This retrospective study was conducted at a university hospital and was approved by the institutional ethics committee (ethical number: ORT-2564–08550). We collected data on 183 patients with hand/wrist injuries or diseases who had visited a hand/wrist outpatient clinic or were admitted for surgery between 2017 and 2020. Inclusion criteria were aged at least 18 years old and able to complete the four PROMs. Demographic data, including age, sex, dominant hand, injured hand, diagnosis, education level and employment status, were recorded. The Thai versions of the PRWHE, MHQ, DASH and EQ-5D were given to all the patients prior to treatment [24,25,26,27]. After completing the four questionnaires, patients were asked to respond to two open-ended questions. (1) Which questionnaire best addressed your symptoms or the severity of your injury during this clinical experience? (2) Please explain why you selected that particular questionnaire. The name of the questionnaire that the participants chose was recorded. Written informed consent was obtained from all patients. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement [28].
The PRWHE questionnaire comprises 15 items grouped into three subscales: pain, specific activities, and usual activities. Response options range from 0 to 10, with lower scores indicating less pain or disability. The total score for the PRWHE ranges from 0 to 100, with lower scores indicating better functional hand use [21].
The MHQ questionnaire consists of 37 items to assess six subscales: overall hand function, activities of daily living, pain, work performance, aesthetics, and patient satisfaction with hand function. Four of these six sections inquire separately about how the right and left hands are impacted. Scores are normalized and summed for a total of between 0 and 100, with 100 representing excellent perceived hand function [19].
The DASH questionnaire contains 30 items in five subscales: common activities; self-care activities; pain symptoms; other symptoms including numbness, joint stiffness, weakness, and sleep problems and psychological effects; and optional sports and work modules, each with five response options (1–5). Lower scores indicate better functional hand use. Total scores range from 0 to 100, with 0 representing no difficulty in the performance of daily tasks [17, 18].
The EQ-5D questionnaire is a two-part outcome measurement which is extensively used to evaluate health status [29, 30]. The first part consists of five subscales: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each subscale has five levels of severity, ranging from no problems to extreme problems. The second part uses numeric scales to evaluate general health condition, with scores ranging from 0 to 100, where higher scores indicate better health.
All four PROMs had previously been translated into Thai and cross-culturally adapted following standard guidelines, and were shown to have adequate internal consistency in all subscales as well as good construct validity and reliability with Thai patients [24,25,26,27, 31,32,33].
The Thai PRWHE, MHQ and DASH were scored manually, following the original scoring algorithms [17, 19, 21], while the scores of the Thai EQ-5D were analyzed using the EQ-5D-5L Crosswalk Index Value Calculator, which is available for ten countries: Denmark, France, Germany, Japan, the Netherlands, Spain, Thailand, the UK, the US and Zimbabwe (https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/valuation-standard-value-sets/crosswalk-index-value-calculator/).
Statistical analysis
For demographic data, categorical variables are reported as frequencies and percentages. Continuous variables are reported as means and standard deviations. Statistical significance was set at P < 0.05.
Patient questionnaire preferences and reasons for selecting a particular questionnaire are reported as percentages of participants.
Univariable and multivariable analysis (multinomial logistic regression) were performed to identify factors related to patient preference. Potential factors were chosen from the demographic data and from reasons given by patients for selecting a particular questionnaire. Factors associated with patient preferences are reported as the relative risk ratio (RRR) with the 95% confidence interval (95% CI).
Responsiveness is defined as the ability of a measurement to detect clinically significant changes over time [34]. Responsiveness of the four PROMs was evaluated by comparing the scores at baseline and at follow-up periods using the standardized response mean (SRM) and effect size (ES). SRM is the observed mean change divided by the standard deviation of the observed change, while ES is the observed mean change divided by the standard deviation of the baseline scores. SRM is the preferred value for comparing paired data measurements at different time points for the same patient. SRM and ES values of 0.8, 0.5, and 0.2 were considered to be large, moderate, and small, respectively [15, 35].
Floor or ceiling effects were considered to be present if more than 15% of patients reported the lowest or highest possible scores [36]. In these patients, the responsiveness is reduced because the changes cannot be evaluated [34]. The data were analyzed using Stata Statistical software 15 (Stata Corp, LP, College Station, TX, USA).