Purpose
An 18-item self-report questionnaire designed to evaluate activity limitations of the hand.
Link to Instrument
Area of Assessment
Activities & ParticipationBodily Functions
General Health & Development
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An 18-item self-report questionnaire designed to evaluate activity limitations of the hand.
18
3-7 minutes
Child
7 - 16
yearsAdult
18 - 70
yearsMeg Kral, MS, OTR/L, CLT
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
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)
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)
Osteoarthritis: (Poiraudeau, 2001; n = 89; Mean Age = 63.2 (8.9) years; Mean Disease Duration = 9.9 (9.4) years; French sample)
Rheumatoid Arthritis: (Poole, 2006)
Rheumatoid Arthritis: (Duruoz, 1996)
MDC calculated from intra-rater reliability = 7.20
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
Rheumatoid arthritis: (Poole, 2006)
Excellent test-retest reliability (ICC = 0.89)
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)
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)
Convergent Validity
Rheumatoid arthritis: (Duruoz, 1996)
Excellent correlations between the DHI and Revel’s Functional Index (RFI) (r = 0.91, p = < 0.0001)
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)
Rheumatoid arthritis: (Duruoz, 1996)
Rheumatoid arthritis: (Duruoz, 1996)
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: (Sezer, 2007; n = 56; Mean Age = 62 (14.2) years; Mean Time Post-CVA = 84 (52.6) days)
SEM for entire group: 0.52
Stroke: (Sezer, 2007)
MDC for entire group: 1.4
Stroke: (Sezer, 2007)
Mean (SD) DHI score; 31.2 (26.6); range = 0-90
Stroke: (Sezer, 2007; n = 70; Retest time = 24 hours)
Excellent test-retest reliability (ICC = .99)
Stroke: (Sezer, 2007)
Excellent internal consistency (Cronbach’s alpha = .97)
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)
Stroke: (Sezer, 2007)
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
Children with unilateral cerebral palsy: (Sanal-Top, 2019)
MDC calculated for entire group = 11.44
Children with unilateral cerebral palsy: (Sanal-Top, 2019)
Mean (SD) score = 22.91 (15.71), range 0-90
Children with unilateral cerebral palsy: (Sanal-Top, 2019; Retest Time = 2 weeks)
Excellent test-retest reliability (ICC = 0.93)
Children with unilateral cerebral palsy: (Sanal-Top, 2019)
Excellent internal consistency (Cronbach’s alpha = 0.94)
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)
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)
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
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)
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
Scleroderma: (Brower, 2004)
MDC calculated for total group = 9.24
Trauma: (Ercalik, 2011)
MDC calculated for total group = 4.16
Scleroderma: (Brower, 2004; n = 40)
Trauma: (Ercalik, 2011)
Diabetes: (Turan, 2009; n = 40; Mean Age = 58.5 (10.7) years; Mean Disease Duration = 315.8 (892.6) months; Turkish sample)
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)
Scleroderma: (Brower, 2004; n = 37, 3 subjects did not return the DHI for Time 2)
Trauma: (Ercalik, 2011)
Excellent test-retest reliability (ICC = .99)
Trauma: (Ercalik, 2011)
Excellent internal consistency (Cronbach’s alpha = .87)
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)
Convergent validity
Trauma: (Ercalik, 2011)
Diabetes: (Turan, 2009)
Hemodialysis: (Duruoz, 2003)
Discriminant validity
Diabetes: (Turan, 2009)
Patients on Hemodialysis: (Duruoz, 2003)
Trauma: (Ercalik, 2011)
Large responsiveness was found between pre-treatment DHI-total and post-treatment DHI-total
SRM = 1.97, ES = 1.39
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.
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.
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.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.