Duruoz Hand Index
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Duruoz Hand Index

Last Updated

Purpose

An 18-item self-report questionnaire designed to evaluate activity limitations of the hand.

Link to Instrument

Instrument Details

Acronym DHI

Area of Assessment

Activities of Daily Living
Coordination
Dexterity
Functional Mobility
General Health
Life Participation
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Populations

Stroke
Spinal Injuries
Mixed Populations
Cerebral Palsy
Arthritis

Key Descriptions

  • 18 questions regarding ability to carry out manual tasks. Questions are grouped in five domains: In the kitchen (8), dressing (2), hygiene (2), in the office (2), and other (4)
  • The patient is instructed to answer each question in terms of the level of difficulty they experience completing various tasks without help from another person or assistive device (Sezer, Yavzer, Sivrioglu, Basaran, & Koseoglue, 2006)
  • Individual items are scored on a 6-point Likert scale where 0=without difficulty and 5=impossible. The 18 individual scores are summed to obtain a composite score
  • The total score ranges from 0-90 with higher scores indicating poorer hand functioning

Number of Items

18

Equipment Required

  • Paper survey
  • Writing Utensil

Time to Administer

3-7 minutes

Required Training

No Training

Age Ranges

Child

7 - 16

years

Adult

18 - 70

years

Instrument Reviewers

Meg Kral, MS, OTR/L, CLT

Body Part

Upper Extremity

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor
General Health

Considerations

  • The DHI has not been studied on patients with significant hand impairments or severe contractures.  Therefore, the DHI may be better suited for patients with mild hand impairments rather than patients with severe hand contractures or severely compromised hand function (Poole, 2005)

  • The DHI has been issued to patients without significant cognitive deficits and therefore, should be considered for patients without cognitive impairments

  • The DHI assesses hand ability and does not take into consideration other symptoms that may impact hand function such as pain or numbness

Arthritis

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Standard Error of Measurement (SEM)

Rheumatoid Arthritis: (Poole, 2006; n = 39; Mean Age = 49.5 (range 22-76) years; Mean Disease Duration = 13.1 (range 1 to 42) years; outpatients diagnosed with RA)

  • SEM calculated using Total Score at Time 1 = 5.91

Rheumatoid Arthritis: (Duruoz, 1996; n = 96; Mean Age = 51.2 (13.2) years; Mean Disease Duration = 115.7 (108.7) months; 70 inpatients and 26 outpatients with RA; French sample)

  • SEM calculated for entire group based on intra-rater reliability = 2.6
  • SEM calculated for entire group based on inter-rater reliability = 3.0

 Osteoarthritis: (Poiraudeau, 2001; n = 89; Mean Age = 63.2 (8.9) years; Mean Disease Duration = 9.9 (9.4) years; French sample)

  • SEM calculated for entire group = 2.77

Minimal Detectable Change (MDC)

Rheumatoid Arthritis: (Poole, 2006)

  • MDC calculated using Total Score at Time 1 = 16.37


Rheumatoid Arthritis: (Duruoz, 1996)

  • MDC calculated from intra-rater reliability = 7.20

  • MDC calculated from inter-rater reliability = 8.32

Normative Data

Rheumatoid arthritis: (Poole, 2006)

  • Mean (SD) DHI scores at Time 1 = 21.23 (17.84), range = 0-70

  • Mean (SD) DHI scores at Time 2 = 19.50 (18.36), range = 0-65

Osteoarthritis: (Poiraudeau, 2001)

  • Mean (SD) DHI scores at first visit = 18.73 (13.84), range = 0-90

Test/Retest Reliability

Rheumatoid arthritis: (Poole, 2006)

  • Excellent test-retest reliability (ICC = 0.89)

Interrater/Intrarater Reliability

Rheumatoid arthritis: (Duruoz, 1996)

  • Excellent intra-rater reliability in 25 inpatients interviewed twice at 24-hour intervals (range 17-32.5 hours) (ICC = .97)

  • Excellent inter-rater reliability in 68 patients (66 inpatients interviewed twice at 24-hour intervals (range 14-31 hours) & 2 outpatients interviewed twice at 3-hour intervals (range 2.5-3.5 hours) (ICC = .96)

Osteoarthritis: (Poiraudeau, 2001; n = 41 subjects who were issued the scale twice at the baseline visit, one hour apart)

  • Excellent inter-rater reliability (ICC = .96)

Criterion Validity (Predictive/Concurrent)

Rheumatoid arthritis: (Poole, 2006)

  • Excellent correlations with the Scleroderma Functional Assessment Questionnaire (SFAQ) (r = 0.85, p = 0.01)

  • Excellent correlations with the Hand Assessment Questionnaire (HAQ) (r = 0.78, p = 0.01)

  • Adequate correlations with the Hand Mobility in Scleroderma Test (HAMIS) (r = 0.39, p = 0.02)

  • Adequate correlations with the Arthritis Hand Function Test (AHFT) (r = 0.54-0.36, p = 0.007-0.02)

  • Poor correlations between with the Keitel Functional Test (KFT) (r = 0.23, p = NS)

Rheumatoid arthritis: (Duruoz, 1996)

  • Excellent correlations with the Visual Analog Scale functional handicap (VAS Hd) (r = 0.78, p < 0.0001)

Construct Validity

Convergent Validity

Rheumatoid arthritis: (Duruoz, 1996)

  • Excellent correlations between the DHI and Revel’s Functional Index (RFI) (r = 0.91, p = < 0.0001)

  • Adequate correlations between the DHI and the Hand Functional Index (HFI) (r = 0.58, p = < 0.001)

Osteoarthritis: (Poiraudeau, 2001)

  • Excellent correlations between the DHI and Revel’s Functional Index (RFI) (r = 0.86)

  • Excellent correlations between the DHI and Dreiser Functional Index (DFI) (r = 0.87)

  • Adequate correlations between the DHI and the Visual Analog Scale (VAS-Hd) (r = 0.67)

Discriminant Validity

Rheumatoid arthritis: (Duruoz, 1996)

  • Adequate correlations between the DHI and:

    • Visual Analog Scale of pain in the elbows, shoulders, & neck (VAS-PESN) (r = 0.48, p = <0.0001)

    • Visual Analog Scale of pain in the hands and wrists VAS-PH (r= 0.53, p = <0.0001)

    • Tenderness (r = 0.51, p = <0.0001)

    • Morning stiffness (r = 0.41, p = 0.0001)

    • Age (r = 0.39, p = 0.0002)

  • Poor correlations between the DHI and:

    • Swelling (r = 0.12, p = 0.24)

    • Disease duration (r = 0.23, p = 0.02)

Osteoarthritis: (Poiraudeau, 2001)

  • Adequate correlations between the DHI and:

  • Tenderness as measured by the Ritchie Articular Index (r = 0.51)

  • VAS pain (r = 0.54)

  • Clinical impairment as measured by rating presences of nodes, swelling, deformation, pain with passive range of motion (r = 0.32)

  • Poor correlations between the DHI and Kallman’s Index Score (KIS) (r = 0.14)

Content Validity

Rheumatoid arthritis: (Duruoz, 1996)

  • Each item was correlated to a subgroup according to the authors’ clinical experience. Each subgroup had specific questions pertaining to them.

Face Validity

Rheumatoid arthritis: (Duruoz, 1996)

  • All questions on the DHI were comprehendible and acceptable according to the patients and the authors’ clinical experience. Patients helped produce the items

Responsiveness

Osteoarthritis: (Poiraudeau, 2001; n = 51; Mean Follow-up Interval = 6.3 (0.5) months, range = 5-7 months)

  • Small level of responsiveness (SRM = -0.26, ES = -0.17)

  • Excellent to adequate correlation between individual changes in the DHI score and individual changes in the DFI (r = 0.65), VAS Hd (r = 0.59), and VAS of pain scores (r = 0.57)

  • Adequate correlation between individual changes in the DHI score and the patient’s overall assessment (r = 0.47)

Stroke

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Standard Error of Measurement (SEM)

Stroke: (Sezer, 2007; n = 56; Mean Age = 62 (14.2) years; Mean Time Post-CVA = 84 (52.6) days)

  • SEM for entire group: 0.52

Minimal Detectable Change (MDC)

Stroke: (Sezer, 2007)

  • MDC for entire group: 1.4

Normative Data

Stroke: (Sezer, 2007)

  • Mean (SD) DHI score; 31.2 (26.6); range = 0-90

Test/Retest Reliability

Stroke: (Sezer, 2007; n = 70; Retest time = 24 hours)

  • Excellent test-retest reliability (ICC = .99)

Internal Consistency

Stroke: (Sezer, 2007)

  • Excellent internal consistency (Cronbach’s alpha = .97)

Construct Validity

Convergent Validity

Stroke: (Sezer, 2007)

  • Excellent correlations between the DHI and the Functional Independence Measure (FIM) self-care section (r = .73, p < 0.001)

  • Adequate correlations between the DHI and Brunnstrom Stages of Arm (r = .54, p < 0.001) and Hand (r = 0.50, p < 0.001)

  • Adequate correlations between the DHI and Sensation (light touch and proprioception) (r = .31, p < 0.05)

Responsiveness

Stroke: (Sezer, 2007)

  • Moderate responsiveness at detecting changes after 4 weeks of inpatient rehabilitation (Effect Size (ES) = .24)

Cerebral Palsy

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Standard Error of Measurement (SEM)

 

Children with unilateral cerebral palsy: (Sanal-Top, 2019; n = 23; Mean Age = 10.87 (2.82) years; Turkish population)

  • SEM calculated for entire group = 4.13

Minimal Detectable Change (MDC)

Children with unilateral cerebral palsy: (Sanal-Top, 2019)

  • MDC calculated for entire group = 11.44

Normative Data

Children with unilateral cerebral palsy: (Sanal-Top, 2019)

  • Mean (SD) score = 22.91 (15.71), range 0-90

Test/Retest Reliability

Children with unilateral cerebral palsy: (Sanal-Top, 2019; Retest Time = 2 weeks)

  • Excellent test-retest reliability (ICC = 0.93)

Internal Consistency

Children with unilateral cerebral palsy: (Sanal-Top, 2019)

  • Excellent internal consistency (Cronbach’s alpha = 0.94)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Children with unilateral cerebral palsy: (Sanal-Top, 2019)

  • Excellent correlations between the DHI and the Manual Ability Classification System (MACS) (r = 0.84, p < 0.0001)

  • Adequate correlations between the DHI and Grip test (r = 0.45, p = 0.027)

  • Adequate correlation between the DHI and Pinch test (r = 0.55, p = 0.006)

Construct Validity

Convergent validity

Children with unilateral cerebral palsy: (Sanal-Top, 2019)

  • Excellent correlations between the DHI and the MACS (r = 0.84; p < 0.0001)

Divergent validity

Children with unilateral cerebral palsy: (Sanal-Top, 2019)

  • Poor correlations between DHI and the Modified Ashworth Scale (MAS) (r = 0.05-0.18)

Spinal Injuries

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Normative Data

Tetraplegia: (Misirlioglu, 2016; n = 40; Mean Age = 35.6 (10.1) years; Mean Duration of Injury = 116.7 (93.7) months; Turkish sample)

  • Mean (SD) score; 50.88 (27.25), range = 5-90

Construct Validity

Convergent validity

Tetraplegia: (Misirlioglu, 2016)

  • Excellent correlations between DHI and:

    • Upper Extremity Motor Score (UEMS) (r =-0.80, p = 0.001)

    • Quadriplegia Index of Function-Short Form (QIF-SF) (r=-0.90, p = 0.001)

    • Visual Analog Scale Hand Function (VAS-HF) (r = 0.79, p = 0.001)

  • Adequate correlations between DHI and the Impairment Scale grade (AIS) (r = -0.48, p=0.002)

Discriminant validity

Tetraplegia: (Misirlioglu, 2016)

  • Poor correlations between DHI and the Health Survey Short Form (SF-36) (r = -0.33, p = 0.04) except for Physical Functioning subscale (r = -0.43, p = 0.006)

Mixed Populations

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Standard Error of Measurement (SEM)

Scleroderma: (Brower, 2004; n = 37, 3 subjects did not return the DHI for Time 2; Mean Age = 53 years, range 26-74; Mean Disease Duration = 11 years, range 3-35)

  • SEM calculated for total group = 3.33

Trauma: (Ercalik, 2011; n = 65; Mean Age = 30.25 (11.07) years; Average Time Post-Op = 4.92 (1.38) weeks; Turkish sample who underwent surgery after flexor tendon injuries)

  • SEM calculated for total group: 1.50

Minimal Detectable Change (MDC)

Scleroderma: (Brower, 2004)

  • MDC calculated for total group = 9.24

Trauma: (Ercalik, 2011)

  • MDC calculated for total group = 4.16

Normative Data

Scleroderma: (Brower, 2004; n = 40)

  • Mean (SD) DHI score = 21.10 (19.25), range 0-66

Trauma: (Ercalik, 2011)

  • Mean (SD) DHI score at baseline = 29.75 (15.01)

Diabetes: (Turan, 2009; n = 40; Mean Age = 58.5 (10.7) years; Mean Disease Duration = 315.8 (892.6) months; Turkish sample)

  • Mean (SD) score = 5.80 (9.58), range = 0-90

Patients on hemodialysis: (Duruoz, Cerrahoglu, Dincer-Turan & Kiirsat 2003; n = 60; Mean Age = 50.0 (13.4) years; Average Duration of Hemodialysis = 55.0 (50.6) months; Turkish sample)

  • Mean (SD) score = 5.57 (11.18), range 0-90

Test/Retest Reliability

Scleroderma: (Brower, 2004; n = 37, 3 subjects did not return the DHI for Time 2)

  • Excellent test-retest reliability (ICC = .97)

Trauma: (Ercalik, 2011)

  • Excellent test-retest reliability (ICC = .99)

Internal Consistency

Trauma: (Ercalik, 2011)

  • Excellent internal consistency (Cronbach’s alpha = .87)

Construct Validity

Concurrent validity

Scleroderma: (Brower, 2004; n = 37)

  • Excellent correlations with the HAQ (r = .79, p = 0.01)

  • Adequate correlations with the KFT (r = .48, p = 0.01)

  • Adequate correlations with all sections of the AHFT (r = .39-.58, p = 0.01-0.05)

  • Poor correlations with the HAMIS (r = 0.28, p = NS)

Content Validity

Convergent validity

Trauma: (Ercalik, 2011)

  • Excellent correlations between the DHI and the Disabilities of the Arm Shoulder & Hand (DASH) (r = .86, p = 0.0001)
  • Adequate correlations between the DHI and VAS-hd (r = .54, p = 0.0001)
  • Adequate correlations between the DHI and grip strength (r = .54, p = 0.0001)

Diabetes: (Turan, 2009)

  • Adequate correlations between the DHI and the HFI (p = 0.59)
  • Excellent correlations between the DHI and the VAS (p = 0.61)

Hemodialysis: (Duruoz, 2003)

  • Excellent correlations between DHI and the HAQ (p = 0.80)
  • Adequate correlations between DHI and the HFI (p = 0.45)

Discriminant validity

Diabetes: (Turan, 2009)

  • Adequate correlations between the DHI and:
    • Restricted hand motion (p = 0.40)
    • Chuck strength-D (dominant hand) (p = 0.42)
    • Pins test-D (pick up pins using Purdue Peg Board with the dominant hand) (p = 0.56)
    • Pins test-ND (pick up pins using Purdue Peg Board with the non-dominant hand) (p = 0.39)
    • Assembly test (using the Purdue Peg Board) (p = 0.35)
  • Poor correlations between the DHI and:
    • Morning stiffness (p = 0.05)
    • Duration of Diabetes (p = 0.05)
    • Body Mass Index (BMI) (p = 0.01)
    • Grip strength-D (p = 0.30)
    • Grip strength-ND (p = 0.26)
    • Tip strength-D (p = 0.23)
    • Tip strength-ND (p = 0.07)
    • Lateral strength-D (p = 0.22)
    • Lateral strength-ND (p = 0.28)
    • Chuck strength-ND (p = 0.14)
    • Serum fasting glucose (p = 0.02)
    • Serum non-fasting glucose (p = 0.30)

Patients on Hemodialysis: (Duruoz, 2003)

  • Poor correlations between DHI and:
    • VAS-hand (p = 0.25, NS)
    • VAS-upext (p = 0.20, NS)
    • Morning stiffness (p = 0.12, NS)
    • Pins_D (p = -0.34)
    • Pins_ND (p = -0.37)
    • Grip strength_D (p = -0.54)
    • Tip strength_D (p = -0.39)
    • Tip strength_ND (p = -0.43)
    • Lateral strength_D (p = -0.35)
    • Lateral strength_ND (p = -0.37)
    • Chuck strength_D (p = -0.35)
    • Chuck strength_ND (p = -0.41)

Responsiveness

Trauma: (Ercalik, 2011)

  • Large responsiveness was found between pre-treatment DHI-total and post-treatment DHI-total

    • SRM = 1.97, ES = 1.39

Bibliography

Brower, L. M., & Poole, J. L. (2004). “Reliability and validity of the Duruöz Hand Index in persons with systemic sclerosis (scleroderma).” Arthritis Care & Research, 51(5): 805-809.

Duruoz, M. T., Cerrahoglu, L., Dincer-Turan, Y., & Kursat, S. (2003). “Hand function assessment in patients receiving haemodialysis.” Swiss Medical Weekly, 133(31-32): 433-438.

Duruöz, M. T., Poiraudeau, S., Fermanian, J., Menkes, C. J., Amor, B., Dougados, M., & Revel, M. (1996). “Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap.” The Journal of Rheumatology, 23(7): 1167-1172.

Erçalik, T., ŞŞahin, F., ErÇalik, C., DoĞĞu, B., Dalgiç, S., & Kuran, B. (2011). “Psychometric characteristics of Duruoz Hand Index in patients with traumatic hand flexor tendon injuries.” Disability and Rehabilitation, 33(17-18): 1521-1527.

Misirlioglu, T. O., Unalan, H., & Karamehmetoglu, S. S. (2016). “Validation of Duruöz Hand Index in patients with tetraplegia.” Journal of Hand Therapy, 29(3): 269-274.

Poiraudeau, S., Chevailier, X., Conrozier, T., Flippo, R. M., Liote, F., Noel, E., Rhumato, R. (2001). “Reliability, validity, and sensitivity to change of the Cochin Hand Functional Disability Scale in hand osteoarthritis.” Osteoarthritis and Cartilage, 9(6): 570-577.

Poole, J. L., Cordova, K. J., & Brower, L. M. (2006). “Reliability and validity of a self-report of hand function in persons with rheumatoid arthritis.” Journal of Hand Therapy, 19(1): 12-17.

Sanal-Top, C., Karadag-Saygi, E., Sacaklidir, R., & Duruoz, M. T. (2019). “Duruoz hand index: Is it valid and reliable in children with unilateral cerebral palsy?” Developmental Neurorehabilitation, 22(2): 75-79.

Sezer, N., Yavuzer, G., Sivrioglu, K., Basaran, P., & Koseoglu, B. F. (2007). “Clinimetric properties of the Duruoz Hand Index in patients with stroke.” Archives of Physical Medicine and Rehabilitation, 88(3): 309-314.

Turan, Y., Duruöz, M. T., Aksakalli, E., & Gürgan, A. (2009). “Validation of Duruöz Hand Index for diabetic hand dysfunction.” Journal of Investigative Medicine, 57(8): 887-891.

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