Favorable effects of explanatory illustrations attached to a self-administered questionnaire for upper extremity disorders

The Hand10 is a self-administered questionnaire for upper extremity disorders. This questionnaire consists of 10 short, easy-to-understand
questions and explanatory illustrations. In the shortening and validation process, the Hand10 demonstrated high acceptability
and reliability among elderly individuals, with the advantage of being compact. We hypothesized that attached illustrations
may contribute to the ability to maintain the psychometric properties of a questionnaire and raise acceptability for the elderly.

A series of 106 elderly patients with upper extremity disorders, whose symptoms had been stable, completed the Hand10, the
Japanese Society for Surgery of the Hand Version of Disability of the Arm, Shoulder and Hand, and the Revised Hasegawa’s Dementia
Scale. Participants were randomly allocated to receive either the illustrated Hand10 or the unillustrated Hand10. The potential
advantages attributed to attached illustrations were investigated.

No significant differences were found in baseline demographic data between subjects who received the illustrated and unillustrated
questionnaires. The average percentage of items that the elderly patients left unanswered was 0.5 % for the illustrated Hand10
and 3.8 % for the unillustrated Hand10. Instrument test–retest reliability assessed with the intraclass correlation coefficient
was 0.92 and 0.86, respectively.

The use of explanatory illustrations attached to the Hand10 contributed to raise acceptability for elderly patients and were
suggested to improve the reproducibility.