Full Length Article| Volume 35, ISSUE 3, P428-434, July 2022

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Concurrent validity and precision of the thumb disability examination (TDX) in first carpometacarpal osteoarthritis

Published:September 23, 2021DOI:


      • Concurrent validity of the bMHQ and TDX was high and statistically significant.
      • The TDX test-retest reliability via intraclass correlation coefficient was excellent.
      • The TDX can reliably find a difference in two scores when it is more than 6 points.
      • The TDX shows a clinically meaningful change in scores when it is more than 17 points.


      Study Design

      A descriptive psychometric study of precision and concurrent validity of the Thumb Disability Examination (TDX).


      Thumb carpometacarpal osteoarthritis (CMC OA) is a painful joint condition impacting the functionality of the hand. Therapists use patient-reported outcome measures to evaluate change in disability and symptomology in response to interventions. The TDX is the only condition-specific outcome measure for persons with thumb CMC OA. Its responsiveness, test-retest reliability and concurrent validity with the DASH are published, yet it's precision and concurrent validity with a hand-region-specific tool has not yet been established.

      Purpose of the Study

      We aimed to determine the precision and concurrent validity of the TDX with a region-specific outcome measure in people with thumb CMC OA.


      Sixteen individuals with a medical diagnosis of CMC OA or a positive pressure-shear test completed the TDX across two visits and the Brief Michigan Hand Questionnaire (bMHQ) at the initial visit. The second visit was 7 to 21 days after the first. Self-administration of the TDX and bMHQ were observed by a licensed occupational therapist.


      Across total and subscale scores of the TDX, standard error of measurement (SEM) values are used to indicate the precision of tool and demonstrate how confident a user can be that change in score exceeds the error inherent to the tool. Minimal detectable change percentage (MDC%) values for the TDX are acceptable (<30%). The TDX demonstrated high concurrent validity with the bMHQ (rs = -0.733; P = .001).


      Precision of the TDX is acceptable and the concurrent validity of the TDX with a commonly used region-specific scale is high. The study was limited by a small, demographically homogeneous sample due to difficulty in recruitment.


      The TDX is a precise and valid outcome measure for individuals having a clinical diagnosis or indications of having thumb CMC OA.


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      JHT Read for Credit

      Quiz: # 862

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The term “region specific” refers to
        • a.
          the upper midwestern USA
        • b.
          the SE section of Minneapolis
        • c.
          an anatomic region, in this case the thumb CMC
        • d.
          an anatomic region, in this case the hand
      • # 2.
        To evaluate whether the score exceeded the inherent error in the tool, ________values were used
        • a.
        • b.
        • c.
        • d.
      • # 3.
        Subjects were included if they
        • a.
          were referred by their employer
        • b.
          had a positive X-ray
        • c.
          scored poorly on the DASH
        • d.
          had a positive shear test
      • # 4.
        The TDX is
        • a.
          a generalized outcome measure similar to the DASH
        • b.
          untested for its validity prior to this study
        • c.
          disease specific
        • d.
          universally used in hand therapy clinics, both in the US & UK
      • # 5.
        The limited sample size makes broad conclusions problematic
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.