Psychometric properties of The Maastricht Upper Extremity Questionnaire: systematic review and meta-analysis

Correia Júnior, Jânio Luiz; Torres, Maria Fernanda da Silva; Costa, Sthefanny Pontes Sampaio; Caldeira, Hermê Fellipo Bordoni; Gonçalves, Marina Pereira; Freitas-Dias, Ricardo

doi:10.5935/2595-0118.20230069-en

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REVIEW ARTICLE • BrJP 6 (3) • Jul-Sep 2023 • https://doi.org/10.5935/2595-0118.20230069-en copy

Psychometric properties of The Maastricht Upper Extremity Questionnaire: systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

This was the first systematic review to evaluate the psychometric properties of the Maastricht Upper Extremity Questionnaire (MUEQ);
This systematic review provided comprehensive and up-to-date evidence of the psychometric properties and level of evidence of the MUEQ;
The evidence based on the internal structure and reliability of the MUEQ did not reach levels considered acceptable in all the studies.

ABSTRACT

BACKGROUND AND OBJECTIVES:

With the necessity to assess musculoskeletal complaints caused by computer use, The Maastricht Upper Extremity Questionnaire (MUEQ) was created, which aims to assess musculoskeletal complaints of the upper limbs, shoulder complex and cervical spine in computer users. However, there is currently no comprehensive summary in the scientific literature on the psychometric properties of the MUEQ. The objective of this study was to conduct a synthesis of all available scientific evidence that has analyzed the psychometric properties of the MUEQ.

This study followed the PRISMA recommendations. The bibliographic search was carried out in the following databases: MEDLINE (via VHL), Embase, LILACS (via VHL), Pubmed, PsycINFO, Scielo, Academic Search Premier, CINAHL, Rehabilitation & Sports Medicine Source, MEDLINE Complete, Web of Science CENTRAL, Scopus and SPORTDiscus. Studies that addressed the psychometric properties of the MUEQ were included, as long as they were original articles of research carried out with human beings and indexed in the databases used. The studies were selected in two phases, with two independent reviewers. A total of 6 articles were included in the analysis. The evidence based on internal structure showed acceptable results. The reliability indexes ranged from α=0.52 to α=0.84, and ICC/composite reliability > 0.70 in the analyzed studies, classified as “good” and “excellent,” respectively.

CONCLUSION:

In general, this research found a lack of detail on the process of content validity and evidence related to external variables and the description of the sample. These problems extended to the evidence based on the internal structure and reliability of the MUEQ, which did not reach levels considered acceptable to ensure its adequacy and accuracy.

Keywords:
Musculoskeletal pain; Occupational health; Surveys and questionnaires; Teleworking; Upper extremity

Authors	Studies	Total sample number	Study characteristics	MUEQ application	Types of psychometric properties	Conflict of interests and sources of funding
Bekiari et al.²²22 Bekiari EI, Lyrakos GN, Damigos D, Mavreas V, Chanopoulos K, Dimoliatis IDK. A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. J Musculoskelet Neuronal Interact. 2011;11(1):52-76.	Study 1	n = 600	Gender: female (60.7%) and male (39.3%). Average age: 37.4. Validation language: Greek. Sample condition: at the workplace. Completion time: 20 minutes. Number of items: 95.	Not reported	Validity of content and evidence based on internal structure	Conflict of interests: declared; Sources of funding: undeclared.
Eltayeb et al.²¹21 Eltayeb S, Staal JB, Kennes J, Lamberts PH, de Bie RA. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. BMC Musculoskelet Disord. 2007;8(1):68.	Study 1	n = 600	Gender: female (49.62%) and male (50.38%). Validation language: Dutch. Sample condition: the study site was the Office of the National Social Security Institute. The questionnaires were distributed through the GAK’s internal mail. Participants were asked to fill in the questionnaire and return it using the enclosed envelope. Completion time: 20 minutes. Number of items: 95.	Printed (e-mail)	Evidence based on internal structure	Conflict of interests: declared; Sources of funding: undeclared.
Eltayeb et al.²³23 Eltayeb SM, Staal JB, Hassan AA, Awad SS, de Bie RA. Complaints of the arm, neck and shoulder among computer office workers in Sudan: a prevalence study with validation of an Arabic risk factors questionnaire. Environ Heal. 2008;7(1):33.	Study 1	n = 282	Gender: female (35%) and male (65%). Validation language: Arabic. Sample condition: on April 1, 2005, the questionnaires were distributed among the participants, delivered to their workplace. Participants were asked to fill in the questionnaire and return it in specially provided boxes. In mid-April, a reminder note was posted to non-respondents. And the end of April 2005 was set as the last return date. Completion time: 30 minutes. No. of items: 109.	In person	Validity of content and evidence based on internal structure	Conflict of interests: declared; Sources of funding: undeclared.
Ghasemi et al.¹⁹19 Ghasemi M, Kamalikhah T, Salesi M, Rahmati F. Evaluation of psychometric properties of the maastricht upper extremity questionnaire (MUEQ) in iranian computer users. J Educ Health Promot. 2021;10:245.	Study 1	n = 282	Gender: female (39%) and male (61%). Average age: 35.17. Validation language: Persian. Sample condition: explanations on how to answer the options and the content of the questions were given to the participants. The place of application of the instrument was the Government Information Technology Administration in Tehran, Iran. Completion time: 20 minutes. Number of items: 109 (95 - 107).	In person	Validity of content and evidence based on internal structure	Conflict of interests: declared; Sources of funding: declared.
Ranasinghe et al.⁴⁵45 Ranasinghe P, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, Rajapakse S, Katulanda P. Work-related complaints of arm, neck and shoulder among computer office workers in an Asian country: prevalence and validation of a risk-factor questionnaire. BMC Musculoskelet Disord. 2011;12(1):68.	Study 1	n = 450	Gender: female (57.3%) and male (42.7%). Average age: 38.2. Validation language: Sinhalese. Sample condition: Telecommunications company in Colombo - Sri Lanka between January and February 2009. Completion time: 30 minutes. Number of items: 94.	Not reported	Content validity	Conflict of interests: declared; Sources of funding: undeclared.
Turci et al.²⁰20 Turci AM, Bevilaqua-Grossi D, Pinheiro CF, Bragatto MM, Chaves TC. The Brazilian Portuguese version of the revised Maastricht Upper Extremity Questionnaire (MUEQ-Br revised): translation, cross-cultural adaptation, reliability, and structural validation. BMC Musculoskelet Disord. 2015;16(1):41.	Study 1	n = 627	Gender: female (74.5%) and male (25.5%). Average age: 33.56. Validation language: Portuguese. Sample condition: University of São Paulo (USP), Ribeirão Preto Campus. Number of items: 41.	Not reported	Validity of content and evidence based on internal structure	Conflict of interests: declared; Sources of funding: declared.
	Study 2		Gender: female (40%) and male (60%). Validation language: Portuguese. Sample condition: University of São Paulo (USP), Ribeirão Preto Campus. Number of items: 41.
	Study 3		Gender: female (55.5%) and male (44.5%). Validation language: Portuguese. Sample condition: University of São Paulo (USP), Ribeirão Preto Campus. Completion time: 14.67 min. No. of items: 41.

Authors	Studies	I1	I2	I3	I4	I5	I6	I7	I8	I9	I10	I11	I12	I13
Bekiari et al.²²22 Bekiari EI, Lyrakos GN, Damigos D, Mavreas V, Chanopoulos K, Dimoliatis IDK. A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. J Musculoskelet Neuronal Interact. 2011;11(1):52-76.	Study 1	N/A	N/A	N	N/A	N/A	N/A	N	N/A	N	N/A	N	N/A	N/A
Eltayeb et al.²¹21 Eltayeb S, Staal JB, Kennes J, Lamberts PH, de Bie RA. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. BMC Musculoskelet Disord. 2007;8(1):68.	Study 1	N/A	N/A	N	N/A	N/A	N/A	N	N/A	N	N/A	N	N/A	N/A
Eltayeb et al.²³23 Eltayeb SM, Staal JB, Hassan AA, Awad SS, de Bie RA. Complaints of the arm, neck and shoulder among computer office workers in Sudan: a prevalence study with validation of an Arabic risk factors questionnaire. Environ Heal. 2008;7(1):33.	Study 1	N/A	N/A	N	N/A	N/A	N/A	N	N/A	N	N/A	N	N/A	N/A
Ghasemi et al.¹⁹19 Ghasemi M, Kamalikhah T, Salesi M, Rahmati F. Evaluation of psychometric properties of the maastricht upper extremity questionnaire (MUEQ) in iranian computer users. J Educ Health Promot. 2021;10:245.	Study 1	Y	Y	N	N	N	N	N	N	N	Y	N	N	Y
Ranasinghe et al.⁴⁵45 Ranasinghe P, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, Rajapakse S, Katulanda P. Work-related complaints of arm, neck and shoulder among computer office workers in an Asian country: prevalence and validation of a risk-factor questionnaire. BMC Musculoskelet Disord. 2011;12(1):68.	Study 1	N/A	N/A	N	N/A	N/A	N/A	N	N/A	N	N/A	N	N/A	N/A
Turci et al.²⁰20 Turci AM, Bevilaqua-Grossi D, Pinheiro CF, Bragatto MM, Chaves TC. The Brazilian Portuguese version of the revised Maastricht Upper Extremity Questionnaire (MUEQ-Br revised): translation, cross-cultural adaptation, reliability, and structural validation. BMC Musculoskelet Disord. 2015;16(1):41.	Study 1	N/A	N/A	N	N/A	N/A	N/A	N	N/A	N	N/A	N	N/A	N/A
	Study 2	N/A	N/A	N/A	N	N	N	N/A	Y	N/A	N/A	N/A	N/A	N/A
	Study 3	N/A	N/A	N	N/A	N/A	N/A	N	N/A	N	N/A	N	N/A	N/A

Authors	Studies	Evidence Based on Internal Structure	Reliability
Bekiari et al.²²22 Bekiari EI, Lyrakos GN, Damigos D, Mavreas V, Chanopoulos K, Dimoliatis IDK. A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. J Musculoskelet Neuronal Interact. 2011;11(1):52-76.	Study 1	Not reported	Not reported
Eltayeb et al.²¹21 Eltayeb S, Staal JB, Kennes J, Lamberts PH, de Bie RA. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. BMC Musculoskelet Disord. 2007;8(1):68.	Study 1	Not reported	Not reported
Eltayeb et al.²³23 Eltayeb SM, Staal JB, Hassan AA, Awad SS, de Bie RA. Complaints of the arm, neck and shoulder among computer office workers in Sudan: a prevalence study with validation of an Arabic risk factors questionnaire. Environ Heal. 2008;7(1):33.	Study 1	Not reported	Not reported
Ghasemi et al.¹⁹19 Ghasemi M, Kamalikhah T, Salesi M, Rahmati F. Evaluation of psychometric properties of the maastricht upper extremity questionnaire (MUEQ) in iranian computer users. J Educ Health Promot. 2021;10:245.	Study 1	PCFI = 0.732; PGFI = 0.680; NFI = 0.680; CFI = 0.800; RMSEA = 0.062.	ICC values: BP = 0.61; WC = 0.77; WD = 0.81; BT = 0.82; WE = 0.67; SS = 0.83; Total = 0.62. Test-retest (alpha): BP = 0.826; WC = 0.977; WD =0.975; BT = 0.789; WE = 0.963; Total: 0.897; SS = 0.986. MUEQ General: 0.897.
Ranasinghe et al.⁴⁵45 Ranasinghe P, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, Rajapakse S, Katulanda P. Work-related complaints of arm, neck and shoulder among computer office workers in an Asian country: prevalence and validation of a risk-factor questionnaire. BMC Musculoskelet Disord. 2011;12(1):68.	Study1	Not reported	Not reported
Turci et al.²⁰20 Turci AM, Bevilaqua-Grossi D, Pinheiro CF, Bragatto MM, Chaves TC. The Brazilian Portuguese version of the revised Maastricht Upper Extremity Questionnaire (MUEQ-Br revised): translation, cross-cultural adaptation, reliability, and structural validation. BMC Musculoskelet Disord. 2015;16(1):41.	Study 1	CAIC = 2,230.40; CFI = 0.91; GFIÿ = 0.90; NNFI = 0.90; ECVI = 3.78; RMSEA = 0.04.	ICC values (95%): D: WS: 0.94 (0.90 - 0.96); BP: 0.85 (0.74-0.91); JC: 0.84 (0.71-0.90); WD: 0.95 (0.91-0.97); BT: 0.94 (0.89-0.96); SS: 0.87 (0.77-0.92) Total: 0.95 (0.90-0.97)
	Study 2		Not reported
	Study 3		Not reported

Assessing the certainty of the evidence						Effect	Level of certainty of the evidence
Nº of studies	Study design	Risk of bias	Inconsistency	Indirect evidence	Imprecision	COR (95% CI)	Level of certainty of the evidence
Head and body posture
3	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.88 [0.85; 0.91]	⨁◯◯◯ Very low
Awkward body posture
3	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.65 [0.57; 0.72]	⨁◯◯◯ Very low
Autonomous management
3	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.80 [0.65; 0.89]	⨁◯◯◯ Very low
Quality of breaks (alternative, no computer)
3	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.80 [0.77; 0.82]	⨁◯◯◯ Very low
Social support
4	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.84 [0.69; 0.92]	⨁◯◯◯ Very low
Work flow
7^* * The same studies were analyzed, with their respective subdivisions in the forest plots. a. High attrition bias and low reporting of the adequacy of the time interval between repeated measurements. b. Lack of compiled (meta-analyzed) studies.	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.68 [0.58; 0.76]	⨁◯◯◯ Very low
Decision authority
4	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.73 [0.65; 0.80]	⨁◯◯◯ Very low
Creative skill development
4	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.78 [0.71; 0.84]	⨁◯◯◯ Very low
Task complexity
3	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.77 [0.54; 0.90]	⨁◯◯◯ Very low
Work pressure
2	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.71 [0.46; 0.86]	⨁◯◯◯ Very low
Office equipment
2	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.52 [0.47; 0.57]	⨁◯◯◯ Very low
Computer position
2	Observational, cross-sectional study	Severe^a	Not severe	Not severe	Not severe	0.61 [0.43; 0.74]	⨁◯◯◯ Very low
Work environment
1	Observational, cross-sectional study	Severe^a	Severe^b	Not severe	Not severe	Not reported	⨁◯◯◯ Very low
Impact of working conditions
1	Observational, cross-sectional study	Severe^a	Severe^b	Not severe	Not severe	Not reported	⨁◯◯◯ Very low

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Psychometric properties of The Maastricht Upper Extremity Questionnaire: systematic review and meta-analysis

HIGHLIGHTS

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: