ABILHAND

Purpose

The ABILHAND is a semi-structured item-response questionnaire that measures manual ability according to an individual’s perceived difficulty performing daily bimanual tasks.

In-Depth Review

Purpose of the measure

The ABILHAND is an interview-based assessment tool that measures a patient’s perceived difficulty using his/her hands to perform manual activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
in daily life. The ABILHAND assesses active function of the upper limbs. The tool measures an individual’s ability to perform bimanual tasks, regardless of strategies used to complete the task (Ashford et al., 2008; Penta et al., 1998)

Available versions

The ABILHAND was originally developed by Penta et al. (1998) as a 56-item, 4-level questionnaire of unimanual and bimanual ability for patients with rheumatoid arthritis. The original ABILHAND was intended to measure rehabilitation outcomes and to provide guidelines for goal setting in treatment planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint" (Anderson, 2008, p. 17)
(Gustafsson et al., 2004). Penta et al. (2001) found that patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. were able to complete unimanual activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
with the unaffected limb, regardless of hand dominance, whereas bimanual tasks were more difficult. Accordingly, a version was developed specifically for patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. that only included bimanual items, as well as two alternate unimanual’ activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
that require skillful use of the affected hand (cutting nails, filing nails). Penta et al. (2001) also reviewed the 4-level scoring criterion (impossible, very difficult, difficult, easy) and found that patients rarely used the very difficult’ score. This indicated that the two intermediate scoring criteria (very difficult, difficult) were not sufficiently differentially distinct. Accordingly, the strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. version of the ABILHAND was developed with a 3-level scoring criterion (impossible, any difficulty, easy).

Other impairment-specific versions were subsequently created with modified item sets and levels. Each version of the ABILHAND has its own Rasch-derived item difficulty calibrations that rely on computerized algorithms to obtain the patient’s overall measure from his/her responses (Simone et al., 2011).

Features of the measure

Items:

The ABILHAND is an inventory of 23 bimanual activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(from most difficulty to least difficult):

1. Hammering a nail
2. Threading a needle
3. Peeling potatoes with a knife
4. Cutting own nails
5. Wrapping up gifts
6. Filing own nails
7. Cutting meat
8. Peeling onions
9. Shelling hazel nuts
10. Opening a screw-topped jar
11. Fastening zipper of jacket
12. Tearing open pack of chips
13. Buttoning up a shirt
14. Sharpening a pencil
15. Spreading butter on a slice of bread
16. Fastening a snap
17. Buttoning up trousers
18. Taking the cap off a bottle
19. Opening mail
20. Squeezing toothpaste on a toothbrush
21. Pulling up the zipper of trousers
22. Unwrapping a chocolate bar
23. Washing hands

Scoring:

The patient is asked to rate his/her perceived difficulty performing items without help, according to the following scoring criteria:

• 0 = impossible
• 1 = difficult
• 2 = easy

Tasks that the patient has not performed in the past 3 months are not scored and are encoded as missing responses.

The ABILHAND was developed using the Rasch measurement model, which provides a method to convert the ordinal raw score into a linear measure on a unidimensional scale. Item scores are entered into the WINSTEPS computer program, and raw ordinal data is converted to linear measures expressed in logits (log-odds probability units). The total score is scaled along a unidimensional continuum with 0 at the centre of the scale, whereby the higher the logit number, the greater the patient’s perceived ability (Gustafsson et al., 2004).

What to consider before beginning:

Users should note that self-estimated measures (i.e. when scores are not based on clinician observation of performance) are subject to overestimation or underestimation of actual performance, depending on motivation and cognitive skills (Penta et al. 2001).

Clinicians should consider patient factors such as self-esteem, insight, vision, hearing, language and cognitive function prior to administering the ABILHAND (Gustafsson et al., 2004).

Mpofu & Oakland (2010) advise caution when using the ABILHAND to measure improvements in impairment of the affected upper limb after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation. The ABILHAND does not take into consideration the arm used to perform a task or compensatory strategies employed to complete the task. Accordingly, improvement in scores may be based on use of compensatory strategies rather than on improvement in the affected arm.

Time:

The ABILHAND takes 10 to 30 minutes to administer (Ashford et al., 2008; Connell et al., 2012).

Training requirements:

No training requirements have been specified for the ABILHAND, although administration by a clinician is recommended (Ashford et al., 2008).

Equipment:

The ABILHAND is a semi-structured questionnaire that does not require specific equipment, however the WINSTEPS computer program is required to process raw scores.

Client suitability

Can be used with:

• Individuals with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.
• Individuals with rheumatoid arthritis
• Individuals with systemic sclerosis

Should not be used with:

• Due to the subjective nature of the patient’s reports, this measure should not be used with individuals with severe cognitive deficits (Penta et al., 2001).
• The ABILHAND may not be suitable for use with patients with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury.
  An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) or apraxia (Gustafsson et al., 2004).

In what languages is the measure available?

• French
• English
• Dutch
• Italian
• Swedish

Summary

What does the tool measure?	Manual ability of the upper extremity.
What types of clients can the tool be used for?	The ABILHAND can be used with, but is not limited to, patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment
Time to administer	10-30 minutes
Versions	AH-RA for rheumatoid arthritis (46 items, 4 levels) AH-RA revised version (27 items, 3 levels) ABILHAND-ULA for upper limb amputees (22 items; 4 levels) SSC-adapted ABILHAND for systemic sclerosis (26 items, 3 levels) ABILHAND – neuromuscular age-independent version (22 items) ABILHAND-Kids (21 items)
Other Languages	French, English, Swedish, Dutch, Italian
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: – Order of difficulty of items has been confirmed by Rasch analysisRasch analysis is a statistical measurement method that allows the measurement of an attribute - such as upper limb function - independently of particular tests or indices.   It creates a linear representation using many individual items, ranked by item difficulty (e.g. picking up a very small item, versus a task requiring a very gross grasp) and person ability.   A well performing Rasch model will have items hierarchically placed from simple to more difficult, and individuals with high abilities should be able to perform all the items below a level of difficulty.  The Rasch model is statistically strong because it enables ordinal measures to be converted into meaningful interval measures. It also allows information from various tests or tools with different scoring systems to be applied using the Rasch model. . – One study reported a high item reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest . index. – One study reported high person separation reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest . . Test-retest: No studies have reported on the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the ABILHAND. Intra-rater: No studies have reported on the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings. of the ABILHAND. Inter-rater: No studies have reported on the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. of the ABILHAND.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: – One study reported that the 23 items of the ABILHAND define a common continuum of manual ability, and items are coherent with the overall questionnaire and contribute to the measurement of manual ability. – One study examined stability of item difficulty of the ABILHAND and found that item hierarchy was substantially retained across different groupings (impairment, age, sex, ability). – One study reported that scores explained 84% of observed variance. The main factor across the residuals explained only 11.4% of the residual variance (1.8% of the total variance). Criterion: Concurrent: One study examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard." of the ABILHAND among patients with chronic upper limb impairment resulting from conditions including strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and reported adequate correlations with the Box and Block Test, Jamar handgrip and Purdue pegboard test, and an adequate negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. with the Nine Hole Peg Test. Predictive: No studies have reported on the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks. of the ABILHAND. Construct: Convergent/Discriminant: No studies have reported on the convergent/discriminant validityThe degree to which an assessment measures what it is supposed to measure. of the ABILHAND. Known Groups: – One study reported highly significant differences in ABILHAND scores between patients with tetraparesis, hemiparesis, other neurological impairments (multiple sclerosis, Parkinson’s disease, ataxia) and healthy subjects. – One study reported no correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between ABILHAND scores and country, age, sex, time since strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., affected side, lesion site or tactile sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity." ; poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. with grip strength and manual dexterity of the unaffected limb; poor negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. with depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. ; adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. with grip strength and manual dexterity of the affected limb; and excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. with upper limb motricity.
Floor/Ceiling Effects	No studies have reported on the floor/ceiling effects of the ABILHAND.
Does the tool detect change in patients?	– No studies have reported on the responsivenessThe ability of an instrument to detect clinically important change over time. of the ABILHAND. – One study reported that the ABILHAND demonstrates 92% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity." and 80% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative). at a lower cutoff score of 80/100.
Acceptability	The ABILHAND is non-invasive and quick to administer. The items are considered reflective of real-life activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. (i.e. ecologically valid).
Feasibility	The ABILHAND is portable and is suitable for administration in various settings. The assessment is quick to administer and requires minimal specialist equipment or training.
How to obtain the tool?	The ABILHAND is available in Penta, M., Tesio, L., Arnould, C., Zancan, A., & Thonnard, J-L. (2001). The ABILHAND questionnaire as a measure of manual ability in chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: Rasch-based validation and relationship to upper limb impairment. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., 32, 1627-34

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the ABILHAND. While additional studies have been conducted on other ABILHAND versions, this review specifically addresses the psychometric properties of the 23-item strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. version of the ABILHAND, unless otherwise specified. Two studies were identified.

Floor/Ceiling Effects

No studies have reported on the floor or ceiling effects of the ABILHAND. However, given the hierarchical relationship of items, lower-level tasks of the ABILHAND may be susceptible to floor effects (Ashford et al., 2008).

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
Penta et al. (2001) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the original 56-item ABILHAND in a sample of 103 patients with chronic stroke using Rasch analysisRasch analysis is a statistical measurement method that allows the measurement of an attribute - such as upper limb function - independently of particular tests or indices.   It creates a linear representation using many individual items, ranked by item difficulty (e.g. picking up a very small item, versus a task requiring a very gross grasp) and person ability.   A well performing Rasch model will have items hierarchically placed from simple to more difficult, and individuals with high abilities should be able to perform all the items below a level of difficulty.  The Rasch model is statistically strong because it enables ordinal measures to be converted into meaningful interval measures. It also allows information from various tests or tools with different scoring systems to be applied using the Rasch model.
and reported high reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
(Rasch separation reliability=0.90; person separation reliability=0.90). The authors examined the stability of the scale through differential item functioning (DIF) tests among 12 subgroups: sex (male/female); country (Belgium/Italy); age (< 60/≥ 60), affected side (dominant/nondominant); delay since strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. (< 2 years/≥ 2 years), level of depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
, dexterity and manual ability of the unaffected limb, grip strength, dexterity and sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
of the affected limb, and motricity of the affected limb. The difficulty hierarchy of the ABILHAND was uniformly perceived by patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Simone et al. (2011) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. (n=83), multiple sclerosis (n=17), peripheral or cerebellar ataxia (n=13), spinal cord lesion (n=10) or Parkinson’s disease (n=3), and 24 health subjects. The ABILHAND demonstrated high reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
(item reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
index=0.94; Cronbach’s alpha=0.99). All items of the ABILHAND fit the Rasch model satisfactorily. There were at least 4 strata of statistically different measures, indicating that variance across scores did not reflect randomness. The authors also examined stability of item difficulty through differential item functioning (DIF) by comparing 4 different groupings of the sample pool: impairment (hemiparesis vs. other); age (≤ 69 vs. > 69); sex (male vs. female); and ability (above median vs. below median). There was a very moderate DIF across the grouping criteria, whereby item hierarchy was substantially retained for all subgroups: impairment (1 outlier: buttoning a shirt); sex (6 outliers: fastening a snap, shelling hazel nuts, hammering a nail, wrapping up gifts, peeling potatoes, spreading butter); age (4 outliers: threading a needle, wrapping up gifts, spreading butter, fastening a snap); and ability (2 outliers: sharpening a pencil, cutting meat).

Test-retest:
No studies have reported on the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ABILHAND.

Intra-rater:
No studies have reported on the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
of the ABILHAND.

Inter-rater:
No studies have reported on the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the ABILHAND. Note, however that inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
is less necessary because administration of the ABILHAND does not rely on clinician-observation of patient performance.

Validity

Content:

Penta et al. (2001) examined the measure of perceived difficulty of the ABILHAND in a sample of 103 patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Item distribution ranged from 1.72 to -2.18 logits. All items fit the Rasch model and the 23 items define a common continuum of manual ability. All point measure correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients (RPM) were positive, indicating that all items are coherent with the overall questionnaire and contribute to the measurement of manual ability. Although fit statistics indicated that most activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
adequately measure recovery of manual ability in chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., 1 item obtained an outlier outfit value (buttoning up a shirt, mean square=1.64), and four items obtained outlier infit values (cutting meat, mnsq=0.69; shelling hazel nuts, mnsq=1.33; tearing open a packet of chips, mnsq=1.22; sharpening a pencil, mnsq=0.65).

Penta et al. (2001) examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the ABILHAND by comparing the ranking of item difficulty with expert opinion of four occupational therapists regarding the involvement of the affected hand in each activity. The following classifications were used: (1) the item does not require the affected limb, if it is broken down into several unimanual sequences; (2) the task requires the affected upper limb to stabilize an object but does not involve any fingers; and (3) the task requires precision grip, grip strength, dexterity or any digital activity from the affected side. Findings indicate that more difficult items also tend to require a greater degree of use of the affected limb, whereas easier items do not require the use of the affected limb.

Simone et al. (2011) examined the validityThe degree to which an assessment measures what it is supposed to measure.
of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. (n=83), multiple sclerosis (n=17), peripheral or cerebellar ataxia (n=13), spinal cord lesion (n=10) or Parkinson’s disease (n=3), and 24 health subjects. Modeled scores explained 84% of observed variance. The main factor across the residuals explained only 11.4% of the residual variance (1.8% of the total variance).

Criterion:

Concurrent:
Simone et al. (2011) compared the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
of the ABILHAND, Jamar handgrip, Box and Block Test (BBT), Purdue pegboard test and Nine Hole Peg Test (NHPT) in a sample of 126 patients with chronic upper limb impairment resulting from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease, and 24 healthy subjects, using Pearson’s r. Adequate correlations were found between the ABILHAND and the Jamar handgrip (r=0.377, p=0.001), BBT (r=0.481, p=0.000) and the Purdue pegboard test (r=0.493, p=0.000), and an adequate negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was found between the ABILHAND and the NHPT (r=-0.370, r=0.007).

Predictive:
No studies have reported on the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the ABILHAND.

Construct:

Convergent/Discriminant:
No studies have reported on the convergent/discriminant validityThe degree to which an assessment measures what it is supposed to measure.
of the ABILHAND.

Known Group:
Penta et al. (2001) examined the relationship of the ABILHAND measures to other demographic and clinical variables in a sample of 103 patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., using univariate ANOVA and correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients (Mann-Whitney U test, Kruskal-Wallis H tests, Spearman p, Pearson r). Tests revealed no significant differences in ABILHAND measures according to demographic indexes of country (Belgium/Italy), sex or age. Clinical variables such as time since strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., affected side (dominant/nondominant), lesion site and tactile sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
of either limb (measured using the Semmes-Weinstein tactile sensation test) were not significantly related to ABILHAND measures. There was a poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between ABILHAND measures and grip strength (Jamar handgrip, R=0.242, P<0.014) and manual dexterity (Box and Block Test, R=0.248, P=0.012) of the unaffected limb, and a poor negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
(Geriatric DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale, p=-0.213, P=0.030). ABILHAND measures demonstrated an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with grip strength (R=0.562, P<0.001) and manual dexterity (R=0.598, P<0.001) of the affected limb, and an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with upper limb motricity (Brunnstrom upper limb motricity test, p=0.730, P<0.001). Results showed a direct relationship between ABILHAND measures of manual ability and impairment on the affected side, where more complex combinations of manual dexterity without/without grip strength and/or upper limb motricity impairment correlated with higher manual disability.

Simone et al. (2011) examined the known-group validityThe degree to which an assessment measures what it is supposed to measure.
of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease, and 24 healthy subjects, using Kruskal-Wallis test. Highly significant differences (P<0.001) were found between patients with tetraparesis, hemiparesis, other neurological impairments (multiple sclerosis, Parkinson’s disease, ataxia) and control participants.

Responsiveness

Simone et al. (2011) reported a satisfactory match between the distribution of item difficulty levels and patients’ ability levels. The average ability of healthy controls vs. patients with chronic upper limb impairment resulting from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease was 89 (standard error=8) vs. 63 (standard error=17).

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
& SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
:
Simone et al. (2011) examined the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease, and 24 healthy subjects. An “impairment-normality” cut-off was computed through logistic regression and a lower cut-off score of 80/100 is proposed for healthy controls (area under ROC curve=0.9097, p<0.05). This allowed correct classification of patients vs. healthy controls with a 92% sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
rate and 80% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
rate, whereby 82% of the sample was correctly classified.

References

• Ashford, S., Slade, M., Malaprade, F., & Turner-Stokes, L. (2008). Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review. Journal of Rehabilitation Medicine, 40, 787-95.
• Connell, L.A. & Tyson, S.F. (2012). Clinical reality of measuring upper-limb ability in neurological conditions: a systematic review. Archives of Physical Medicine and Rehabilitation, 93, 221-8.
• Gustafsson, S., Sunnerhagen, K.S, & Dahlin-Ivanoff, D. (2004). Occupational therapists’ and patients’ perceptions of ABILHAND, a new assessment tool for measuring manual ability. Scandinavian Journal of Occupational Therapy, 11, 107-17.
• Mpofu, E. & Oakland, T. (2010). Rehabilitation and Health Assessment: Applying ICF Guidelines. New York: Springer Publishing Company.
• Penta, M., Tesio, L., Arnould, C., Zancan, A., & Thonnard, J-L. (2001). The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke, 32, 1627-34.
• Simone, A., Rota, V., Tesio, L., & Perucca, L. (2011). Generic ABILHAND questionnaire can measure manual ability across a variety of motor impairments. International Journal of Rehabilitation and Research, 34, 131-40.

See the measure

How to obtain the ABILHAND:

The ABILHAND is available in Penta, M., Tesio, L., Arnould, C., Zancan, A., & Thonnard, J-L. (2001). The ABILHAND questionnaire as a measure of manual ability in chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: Rasch-based validation and relationship to upper limb impairment. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., 32, 1627-34.