Clinimetric properties of the Duruoz Hand Index in patients with stroke

Abstract

Objective: To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke.

Design: Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program.

Setting: Three different inpatient rehabilitation centers.

Participants: A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days.

Interventions: Not applicable.

Main Outcome Measures: Brunnstrom stages, Mocline Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman p correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test.

Results: The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval,.93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P <.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P <.05).

Conclusions: The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.