Qualitative study informing the development and content validity of the HAND-Q: A modular patient-reported outcome measure for hand conditions

Kyra Sierakowski, Manraj N. Kaur, Kathleen Sanchez, Gregory Bain, Stefan J. Cano, Philip Griffin, Anne Klassen, Andrea L. Pusic, Don Lalonde, Nicola R. Dean

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Objectives The purpose of this study was to identify and understand the issues that are relevant to patients with hand conditions. The data were used to develop a patient-reported outcome measure (PROM) for adults with hand conditions (HAND-Q) and refine it with input from patients and clinician experts. Design Semistructured qualitative interviews were used to understand what matters to patients. Cognitive debriefing was used to refine preliminary HAND-Q scales. Setting Hand clinics in tertiary healthcare centres in Canada, Australia and USA. Participants Eligible participants were English-speaking adults who had experienced hand surgery in the preceding 12 months and were at least 4 weeks post-hand surgery A total of 62 in-depth interviews (females, n=34; mean age=65 years) were conducted to develop an item pool and draft the HAND-Q scales. The preliminary scales were refined through cognitive debriefing interviews with 20 participants and feedback from 25 clinician experts. All interviews were audiorecorded, transcribed verbatim and coded using a line-by-line approach. Results Qualitative data were organised into two top-level domains of health-related quality of life and satisfaction with treatment outcomes. The scales were refined iteratively, and the field-test version included 319 unique items and 20 independently functioning scales. Conclusions The HAND-Q is a comprehensive PROM developed using extensive patient and clinician expert input, following established guidelines for PROM development and validation. In the next phase, the psychometric properties of the HAND-Q will be established in an international field test, following which the HAND-Q will be available for use in clinical research and practice.

Original languageEnglish
Article numbere052780
Number of pages9
JournalBMJ Open
Issue number4
Publication statusPublished - 5 Apr 2022

Bibliographical note

Funding Information:
Funding This work has received funding from the Australasian Foundation for Plastic Surgery Plastic & Reconstructive Surgery (PRS) Research Scholarship and the Royal Australasian College of Surgeons, Foundation for Surgery Small Project Grant.

Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.


  • hand & wrist
  • health services administration & management
  • surgery


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