Upper Extremity Function Test (UEFT)

Evidence Reviewed as of before: 19-04-2013
Author(s): Katie Marvin, MSc. PT
Editor(s): Annabel McDermott; Nicol Korner-Bitensky, PhD OT

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 activities 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 activities. The UEFT was designed primarily to quantify the patient’s ability to execute upper extremity activities 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 activities of daily living. The UEFT has not yet been correlated to vocational activities 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 stroke.

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 stroke.
Is this a screening 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
Reliability

Inter-rater reliability:

  • 1 study investigated inter-rater reliability of the UEFT and found strong inter-rater reliability.

Test-retest reliability:

  • 1 study investigated the test-retest reliability of the UEFT and found strong inter-rater reliability in a sample of patients with chronic upper extremity impairment resulting from conditions including stroke.
Validity

Predictive Validity:

  • 1 study examined the predictive validity 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 responsiveness 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 stroke.

Floor/Ceiling Effects

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

Reliability

Internal consistency:
No studies have examined the internal consistency of the UEFT.

Intra-rater:
No studies have examined the intra-rater reliability of the UEFT.

Inter-rater:
Carroll (1965) investigated inter-rater reliability 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 stroke. 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 stroke. 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 reliability.

Test-retest:
Carroll (1965) examined test re-test reliability of the UEFT in a sample of 23 patients with chronic stable upper extremity impairment due to varying causes (including stroke) 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 reliability.

Validity

Content

No studies have examined the content validity of the UEFT.

Criterion

Concurrent:
No studies have examined the concurrent validity of the UEFT.

Predictive:
Barrecca, Finlayson, Gowland & Basmajian (1999) examined the predictive validity of the UEFT and the Halstead Category Test in 16 patients with stroke. 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 stroke.

Sensitivity/ Specificity:
No studies have examined the specificity of the UEFT.

Construct

Convergent/Discriminant:
No studies have examined the discriminant validity of the UEFT.

Known Groups:
No studies have examined the known groups validity of the UEFT.

Responsiveness

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

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.

Table of contents
We need your feedback