Jebsen Hand Function Test (JHFT)

Evidence Reviewed as of before: 17-09-2012
Author(s): Jennifer Vissers
Editor(s): Annabel McDermott, OT; Nicol Korner-Bitensky, PhD OT

Purpose

The Jebsen Hand Function Test (JHFT) assesses fine motor skills, weighted and non-weighted hand function activities during performance of activities of daily living.

In-Depth Review

Purpose of the measure

The Jebsen Hand Function Test (JHFT) is a standardized evaluative measure of functional hand motor skills (Hummel et al., 2005).

Available versions

The JHFT was developed in 1969 by Jebsen, Taylor, Treischmann, Trotter, and Howard (Cook, McCluskey, & Bowman, 2006). The JHFT is also referred to as the Jebsen-Taylor Hand Function Test or the Jebsen-Taylor Test of Hand Function.

A 3-item version (Modified Jebsen Hand Function Test, MJT) was developed by Bovend’Erdt et al. (2004) to measure gross functional dexterity in patients with moderate unilateral or bilateral upper limb impairment.

An 8-item Australian version was developed by Agnew and Maas (1982). It consists of the original 7 items with the addition of a grip strength item, measured using the Jamar dynamometer (Cook, McCluskey, & Bowman, 2006).

Features of the measure

Items:

The JHFT consists of 7 items that measure: (a) fine motor skills; (b) weighted functional tasks; and (c) non-weighted functional tasks (Jebsen et al., 1969):

  • Writing a short sentence (24 letters, 3rd grade reading difficulty)
  • Turning over a 3×5 inch card
  • Picking up small common objects
  • Simulated feeding
  • Stacking checkers
  • Picking up large light cans
  • Picking up large heavy cans

Administration guidelines specify that testing begin with the non-dominant hand (Jebsen et al., 1969). Further details about the administration procedures of the JHFT can be found in the original article by Jebsen et al. (1969).

Items of the Modified Jebsen Hand Function Test (MJT) (Bovend’Erdt et al., 2004):

  • Turning over 5 cards
  • Stacking 4 cones
  • Spooning 5 kidney beans into a bowl (simulated feeding)

Scoring:

Each item is scored according to time taken to complete the task. Times are rounded to the nearest second (Spinal Cord Injury Rehabilitation Evidence, 2010). The scores for all 7 items are then summed for a total score. Jebsen et al. (1969) established norms with a sample of 300 healthy subjects of different age groups (20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-94 years). With the exception of writing, all items took under 10 seconds to perform. See Jebsen et al. (1969) for norms according to age, gender and hand use (dominant/non-dominant).

What to consider before beginning:

It is necessary to identify the patient’s dominant hand before beginning the JHFT. When working with patients with stroke it is recommended to take into consideration the area(s) of cortical insult, as damage to areas of the brain responsible for speech and language function may affect performance on the writing task (Celink et al., 2007). Prior to beginning the writing task, individuals should be reminded to use reading glasses if necessary (Jebsen et al., 1969).

Time:

The JHFT requires 15 – 45 minutes to complete.

Training requirements:

No specific training is required.

Equipment:

The JHFT does not require standardized equipment but the following equipment is used (Jebsen et al., 1969):

  • wooden board (41 1/2 inches long x 11 1/4 inches wide x 3/4 inch thick)
  • ball point pen
  • 8×11 inch sheets unruled paper
  • 5×8 inch index cards
  • 3×5 inch index cards
  • 1 pound coffee can
  • 1 inch paper clips
  • teaspoon
  • 5 kidney beans
  • standard size wooden checkers
  • 5 empty 303 cans
  • 5 full (1 pound) 303 cans.

Test equipment can be collated by the clinician or purchased as pre-packaged assessment kits from suppliers including:

Client suitability

Can be used with:

Clients with neurological or musculoskeletal conditions, e.g. stroke, spinal cord injury, arthritis (Cook, McCluskey, & Bowman, 2006).

This assessment has been administered in clients ? 8 years of age (Cook, McCluskey, & Bowman, 2006).

Should not be used with:

Individuals with speech and language disorders may have difficulty understanding instructions.

The writing task can be excluded for individuals with speech and language difficulties due to dominant cerebral hemisphere stroke (Beebe & Lang, 2009, 2007; Hummel et al., 2005).

Languages of the measure

  • English
  • Portuguese (Ferreiro, dos Santos, & Conforto, 2010)

Summary

What does the tool measure? Hand function
What types of clients can the tool be used for? The JHFT can be use with, but is not limited to clients with stroke.
Is this a screening or assessment tool? Assessment
Time to administer 15-45 minutes
Versions
  • JHFT
  • Modified Jebsen Hand Function Test (MJT)
  • JHFT Australian version, Portuguese version
Other Languages English, Portuguese
Measurement Properties
Reliability

Internal consistency:

One study reported excellent internal consistency of the JHFT (Portuguese version), and adequate to excellent internal consistency of individual items.

Test-retest:

One study reported adequate to excellent test-retest reliability of JHFT individual items.
– One study reported excellent test-retest reliability of the MJT.

Intra-rater:

One study reported excellent intra-rater reliability of the JHFT (Portuguese version).

Inter-rater:
– One study reported excellent inter-rater reliability of the JHFT (Portuguese version) and individual items.

Validity

Content:

  • No studies have examined the content validity of the JHFT.

Criterion:

Concurrent:

  • Two studies reported excellent correlation between the JHFT and grip strength, pinch strength, Action Research Arm Test, Nine Hole Peg Test, and Stroke Impact Scale – Hand Domain.
  • One study reported an excellent correlation between the MJT and the Nine Hole Peg Test and an adequate correlation with grip strength.

Predictive:

  • No studies have examined the predictive validity of the JHFT.

Construct:

  • No studies have examined the construct validity of the JHFT.
  • One study reported no significant difference in scores on the JHFT (Portuguese version) according to education level or hand dominance.
Floor/Ceiling Effects No studies have examined the floor or ceiling effects of the JHFT.
Sensitivity/ Specificity No studies have reported on the sensitivity or specificity of the JHFT.
Does the tool detect change in patients?

One study reported moderate responsiveness of the JHFT from 1 to 3 months post-stroke, and from 3 to 6 months post-stroke.

Acceptability The JHFT is comprised of simple, familiar, and functional tasks. Consideration must be paid to individuals with speech and language difficulties, who may have difficulty understanding instructions and performing the writing task.
Feasibility The JHFT is easy to administer and does not require standardized equipment.
How to obtain the tool?

Information regarding test administration is provided in:

Jebsen, R.H., Taylor, N., Trieschmann, R.B., Trotter, M.J., & Howard, L.A. (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50(6), 311 – 319.

Assessment kits can be purchased from:

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the Jebsen Hand Function Test (JHFT). While studies have been conducted with other patient groups, this review specifically addresses the psychometric properties relevant to patients with stroke. At the time of publication five studies were identified: three relating to the JHFT, and one each for the JHFT (Portuguese version) and the Modified Jebsen Hand Function Test (MJT).

Floor/Ceiling Effects

No studies have examined the floor or ceiling effects of the JHFT.

Reliability

Internal consistency:
Ferreiro, dos Santos, & Conforto (2010) examined the internal consistency of the JHFT (Portuguese version) with a sample of 40 patients with stroke using Cronbach’s alpha, and reported excellent internal consistency(α=0.924). Internal consistency of individual items, reported using Pearson’s correlation coefficient and Cronbach’s alpha , was adequate to excellent (writing: r=0.812, α=0.844; card turning r=0.857, α=0.632; small common objects r=0.657, α=0.651; simulated feeding r=0.813, α=0.646; checkers r=0.712, α=0.633; large light objects r=0.849, α=-0.681; large heavy objects r=0.898, α=0.687).

Test-retest:
Jebsen et al. (1969) examined test-retest reliability of the JHFT in a sample of 26 patients with a range of upper limb conditions including hemiparesis from cerebral vascular disease (n=5), using Pearson’s correlation coefficient. Test-retest reliability of individual tasks was adequate to excellent (writing: r=0.67, 0.84; cards: r=0.91, 0.78; small objects: r=0.93, 0.85; simulated feeding: r=0.92, 0.60; checkers: r=0.99, 0.91; large light objects: r=0.89, 0.67; large heavy objects: r=0.89, 0.92, dominant and non-dominant hands respectively).

Bovend’Eerdt et al. (2004) examined the test-retest reliability of the Modified Jebsen Hand Function Test (MJT) in a sample of 26 individuals with neurological disorders including stroke (n=12), Multiple Sclerosis (n=7), head injury (n=4), and tumours (n=3). The mean time between retesting was 9.6 days. The study reported excellent test-retest reliability of the MJT (r = 0.95), using Pearson’s correlation coefficient.

Intra-rater:
Ferreiro, dos Santos, & Conforto (2010) examined intra-rater reliability of the JHFT (Portuguese version) with a sample of 40 patients with stroke and reported excellent intra-rater reliability (ICC=0.997), using intraclass correlation coefficient (ICC).

Inter-rater:
Ferreiro, dos Santos, & Conforto (2010) examined the inter-rater reliability of the JHFT (Portuguese version) with a sample of 40 patients with stroke using intraclass correlation coefficient (ICC), and reported excellent inter-rater reliability (ICC=1.0). Inter-rater reliability for individual items was also excellent (writing, ICC=0.999; card turning, ICC=0.977; small common objects, ICC=0.998; simulated feeding, ICC=0.991; checkers, ICC=0.995; large light objects, ICC=0.988; large heavy objects, ICC=0.991).

Validity

Content:

No studies have examined the content validity of the JHFT

Criterion:

Concurrent:
Beebe & Lang (2009) examined the concurrent validity of the JHFT with grip and pinch strength (measured by dynamometer), the Action Research Arm Test (ARAT) , Nine Hole Peg Test (NHPT), and the Stroke Impact Scale – Hand domain (SIS-Hand) in a sample of 33 patients with stroke, using Spearman’s correlation. Measures were administered at 1 month, 3 months and 6 months post-stroke. The JHFT demonstrated excellent correlations with grip strength (r=0.79-0.81), pinch strength (0.60-0.79), ARAT (r=0.87-0.95), NHPT (0.84-0.97) and SIS-Hand (0.61-0.83) at all time points.

Note: The study did not use the first task of the JHFT (writing a sentence) due to its dependence on hand dominance and education level.

Beebe & Lang (2007) examined concurrent validity of the JHFT with grip and pinch strength (measured by dynamometer), Action Research Arm Test (ARAT), 9-Hole Peg Test (NHPT), and Stroke Impact Scale – Hand Function Subscale (SIS-Hand) in a sample of 32 participants with stroke, using Pearson’s product moment correlation. The JHFT demonstrated excellent correlations with ARAT (r=-0.89), grip strength (r=-0.76), pinch strength (r=-0.68), 9-HPT (r=-0.89), and SIS-Hand Function (r=-0.82).

Note: The study did not use the first task of the JHFT (writing a sentence) due to its dependence on hand dominance and education level.

Bovend’Eerdt et al. (2004) examined the concurrent validity of the Modified Jebsen Hand Function Test (MJT) with the University of Maryland Arm Questionnaire for Stroke (UMAQS), Nine Hole Peg Test (NHPT), and grip strength (measured by dynamometer) in a sample of 26 individuals with neurological disorders including stroke (n=12), Multiple Sclerosis (n=7), head injury (n=4), and tumours (n=3). Measures were administered on two occasions (T1, T2) on average 9.6 days apart. The MJT showed excellent correlation with the NHPT (r=0.86 and 0.88 on T1 and T2 respectively) and adequate correlation with grip strength (r=0.44, significant on T2 only), using Pearson’s correlation coefficient. Correlations between the MJT and UMAQS were not significant at either time point.

Predictive:
No studies have examined the predictive validity of the JHFT.

Construct:

No studies have examined the construct validity of the JHFT.

Known Groups:
Ferreiro et al. (2010) reported no significant difference in scores on the JHFT (Portuguese version) according to education level or hand dominance in a sample of 40 patients with stroke.

Responsiveness

Beebe & Lang (2009) measured the responsiveness of the JHFT with a sample of 33 patients with stroke, using the single population effect size method. Measures were taken at 1, 3 and 6 months post-stroke, during which time participants received conventional stroke rehabilitation. The JHFT demonstrated moderate responsiveness from 1 to 3 months post-stroke (ES=0.69) and from 3 to 6 months post-stroke (ES=0.73).

Sensitivity & Specificity:
No studies have examined the sensitivity and specificity of the JHFT.

References

  • Beebe, J.A. & Lang, C.E. (2007). Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis. Neurorehabilitation and Neural Repair, 21(3), 279 – 291.
  • Beebe, J.A. & Lang, C.E. (2009). Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke. Journal of Neurologic Physical Therapy, 33(2), 96-103.
  • Bovend’Erdt, T.J.H., Dawes, H., Johansen-Berg, H., & Wade, D.T. (2004). Evaluation of the Modified Jebsen Test of Hand Function and the University of Maryland Arm Questionnaire for Stroke. Clinical Rehabilitation, 18, 195-202
  • Celnik, P., Hummel, F., Harris-Love, M., Wolk, R., & Cohen, L. (2007). Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. Archives of Physical Medicine and Rehabilitation, 88, 1369-76.
  • Cook, C., McCluskey, A., & Bowman, J. (2006). Jebsen Test of Hand Function. Penrith South, NSW: University of Western Sydney. Retrieved from http://www.maa.nsw.gov.au/default.aspx?MenuID=376
  • Duncan, P., Richards, L., Wallace, D., Stoker-Yates, J., Pohl, P., Luchies, C., Ogle, A., & Studenski, S. (1998). A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke, 1998(29), 2055-2060.
  • Ferreiro, K.N., dos Santos, R.L., & Conforto, A.B. (2010). Pyschometric properties of the Portuguese version of the Jebsen-Taylor test for adults with mild hemiparesis. Revista Brasileira de Fisioterapia (Brazilian Journal of Physiotherapy), 14(5), 377-81.
  • Jebsen, R.H., Taylor, N., Trieschmann, R.B., Trotter, M.J., & Howard, L.A. (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50(6), 311 – 319.
  • Hummel, F., Celnik, P., Giraux, P., Floel, A., Wu, W., Gerloff, C., & Cohen, L. (2005). Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain, 2005(128), 490-9.
  • Poole, J. (2003). Measures of Adult Hand Function: Arthritis Hand Function Test (AHFT), Grip Ability Test (GAT), Jebsen Test of Hand Function, and The Rheumatoid Hand Functional Disability Scale (The Duruöz Hand Index [DHI]). Arthritis and Rhematism (Arthritis Care and Research), 49(5S), S59-66.
  • Spinal Cord Injury Rehabilitation Evidence. (2010). Jebsen Hand Function Test. Retrieved from http://www.scireproject.com/outcome-measures/jebsen-hand-function-test
  • Wu, C., Seo, H., & Cohen, L. (2006). Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. Archives of Physical Medicine and Rehabilitation, 87, 351-7.

See The Measure

How to obtain the JHFT?

Administration instructions are published in Jebsen, R.H., Taylor, N., Trieschmann, R.B., Trotter, M.J., & Howard, L.A. (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50(6), 311 – 319.

While the JHFT does not require standardized equipment, assessment kits can be purchased from:

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