Purpose: The objective of this study was to develop a self-administered outcome measurement tool for individuals with hand and wrist injuries, and to evaluate the reliability and validity of the new instrument, te Hand Assessment Tool (HAT). Methods: Questionnaire items were generated by review and modification of existing instruments, expert opinion, and a pilot study. Factor analysis identified 7 factors and reduced the instrument from 30 to 14 questions. The final version of the HAT-, the SF12, and Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH) were administered to 94 consecutive new hand clinic patients with a variety of of hand and wrist problems. Participants responded to the questionnaire items by comparing their current performance to how they would have usually performed the task. Statistical analyses were conducted to determine internal consistency, test re-test reliability, and construct validity. Pearson correlations were contructed to correlate the HAT with the DASH, SF12 physical score, and SF12 mental health score. Results: Statistical analyses indicated excellent internal consistency with Cronbach’s alpha of 0.91. Test re-test reliability of the HAT indicated good agreement. The concordance correlation coefficient was 0.73, with 95% confidence interval. The Pearson correlation coefficient of 0.91 with 95% confidence interval showed a strong positive correlation between the HAT and DASH. This indicates that the HAT is a very good representation of the DASH. Robustness of the instrument was evaluated by removing the data fomr the 4 functional questions that are similar on the HAT and DASH. The Pearson correlation was 0.89 still indicating a strong positive correlation. A modest agreement existed to the SF12 physical score. The Pearson correlation coefficient was 0.52, with 95% confidence interval . The HAT did not correlate to the SF12 mental health score. The Pearson correlation coefficient was 0.35, with 95% confidence interval. Conclusion: The HAT correlates well to the DASH and SF12 physical score and proves to be a reliable and valid instrument for evaluation of functional outcome for individuals that sustain wrist or hand injury. As expected the HAT does not correlate well with the SF12 mental health score. There are notable differences between the HAT and DASH. The HAT does not ask the respondents to rate pain or weakness nor does it ask them to rate the impact of their injury to their work. The HAT does however ask respondents to rate the impact of the appearance of their injured hand. More than fifty percent of the functional questions in the HAT are different from the DASH nevertheless there was excellent agreement. Unlike the DASH, the HAT takes the approach of basing the comparison on performance without compensatory strategies or the use of adaptive equipment. It is hoped that this new instrument will be particularly useful when examining intervention or disease process of wrist and hand pathology and its impact to usual functional activity. Functional activities in the HAT are notably different from the DASH. The researchers believe that the HAT will provide for a more specific instrument to measure hand and wrist outcome.
