The translation and validation of questionnaires were performed by the following subjects: a) English/Spanish Anglophone translator, b) Participating investigators committee A (RAR, COLL, GMR, EAH, and JVM), c) Committee B: 12 people (not researchers, not doctors, and variable schooling), who were hospital workers or family members; d) healthy subjects n=10, different from committee B, but hospital workers and family, and e) patients with rheumatic disease of the hands n=16.

• a)

  DASH. This instrument had already been translated into Spanish and validated in Spain10; starting with this release, committees A and B, led by 3 people, conducted an independent review and then met to discuss each question and its wording; during this process 5 words were replaced whose use is not common in the Spanish spoken in Mexico and, in addition, changed the presentation format for the various response options.

• b)

  m-SACRAH and AUSCAN, following the methodology suggested,13–17 were first translated and then back-translated (Committee A and Anglophone translator). The committee independently reviewed the original questionnaires in English and the back-translated version first and then a joint meeting did it, and was finally approved after joint evaluation and discussion of the final versions by committees A and B.

• c)

  Cochin was recently translated and validated in México11; this questionnaire was requested from the authors and the version provided by them was used in this study.

The final version of the DASH, m-SACRAH, AUSCAN, and Cochin were approved by resolution of committee A, subsequently revised and approved by committee B and, finally, became a pilot study with the healthy subjects who were asked to notify if they understood the questions and possible answers, as well as to disclose any confusion with any questions or if they had comments. According to the observations obtained in the pilot study, the committee made changes deemed necessary in the wording of the questions (face and content validity).

Questionnaires were applied on a normal day at the rheumatology clinic and patients who agreed to participate in the study through written informed consent were evaluated by the rheumatologist responsible and subsequently received a booklet, responding alone, with the help of a relative or interviewer if you so required. The booklet consisted of the 4 questionnaires (m-SACRAH, AUSCAN, Cochin, and DASH) in variable order; we recorded the time required for patients to answer each one and, finally, we asked which questionnaire they preferred.

The reliability or consistency was measured with Cronbach's alpha in the 4 questionnaires. The stability was determined in some patients without clinical changes in which we applied one of the four questionnaires, 3 days after the first.

The variables analyzed in the patient group were: age, sex, hand dominance, diagnosis, number of tender, swollen joints, and limited mobility. The rheumatologist assessment was a pre-response to questionnaires and included 2 visual analog scales from 0 (best) to 10cm (worst possible), the first referring to the function of the hands and the second to the patient overall (construct validity).

As part of the analysis, we evaluated the discriminatory ability of the questionnaires between 2 groups with condition of the hand, mild affection (assessment of hand function by VAS: 0–4cm) and moderate to severe disease (VAS hand function 5–10cm).

Initially, all subjects (healthy and patients) were included in a group with varying disorders in hand function, regardless of diagnosis they had. We assessed whether a greater clinical dysfunction of the hands was related to demographic and clinical variables, and higher scores on the various function questionnaires using t test, linear correlation and Cronbach's alpha. The score of the questionnaires on the day of the visit was compared with the same score after 3 days (test-retest), using intraclass correlation coefficient.

We included 10 healthy subjects and 16 patients with rheumatic diseases and varying degrees of involvement of the hands (3 with osteoarthritis of the hands,18 5 with rheumatoid arthritis,19 4 with gout20 and 4 with systemic sclerosis21); data shown in Table 1.

The 4 questionnaires were similar for the assessment of rheumatic patients; the general data of each are found in Table 2.

There was good correlation of the 4 questionnaires with each other (Table 3) and although smaller in power, with hand function (VAS) conducted by the physician, and this, in turn, was related to the general health VAS status (r=0.649, P=.006) and number of swollen joints (r=0.585, P=.017). All questionnaires had a tendency to show lower scores, although this may be secondary to most of the patients having mild to moderate functional impairment.

When patients were divided into 2 groups according to the hand function VAS, no significant differences between groups were seen in terms of age and education (45±12 years vs 43±7 and 9 years±4 vs 8.7±3, respectively), or in the required time to complete the questionnaires.

However, the total score was different in patients with mild vs moderate to severe disease for the AUSCAN, m-SACRAH, and DASH questionnaires; the difference was not significant for Cochin (Table 4).

After answering them, we asked patients to indicate which of the 4 was their favorite: 62.5% (10/16) preferred AUSCAN, 25% (4/16) Cochin, and 12.5% (2/16) the m-SACRAH; no patients preferred the DASH.