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The Impact of Hand Nerve Disorders (I-HaND) Scale: Latest Updates and How to Use It
The I-HaND Scale is a patient-reported outcome measure (PROM) designed specifically for people with upper limb nerve disorders. Developed with direct input from patients and clinicians, it was developed to capture the real-life impact of nerve problems in the hand, from pain and weakness to challenges in everyday activities.
The I-HaND is freely available for use under a Creative Commons license.
A Tool Developed with and for Patients
The original I-HaND consists of 32 questions and was developed using rigorous psychometric methods. It has shown strong reliability and validity, meaning it gives trustworthy information and can detect changes over time. Its strength lies in how well it reflects the patient voice, shaped by interviews with people living with hand nerve conditions and refined through expert feedback (Ashwood et al, 2018a and b) https://doi.org/10.1177/1753193418780554 and https://doi.org/10.1016/j.jht.2017.10.015
What’s New?
Recent research (Harvey et al, 2025) https://doi.org/10.1177/17531934251324381 has taken things further by using more advanced methods, known as Item Response Theory (IRT). This revealed that the I-HaND actually measures two distinct areas: Pain and Motor Function.
Although the full 32-item scale still has real value, especially in clinical settings where individual items can inform detailed treatment planning, recent research suggests that for research purposes, it’s best to use the Part II and III separately.
Computerised Adaptive Testing (CAT)
One exciting outcome of the recent study is the development of a computerised adaptive version of the I-HaND. These versions are smart: they ask just a few tailored questions to give an accurate score for pain and motor function. In fact, each part can often be completed with only three questions, greatly reducing the time it takes for patients to fill in, while maintaining precision.
These CAT versions are already being used in clinical practice via smartphone apps, allowing for more frequent check-ins on symptoms without overburdening patients.
How Should I Use the I-HaND?
Accessing the Tools
Both versions of the I-HaND, the full 32-item scale and the two-part research version (along with details for scoring), can be downloaded from this website under a Creative Commons license. We hope it continues to support your work in improving care for patients with peripheral nerve disorders.
Please contact Prof C Jerosch-Herold if you wish to translate and cross-culturally adapt the I-HaND for use in other languages and countries. These are derivative works and require a licence agreement.
Ongoing projects
Translation and cross-cultural adaptation of the I-HaND is currently underway into Turkish, Dutch, German, Swedish and Brazilian Portuguese
References:
Ashwood M, Jerosch-Herold C, Shepstone L (2018) Development and validation of a new patient-reported outcome measure for peripheral nerve disorders of the hand, the I-HaND Scale. J Hand Surgery Eur 2018 43:864-874 https://doi.org/10.1177/1753193418780554
Ashwood M, Jerosch-Herold C, Shepstone L (2018) Learning to live with a hand nerve disorder: A constructed grounded theory. J of Hand Therapy 2019: 32:3: 334-344 DOI: https://doi.org/10.1016/j.jht.2017.10.015
Harvey MR, Harrison C, et al. Computerized adaptive testing with the I-HaND scale for monitoring patients with upper limb nerve pathology. Journal of Hand Surgery (European Volume). 2025;0(0). https://doi.org/10.1177/17531934251324381
The research team
Principal Investigator: Dr Mark Ashwood (School of Health Sciences, UEA)
Co-investigators: Professor Christina Jerosch-Herold (School of Health Sciences, UEA); and Professor Lee Shepstone (Norwich Medical School, UEA)
External collaborators/Local Principal Investigators: Mrs Debbie Larson; Mrs Kathryn Johnson; Mrs Caroline Miller; Mr Dominic Power; Mrs Nikki Burr; Mrs Megan Blakeway; Ms Sarah Mee; Mrs Raelene Marx; Dr Niall Fitzpatrick; Miss Sarah Turner and the members of their clinical teams.
Funding
Mark Ashwood was funded through a University of East Anglia, Faculty of Medicine and Health Sciences PhD Studentship. Christina Jerosch-Herold was funded through a National Institute for Health Research (NIHR) Senior Research Fellowship (NIHR-SRF-2012-05-119).