Cross-cultural adaptation, reliability, validity and responsiveness of the hand assessment tool (HAT-Sp) in Spain

The HAT is a questionnaire designed to measure activity limitations in patients with hand and wrist injuries, without assistance. This study aimed to translate, culturally adapt, and validate the psychometric properties of the HAT-validity, reliability, and responsiveness-for different hand conditions in Spain.

Cultural adaptation followed recommendations from the American Academy of Orthopaedic Surgeons (AAOS). Validation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines and involved 262 hand patients. Reliability was assessed with Cronbach's alpha and intraclass correlation coefficient (ICC) (2,1), for test-retest reliability, the standard error of measurement (SEM) and the smallest detectable change (SDC) were used to assess measurement error. Confirmatory factor analysis (CFA) and construct validity using Pearson's correlation coefficient evaluated validity. Responsiveness was measured using effect size (ES) and standardised response mean (SRM).

The adaptation process showed no significant changes, with strong expert agreement (Kendall's W = 0.81, p < 0.001) and patient difficulty below 15%. Reliability was confirmed with an excellent Cronbach's alpha of 0.91, ICC values of 0.99, and low measurement error (SEM of 0.72 and SDC of 1.41). CFA showed a good model fit (RMSEA of 0.04, SRMR of 0.05). HAT showed a high correlation with DASH (r = 0.78, p < 0.001) and a weak correlation with EQ-5D (r = -0.07, p > 0.05). Responsiveness, assessed in 222 patients, yielded a moderate ES of -0.62 and an SRM of -0.72.

The HAT-Sp is a well-adapted and widely accepted tool among both Spanish patients and experts. The study demonstrated its strong reliability, validity, and responsiveness in activity limitation without assistance in patients with various hand and wrist injuries following physiotherapy.