one word was selected that fitted best with the original questions.
An average IOC of 0.972 indicated good content validity [
Ten patients with orthopedic hand injuries, of whom eight were female and two were male, participated in the field test. All of them were right handed. Eight patients had right hand injuries while the rest had left hand injuries. All the patients could answer the MHQ-Thai version without any assistance from the researcher. They had no difficulty in understanding the questionnaire. Therefore, none of them recommended any changes in the language used. The final version was approved and will become available on the MHQ website (
The demographic data for the 30 patients with hand injuries are shown in Table
Demographic data of participants (
Demographic data | Number of patients (%) |
---|---|
Gender | |
Male | 9 (30) |
Female | 21 (70) |
Education | |
None | 1 (3.33) |
Primary education | 8 (26.67) |
Secondary education | 9 (30) |
Diploma | 7 (23.33) |
Undergraduate | 5 (16.67) |
Graduate | 0 (0) |
Dominant side | |
Right | 25 (83.33) |
Left | 5 (16.67) |
Affected side | |
Right | 15 (50) |
Left | 12 (40) |
Both | 3 (10) |
Cause of injury | |
Bone injury: fracture | 14 (46.67) |
Joint degeneration: arthritis and subluxation | 3 (10) |
Muscle, tendon, and ligament injury | 11 (36.67) |
Nerve injury | 1 (3.33) |
Unknown | 1 (3.33) |
Previous work | |
Yes | 24 (80) |
No | 6 (20) |
Occupation after injury | |
Yes | 12 (40) |
No | 18 (60) |
Income | |
Up to 5000 baht | 9 (30) |
5000-10,000 baht | 9 (30) |
10,001-15,000 baht | 4 (13.33) |
15,001-20,000 baht | 4 (13.33) |
Above 20,000 baht | 4 (13.33) |
Family income | |
Up to 10,000 baht | 4 (13.33) |
10,001-20,000 baht | 7 (23.33) |
20,001-30,000 baht | 10 (33.33) |
30,001-40,000 baht | 6 (20) |
Above 40,000 baht | 3 (30) |
Medical expense reimbursement plan | |
Yes | 25 (83.33) |
Social security scheme | 6 (20) |
Universal coverage scheme | 11 (36.67) |
Government enterprise officer | 8 (26.67) |
No (self-supporting) | 5 (16.67) |
Worker compensation scheme | |
Yes | 6 (20) |
No | 24 (80) |
The MHQ scores for the six domains are shown in Table
The MHQ-Thai version score for the six domains (
Domains | First assessment | Second assessment | ||
---|---|---|---|---|
Mean | SD | Mean | SD | |
Overall function | 65.50 | 18.88 | 68.92 | 18.66 |
ADL | 62.18 | 23.87 | 65.89 | 26.99 |
Work performance | 46.17 | 27.09 | 45.17 | 27.50 |
Pain | 23.83 | 21.99 | 21.75 | 21.25 |
Aesthetics | 72.09 | 15.13 | 75.21 | 16.41 |
Satisfaction | 66.67 | 23.40 | 69.65 | 23.16 |
Total | 64.79 | 18.75 | 67.18 | 19.58 |
Each domain in the MHQ-Thai version was correlated with the other domains with different levels of correlation coefficients, ranging from low to high, as shown in Table
Construct validity of the MHQ-Thai version.
Spearman’s rho | Overall function | ADL | Work performance | Pain | Aesthetics | |
---|---|---|---|---|---|---|
Overall function | ||||||
ADL | 0.671 | |||||
Work performance | 0.369 |
0.706 | ||||
Pain | −0.693 |
−0.731 |
−0.605 | |||
Aesthetics | 0.403 |
0.694 |
0.428 |
−0.355 | ||
Satisfaction | 0.807 |
0.743 |
0.648 |
−0.798 |
0.507 |
Notes:
Internal consistency was good for the MHQ-Thai version (
Internal consistency of the MHQ-Thai version.
Domains | Cronbach’s |
---|---|
Overall function | 0.778 |
ADL | 0.992 |
Work performance | 0.892 |
Pain | 0.947 |
Aesthetics | 0.477 |
Satisfaction | 0.850 |
Total | 0.835 |
Table
Test-retest reliability of the MHQ-Thai version.
Domains | ICC | 95% confidence Interval | |||||
---|---|---|---|---|---|---|---|
Lower bound | Upper bound | Value | df1 | df2 | Sig | ||
Overall function | 0.912 | 0.824 | 0.957 | 21.791 | 29 | 29 | 0.000 |
ADL | 0.882 | 0.767 | 0.942 | 15.928 | 29 | 29 | 0.000 |
Work performance | 0.776 | 0.581 | 0.887 | 7.937 | 29 | 29 | 0.000 |
Pain | 0.941 | 0.881 | 0.972 | 33.133 | 29 | 29 | 0.000 |
Aesthetics | 0.799 | 0.619 | 0.899 | 8.933 | 29 | 29 | 0.000 |
Satisfaction | 0.963 | 0.924 | 0.982 | 53.190 | 29 | 29 | 0.000 |
Total | 0.953 | 0.904 | 0.977 | 41.534 | 29 | 29 | 0.000 |
Note: ICC (3,1) absolute agreement.
This study was aimed at translating the MHQ into Thai and validating the MHQ-Thai version. The study showed that the MHQ was translated into Thai without any major changes. The MHQ-Thai version obtained good validity and reliability results when tested.
To achieve linguistic and cultural equivalence between the original version and the translated version of the questionnaire, its translation and adaptation required the use of a unique method [
The content validity of the MHQ-Thai version was satisfactory. A slight adaptation was made on the demographic data collected regarding patient characteristics. To suit the Thai context, ethnic background, job, income, and medical expense reimbursement plan were adjusted. The item on the ethnic background was taken out because the population of Thailand is relatively homogeneous [
During the testing phase of the prefinal version of the MHQ-Thai version, the respondents had no difficulty in completing the questionnaire. Therefore, the results of this study indicate that the MHQ was successfully cross-culturally adapted into Thai, which was similar to conclusions reached when it had been translated into other languages [
An instrument achieves reliability if it produces consistent, reproducible results on repeated administration [
The ICC of the total score of the MHQ-Thai version showed excellent test-retest reliability for patients with hand injuries. The ICC for each domain was also good to excellent, which was a similar result to the original MHQ and the other translated MHQs [
Even though the MHQ-Thai version was a valid and reliable questionnaire, some limitations were found in this study. Beaton et al. suggested that 30 to 40 participants were required to test the prefinal version of the translation [
The MHQ was translated and cross-culturally adapted into Thai. The MHQ-Thai version performed well in both validity testing and reliability testing, which was similar to the original MHQ and other translated versions. As long as the questionnaire is reliable and valid, the MHQ-Thai version could be used as an outcome measurement for self-perception of Thai patients with hand injuries.
The data used to support the findings of this study are available from the corresponding author upon request.
The authors have no conflicts of interest to declare.
The authors would like to thank the occupational therapists who provided valuable opinions on the process of translation and adaptation. This study received a research grant from the Faculty of Associated Medical Sciences, Chiang Mai University, Chiangmai, Thailand.