Background The Swedish National Healthcare Quality registry for hand surgery, called HAKIR, includes collection of patient-reported outcome measures (PROMs) for all operations performed at the specialist departments of hand surgery. A prerequisite for PROMs is that the collection of data is based on psychometrically sound outcome instruments. This study therefore aims to evaluate content and construct validity, floor and ceiling effects, data completeness and magnitude of change over time for the eight-item HAKIR questionnaire.Methods Content validity was investigated by patients, an expert group and literature review. Construct validity was investigated through predefined hypotheses and correlation statistics between single-item questions and QuickDASH. Floor and ceiling effect and data completeness was analysed on 13197 preoperative, 10702 three months and 9986 twelve months postoperative questionnaires. Changes in scores for single-items between pre- and 3 and 12 months follow-up for elective hand-related diagnosis and between 3 and 12 months for acute injuries was quantified by effect size calculations.Results The HAKIR Questionnaire (HQ-8) included items concerning pain on load, pain on motion without load, pain at rest, stiffness, weakness, numbness, cold sensitivity and ability to perform daily activities. Correlation coefficients between single-items and total QuickDASH score at pre, 3 and 12 months follow-up ranged from 0.44-0.79. No ceiling effect but a floor effect in the total group was seen in all items at all follow-ups. Percentage of missing item responses was < 2.6% except for the cold sensitivity question. The magnitude of change for individual items varied between small to large effects size in elective hand-related diagnosis. For acute injuries a small effect size was seen between 3 and 12 months follow-up.Conclusions This study provides evidence of content and construct validity of the HQ-8 including lack of ceiling effect, expected floor effect, good data completeness and ability to detect changes in scores over time. Associations between single-items and QuickDASH indicate that HQ-8 measures unique disability aspects important in hand surgery. Further studies are needed to evaluate test-retest reliability, responsiveness including clinically important change of the HQ-8 questions in subgroups of hand-related diagnoses.