use in international multicenterclinical trials. The Michigan HandOutcomes Questionnaire (MHQ) is ahand-specific outcomes instrument,which measures the health outcomesof patients with chronic hand condi-tions. The MHQ contains six distinctscales (1) overall hand function, (2)activities of daily living (ADLs), (3)pain, (4) work performance, (5) aes-thetics, and (6) patient satisfactionwith hand function. The objective ofour study was to perform cross-cultural adaptation of the MHQ andto evaluate its reliability and validityfor Turkish speaking patients withupper extremity conditions.

Methods: The MHQ questionnairewas translated into Turkish by twodifferent and independent nativeTurkish speakers. Both Turkish trans-lations were than compared for in-consistencies. The questionnaire wasthen retranslated, into English by twonative English speakers. Each of theEnglish translations was then com-pared with the original English MHQand checked for inconsistencies. TheTurkish version was then jointly re-viewed by a bilingual team. Theyagain compared the Turkish versionwith original English version to detecterrors of interpretation and nuancesthat might have been missed. Thisversion was finalized after slightchanges were made by consensus.The study was conducted on 70 pa-tients who had different upper ex-tremity complaints in HacettepeUniversity Health Sciences FacultySchool of Physical Therapy andRehabilitation. MHQ and Disabilitiesof the Shoulder and Hand Question-naire (DASH) were administered tothe patients with an interval of sevendays (retest). Instrument test-retestreliability was assessed with the in-terclass correlation coefficient (ICC)and with the Pearson’s correlationcoefficient.

Results: Translation-back transla-tion revealed no major difficulties.The internal consistency of the disa-bility/symptom scores of the MHQwas high. The levels of test-retestreliability of the DASH were foundexcellent. The MHQ scale showed ahigh correlation with DASHQuestionnaire. MHQ demonstratedgood reliability and validity.

Conclusions: Despite the linguisticand cultural differences, the

e12 JOURNAL OF HAND THERAPY

reliability and validity of the MHQwere just as excellent as those of theoriginal MHQ. Our findings showthat the Turkish version of the MHQis a reliable and valid instrument forthe domain-specific outcome mea-sure in Turkish speaking patientswith upper extremity complaints.

Relevance: MHQ is an adequateand useful instrument to measurefunctional disability in upper extrem-ity complaint Turkish speakingpatients.

OBJECTIVES

1. To perform cross-cultural ad-aptation of the MHQ.

2. To evaluate its reliability andvalidity for Turkish speakingpatients with upper extremityconditions.

ADAPTATION ANDVALIDATION OFTURKISH VERSIONOF THE MILLIKEN ADLSCALE (MAS)

Burcu Semin Akel, HacettepeUniversity, Cigdem Oksuz,Hulya Kayihan, Turkey

Purpose: None of the instrumentsthat measure the participation restric-tions of upper extremity impairmentare client-centered, nor do they targetactivity limitations. The MillikenADL Scale (MAS) is a client-centeredactivity limitation assessment mea-sure of upper extremity disability.The instrument can be used withany impairment that results in upperextremity activity limitations. TheMAS provides concomitant ratingscales to measure ‘‘ability’’ and ‘‘ne-cessity’’ for each item. Most question-naires were developed in Englishspeaking countries. Cross-culturaladaptation of validated outcome in-struments has been advocated in or-der to facilitate their use ininternational multicenter clinicaltrials. The aim of this study was toadapt the MAS for use in Turkey, andto test its reliability and validity forTurkish-speaking adults who haveupper extremity activity limitations.

Methods: The MAS questionnairewas translated into Turkish by two

different and independent nativeTurkish speakers. Both Turkish trans-lations were than compared for in-consistencies. The questionnaire wasthen retranslated, into English by twonative English speakers. Each of theEnglish translations was then com-pared with the original English MASand checked for inconsistencies. TheTurkish version was then jointly re-viewed by a bilingual team. Theyagain compared the Turkish versionwith original English version to de-tect errors of interpretation andnuances that might have beenmissed. This version was finalizedafter slight changes were madeby consensus. The study was con-ducted on 100 patients who had dif-ferent upper extremity complaints inHacettepe University Health SciencesFaculty School of Physical Therapyand Rehabilitation. MHQ andDisabilities of the Shoulder andHand Questionnaire (DASH) wereadministered to the patients with aninterval of seven days (retest).Instrument test-retest reliability wasassessed with the interclass correla-tion coefficient (ICC) and with thePearson’s correlation coefficient.

Results: Translation-back transla-tion revealed no major difficulties.Reliability of the Turkish versionwas very good, with high internalconsistency and reproducibility. TheMAS showed a high correlation withDASH Questionnaire.

Conclusions: In conclusion, ourresults display that the Turkish ver-sion of theMAS is a reliable and validregion specific client-centered self-report questionnaire It seems to be areliable, consistent and valid instru-ment to assess activity limitation inupper extremity complaint patients.

Relevance: Turkish version of theMAS will lead to better assessmentand follow up of the functional ca-pacities in daily living activities ofpatients who had different upper ex-tremity activity limitations in Turkey.

OBJECTIVES

1. To adapt the MAS for use inTurkey.

2. To test its reliability and valid-ity for Turkish-speaking adultswho have upper extremity ac-tivity limitations.

ADHERENCE TOTHERAPEUTIC SPLINTWEAR IN ADULTS WITHACUTE UPPER LIMBINJURIES: ASYSTEMATIC REVIEW

Lisa O’Brien, MonashUniversity/The Alfred Hospital,Australia

Purpose: Non-adherence withtherapeutic splinting in acute handinjury can reduce treatment benefits,increase risk of disability, and biasassessment of treatment efficacy. Thissystematic review aims to criticallyanalyse the literature on splinting ofacute upper limb injuries to identifykey factors that could influence pa-tient adherence with splint wear.

Methods: Trials were identifiedfrom searches of EMBASE,MEDLINE, CINAHL (to June 2009)and reference lists of articles andrelevant reviews. Search terms usedwere patient compliance/adherencebehaviour, splint/s, othosis/es,brace. Where possible, randomizedcontrolled trials or prospective cohortstudies were sought, then cross-sectional and retrospective studiesif the former were not available.Studies specifically addressingchronic conditions were excluded.All relevant trials were assessed formethodological quality by the authorusing explicit criteria. Data wereextracted by using a standardizedform designed by the author.

Results: Six studies (one rando-mised controlled trial, two cross sec-tional analytic surveys, and threeretrospective file reviews) involving490 people were included. Due to theheterogeneity of studies synthesis isnarrative rather than quantitative.There was no consistent correlationbetween adherence and age or gen-der. One study found a correlationwith patient perception of positiveeffect, and one found negative corre-lations with agitation and brain in-jury severity.

Conclusions: Studies found wereof varied quality and may be suscep-tible to bias. This is a field with littlepublished scientific evidence, andfuture research should measureadherence relationshipswith socio-eco-nomic, health care/system, therapy-and patient-related characteristics.

Relevance: This review found noconsistent relationship betweensplint adherence and socio-economicand condition-related factors, sug-gesting that there is little to be gainedfrom adapting treatment based onthese variables in isolation. It is vitalthat patients are supported through-out their therapy, and not blamed forfluctuating or poor adherence. Therewas some evidence that treatment/therapy-related factors such as im-mediacy of benefit, splint comfort,and minimising interference withlifestyle and daily living activitiescan improve splint adherence.

OBJECTIVES

1. To critically analyse the litera-ture on splinting of acute up-per limb injuries.

2. To identify key factors thatcould influence patient adher-ence with splint wear in acuteupper limb injury.

RING SPLINTING: DOTHEY REVERSEDEGENERATIVECHANGES IN THEHANDS?

Rebecca A. Norton, HandWorks,Unites States of America

Purpose: To educate therapists andphysicians about the use of fingerring splints as a way to preventdegenerative decline of the fingerand thumb joints, and even to reversechanges that have occurred.

Methods: Through photos, clinicalmeasurements, patient testimonials aprogram to manage inflammation,produce accurate sizing and fittingof ring splints, and document before/after changes will be presented.

Results: Common joint changesassociated with OA may actually bereversible–Heberden’s nodes can dis-appear, lateral deviations can be cor-rected to neutral, and deformingbody mechanics to the thumb canlimit further erosion of CMC/MCPjoint damage with this program.

Conclusions: Many patients havetold me that their doctor has toldthem ‘‘It’s only arthritis, nothing canbe done, and you just have to live

with it’’, but with ring splints andinstruction in edema management,ROM and joint protection in combi-nation with splints, this is no longernecessary. Hand therapy can correctjoint deformities on many patients,and prevent worsening of furtherdeformity for the duration of a pa-tient’s life, thereby allowing morenormal functional use.

Relevance: 70% of US adults de-velop OA by the time they are 70years of age. While hand therapiststeach many patients about joint pro-tection principles, many are sur-prised to learn that some patientscan also decrease osteophyte produc-tion, realign both the PIP and DIPjoint to neutral, and protect thethumb joints to delay surgery withring splints and body mechanicstraining.

OBJECTIVES

1. To introduce Silver Ring Splintfitting principles for a varietyof finger conditions.

2. To educate the hand therapycommunity as a whole as towhy joint deformity occurs,and what is possible to reverseexisting joint changes, and toprevent worsening of jointchanges.

3. To discuss thumb mechanicsas a means to prevent furtherjoint deformity of the MCP/CMC joints and to prevent pro-gression to surgery.

ALTERNATIVESPLINTING APPROACHFOR PROXIMALINTERPHALANGEALJOINT FLEXIONCONTRACTURES:NOPROFILE STATIC-PROGRESSIVESPLINTING ANDCYLINDER SPLINTCOMBO

Paolo Boccolari, Policlinico ofModena University Hospital,ItalyPurpose: Published in JHT 22:288-

93 2009 PIPj flexion contracture is a

October–December 2010 e13