Reliability and Validity of Upper Extremity Patient-Reported Outcomes Measures in Assessing Traumatic Finger Amputation Management.

Abstract

PURPOSE This study investigates the psychometric properties of patient-reported outcomes (PROs) instruments for assessing outcomes in post-surgical traumatic digit amputation patients. We hypothesize the MHQ(Michigan Hand Outcomes Questionnaire) and DASH(Disabilities of the Arm, Shoulder, and Hand Questionnaire) are the most valid and reliable instruments. METHODS We studied traumatic digit amputation patients as part of the Finger Replantation ANd amputation CHallenges in assessing Impairment, Satisfaction, and Effectiveness(FRANCHISE) study initiated by the Plastic Surgery Foundation. MHQ, DASH, Patient-Reported Outcomes Measurement Information System (PROMIS), and SF-36 were used to assess patients at least one year postoperatively. Internal consistency was measured by Cronbach's alpha(α) and criterion validity with Pearson's correlation coefficient(r). Construct validity was tested with four predefined hypotheses. Discriminant validity was analyzed by receiver operating characteristic curves. RESULTS 168 replantation and 74 revision amputation patients met the inclusion criteria. All instruments demonstrated fair to good internal consistency in both cohorts(0.70.60) in both cohorts. SF-36 had moderate to weak correlation with the remaining instruments, and its mental component had poor discriminant validity(area under the curve 0.64 - 0.67). MHQ, DASH, and PROMIS demonstrated good construct validity confirming 75-100% of predefined hypotheses, whereas SF-36 only confirmed 25%. CONCLUSIONS We recommend using MHQ or DASH when assessing PROs in digit amputation patients based on good internal consistency and validity. PROMIS has fair validity and reliability but should be an adjunct instrument. SF-36 should not be used as a primary assessment tool, but as an adjunct to assess overall quality of life.