Upper Extremity Function Test (UEFT)

Purpose

The Upper Extremity Function Test (UEFT) is an evaluative measure to assess upper extremity functional impairment and the severity of impairment in patients exhibiting dysfunction in the upper extremity.

In-Depth Review

Purpose of the measure

The Upper Extremity Function Test (UEFT) is an evaluative measure to assess upper extremity functional impairment and the severity of impairment in patients exhibiting dysfunction in the upper extremity. The test assesses function based on the assumption that complex upper extremity movements used in everyday 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.
are made up of certain movement patterns (e.g. supination/pronation, grasp/release, pinch grip, etc.), so that evaluation of these movement patterns can predict the patient’s ability to perform functional 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.
. The UEFT was designed primarily to quantify the patient’s ability to execute upper extremity 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.
of a general nature, and does not take into consideration factors such as skill, speed, range of motion, endurance, sensation etc. The selected list of test items is believed to represent the upper limb movements that are necessary to perform many of the major 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.
of daily living. The UEFT has not yet been correlated to vocational 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.
of the upper extremity.

Available versions

The Action Research Arm Test (ARAT) was developed by Ronald Lyle in 1981 by adapting theUpper Extremity Function Test (UEFT)(Carroll, 1965). TheUEFTtest administration and scoring was simplified, the time required to administer the test was shortened, and items were grouped based on the hierarchical scale (Guttman Scale) (Lang, Wagner, Dromerick, & Edwards, 2006). Due to the need for more specific and detailed instructions related to the client’s position, scoring and test administration, Yozbatiran, Der-Yeghiaian, and Cramer (2008) proposed a standardized approach to the ARAT.

Please visit our Action Research Arm Test module for further information.

Features of the measure

Items:

The UEFT consists of 33 items or tasks, detailed below.

Description of tasks:

The patient is positioned comfortably in a chair in front of the table used for testing. The patient is evaluated while performing different tasks, such as moving objects to a shelf, placing objects over a peg, writing their name, etc. The objects are of varying shapes and weights in order to evaluate the patient’s grasp, grip, pinch, placing, arm extension and elevation, pronation and supination, and functional strength.

Please note that the patient is not permitted to move from the chair during testing (unless a break is required), although weight transfer and rolling from side to side of the buttock is permitted. Each arm is tested individually. Demonstration of tasks are permitted (Carroll, 1965)

Scoring and Score Interpretation:

The UEFT uses a simple scoring method where results can be compared at different time intervals.

Scoring:

3	Performs test normally.
2	Completes test, but takes abnormally long time or has great difficulty.
1	Performs test partially. This grade is assigned when the patient is able to pick up or lift the test item from the table but is unable to place the object in its correct end position. For example, in items 27 to 29, the patient is able to lift the pitcher or glass but is unable to pour the water into the proper receptacle.
0	Can perform no part of the test. If the patient pushes objects out of their slots or around on the table a grade of 0 is assigned.

The total score is tallied. The maximum score for the dominant hand is 99 as compared to a maximum score of 96 for the non-dominant hand, because item 33 consists of writing of the patient’s name with the dominant hand.

The authors of the test concluded that a score increase or decrease of 10 points represents a meaningful gain or loss of important function, respectively.

Nearly equal scoring points have been allotted for the two functions prehension’ (grasp, grip and pinch) and placing’ (shoulder stability; shoulder abduction and flexion/extension; elbow flexion/extension; wrist flexion/extension and pronation/supination); as such, both functions need to be intact in order for a high score to be awarded.

Score interpretation:

0 to 25:	Trace function
26-50:	Very poor
51-75:	Poor
76-89:	Partial function
90-98:	Functional
99 (dominant hand) / 96 (non-dominant hand):	Maximal function

Functional Implications of UEFT:

Basmajian et al. (1982) investigated the functional implications of UEFT scores and found the following scores to be indicative of the following patient capabilities:

• 0: no function
• 10: holding a book for reading
• 20: driving
• 30: carrying objects from place to place
• 40: dressing
• 50: feeding
• 60: shaving/make-up
• 70: hand crafts
• 80: fine crafts (needlework, gardening, capentry)
• 90: card playing
• 100: letter writing/typing

Adapted from Basmajian, Gowland, Brandstater, Swanson & Trotter (1982).

Time:

The UEFT takes approximately 1 hour to administer (Lyle, 1981).

Training requirements:

None typically reported, however it is recommended that the clinician is familiar with the assessment tool.

Subscales:

None typically reported.

Equipment:

• 17.5 in. width x 28.5 in. length x 30.75 in. height table
• 3.75 in. width shelf mounted 14.75 in. from the table
• Wooden cubes: 4 x 4 x 4in. (576g); 3 x 3 x 3in. (243g); 2 x 2 x 2in. (72g); 1 x 1 x 1 (9g)
• Large iron pipe: 1.625 O.D. x 6.125in. (500g)
• Small iron pipe: 0.87 O.D. x 4.125 (125g)
• Slate: 4.125 x 1 x .375 (61g)
• Wooden ball: 3 O.D. (100g)
• Glass marble 0.625 O.D. (6.3g)
• Metal sphere 0.44 O.D. (6.6g); 0.25 O.D. (1.0g); 0.16 (0.34g)
• Steel washer 0.16 thick x 1.375 O.D. x 0.56 I.D. (14.5g)
• Iron 6 lb approximately
• 2 Plastic tumblers 8 fl. oz
• Aluminum water pitcher 3 qt capacity
• Pencil

*O.D. = outside diameter; I.D. = inside diameter

Please refer to Carroll (1965) for further information regarding administration set-up of the UEFT.

Alternative form of the Action Research Arm Test

None typically reported.

Client suitability

Can be used with:

• Clients 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..

Should not be used with:

• When administering the UEFT to clients with upper extremity amputations, the total score should be adjusted according to the following scale.

Total UEFT Scores for people with amputations:

Wrist:	0
Three fingers:	41
Middle finger:	87
Index finger and 2nd metacarpal:	84
Thumb and metacarpal-phalangeal joint:	91
Index finger at proximal interphalangeal joint:	93

Languages of the measure?

There are no official translations of the UEFT.

Summary

What does the tool measure?	The UEFT measures specific changes in upper extremity impairment and function
What types of clients can the tool be used for?	The UEFT can be used with, but is not limited to clients 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	The UEFT takes approximately 1 hour to administer.
Versions	The Action Research Arm Test (ARAT) was developed by Ronald Lyle in 1981 by adapting the Upper Extremity Function Test (Carroll, 1965).
Other Languages	There are no official translations.
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 .	Test-retest: One study investigated 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 UEFT and found strong 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. in a sample of patients with chronic upper extremity 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.. Inter-rater: One study investigated 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 UEFT and found strong 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. .
ValidityThe degree to which an assessment measures what it is supposed to measure.	Predictive: One study examined 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 UEFT and found admission UEFT scores to be predictive of discharge UEFT scores.
Floor/Ceiling Effects	No studies have examined the floor/ceiling effects of the UEFT.
Does the tool detect change in patients?	No studies have formally examined the responsivenessThe ability of an instrument to detect clinically important change over time. of the UEFT.
Acceptability	The UEFT is simple to administer and can be easily administered in a variety of settings (e.g. home or medical office settings).
Feasibility	The administration of the UEFT and the ARAT is quick and simple, but requires standardized equipment.
How to obtain the tool?	Please refer to the initial validation study by Carroll (1965) for further information on the UEFT.

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the Upper Extremity Function Test. Limited information is available on the UEFT. However, the Action Research Arm Test, developed in 1981 as an adaptation of the UEFT, is a more reliable, valid and responsive measure currently used for clients 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..

Floor/Ceiling Effects

No studies have examined the floor/ceiling effects of the UEFT.

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.:
No studies have 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 UEFT.

Test-retest:
Carroll (1965) examined test re-test 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 .
of the UEFT in a sample of 23 patients with chronic stable upper extremity impairment due to varying causes (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 7 patients with typical upper extremity function. The UEFT was administered two times, 30 days apart. Scores for individuals with typical upper extremity function were identical on the two different testing days. Of scores attained for patients with chronic stable upper extremity impairment, 1 case was identical, 5 cases showed a 1-point difference, 7 cases showed a 3-point difference, 2 cases showed a 5-point difference, and 3 cases showed a difference of 6, 7 and 8 points. The results of this initial validation study suggest that UEFT has strong test re-test 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 .
.

Intra-rater:
No studies have examined 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 UEFT.

Inter-rater:
Carroll (1965) investigated 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 UEFT among clinicians who were either experienced or not experienced with the UEFT. Two raters with experience using the UEFT rated the upper extremities of 48 individuals 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.. The two examiners rated 46% of the patients identically, 21% within 1 point, 8% within 2 points, 10% within 3 points, 8% within 4 points and 6% of patients within 5 points. Subsequently, three examiners without experience using the UEFT were educated on the grading system and were then asked to rate the performance of 15 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.. The inexperienced raters scored within 7 points of the experienced raters 97% of the time. The results of this study indicate that the UEFT has strong 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.
.

Validity

Content:

No studies have 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 UEFT.

Criterion:

Concurrent:
No studies have 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 UEFT.

Predictive:
Barrecca, Finlayson, Gowland & Basmajian (1999) examined 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 UEFT and the Halstead Category Test in 16 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.. Admission UEFT and Halstead Category Test scores were found to be predictive of discharge UEFT scores (approximately 5 weeks later), even in patients with severe upper extremity disability following 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..

Construct:

Convergent/Discriminant:
No studies have examined the discriminant validityMeasures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.
of the UEFT.

Known Groups:
No studies have examined the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the UEFT.

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).
:
No studies have examined the specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the UEFT.

Responsiveness

Popovic, Popovic, Sinkjaer, Stefanovic & Schwirtlick (2003) investigated the effects of Functional Electrical Stimulation on upper extremity function in 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.. The UEFT was used as an outcome measure and was able to detect change in upper extremity function in 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..

References

• Barreca, S., Finlayson, A., Gowland, C. & Basmajian, J. (1999). Use of the Halstead Category Test as a predictor of functional recovery in the hemiplegic upper limb: A cross-validation study. The Clinical Neuropsychologist, 13(2), 171-178.
• Basmajian, C., Gowland, M., Brandstater, L., Swanson, L. & Trotter, J. (1982). EMG feedback treatment of upper limb in hemiplegic stroke patients: A pilot study. Archives of Physical Medicine Rehabilitation, 63, 614.
• Carroll, D. (1965). A quantitative test of upper extremity function. Journal of Chronic Diseases, 18, 479-491.
• Lang, C.E., Wagner, J.M, Dromerick, A.W., & Edwards, D.F. (2006). Measurement of upper extremity function early after stroke: properties of the action research arm test.Archives Physical Medicine and Rehabilitation, 87, 1605-1610.
• Lyle, R.C. (1981). A performance test for assessment of upper limb function in physical rehabilitation treatment and research. International Journal of Rehabilitation Research, 4(4), 483-492.
• Okkema, K.A. (1998). Functional evaluation of upper extremity use following stroke: A literature review. Topics of Stroke Rehabilitation, 4(4), 54-75
• Popovic, M.B., Popovic, D.B., Sinkjaer, T., Stefanovic, A. & Schwirtlich, L. (2003). Clinical evaluation of Funcational Evaluation Therapy in acute hemiplegic subjects. Journal of Rehabilitation Research and Development, 40(5), 443-454.

See the measure

Further information on the UEFT can be found in the following publication:

Carroll, D. (1965). A quantitative test of upper extremity function. Journal of Chronic Diseases, 18, 479-491.