Cross-Cultural Adaptation and Psychometric Validation of the Arabic Duruöz Hand Index: A Reliable Patient-Reported Measure for Hand Disability in Arabic-Speaking Populations
Marc Boutros, Guy Awad, Caren Hassan, Shaza Hammad, Antonella Leba, Tia Maria Akoury, Sami Kais, Sami Roukoz, Rami El AbiadBackground:
The Duruöz Hand Index (DHI) is a validated patient-reported outcome measure assessing hand-related functional disability. No formally translated and validated Arabic version previously existed. This study aimed to translate, culturally adapt, and psychometrically validate the Arabic version (DHI-AR).
Methods:
A prospective cross-sectional validation study was conducted following established cross-cultural adaptation guidelines, including forward translation, reconciliation, back-translation, expert review, and pilot testing. Adults (≥18 years) with hand or wrist pain or functional limitation were recruited from 2 outpatient clinics. Participants completed the DHI-AR and the validated Arabic Patient-Rated Wrist/Hand Evaluation (PRWHE-AR). A clinically stable subgroup completed the DHI-AR again after 5 to 10 days. Analyses assessed internal consistency, test-retest reliability, measurement error, structural validity, convergent validity, and interpretability.
Results:
A total of 439 participants were included; 76 completed the retest. Internal consistency was excellent (Cronbach’s α = 0.980). Test-retest reliability was excellent (intraclass correlation coefficient [ICC](2,1) = 0.993; 95% CI, 0.990-0.996). Measurement error was low (SEM = 2.30), with minimal detectable change values of 6.38 points for individuals and 0.73 for groups (0-90 scale). Structural validity supported essential unidimensionality (74.82% variance explained). Convergent validity with the PRWHE-AR was strong (ρ = 0.793-0.868;
Conclusion:
The DHI-AR demonstrated strong internal consistency, excellent test-retest reliability, low measurement error, a predominantly unidimensional component structure, and strong convergent validity. Responsiveness, minimal clinically important difference, and measurement invariance require further evaluation.