Elsevier

Journal of Hand Therapy

Volume 19, Issue 3, July–September 2006, Pages 328-349
Journal of Hand Therapy

Scientific/Clinical Article
The Upper Limb Functional Index: Development and Determination of Reliability, Validity, and Responsiveness

https://doi.org/10.1197/j.jht.2006.04.001Get rights and content

Abstract

Purpose

Current upper limb regional self-report outcome measures are criticized for poor clinical utility, including length, ease, and time to complete and score, missing responses, and poor psychometric properties. To address these concerns a new measure, the Upper Limb Functional Index (ULFI), was developed with reliability, validity, and responsiveness being determined in a prospective study.

Methods

Patients from nine Australian outpatient settings completed the ULFI and two established scales, the Disabilities of the Arm, Shoulder, and Hand (DASH) (n = 214) and the Upper Extremity Functional Scale (UEFS) (n = 64) concurrently to enable construct and criterion validity to be assessed. Two subgroups were used to assess test–retest reliability at 48-hour intervals (n = 46) and responsiveness through distribution-based methods (n = 29). Internal consistency, change scores, and missing responses were calculated. Practical characteristics of the scale were assessed.

Results

The ULFI correlated with the DASH (r = 0.85; 95% CI) and UEFS (r = 0.78; 95% confidence interval [CI]), demonstrated test–retest reliability (intraclass correlation coefficient = 0.96; 95% CI) and internal consistency (Cronbach alpha = 0.89). The change scores of the ULFI with standard error of the measurement was 4.5% or 1.13 ULFI-points and minimal detectable change at the 90% CI was 10.4% or 2.6 ULFI-points. Responsiveness indices were standardized response mean at 1.87 and effect size at 1.28. The ULFI demonstrated an impairment range of 0–100%, with no missing responses and a combined patient completion and therapist scoring time of less than 3 minutes.

Conclusions

The ULFI demonstrated sound psychometric properties, practical characteristics, and clinical utility thereby making it a viable clinical outcome tool for the determination of upper limb status and impairment. The ULFI is suggested as the preferred upper limb regional tool due to its superior practical characteristics and clinical utility, and comparable psychometric properties without a tendency toward item redundancy.

Section snippets

Study Design

The development, construction, and final validation of a new regional upper limb questionnaire require a methodological process that is systematic and follows established protocols. The “Guyatt Model” of questionnaire development30, 44, 45 achieves this through its systematic three-stage process as demonstrated in Figure 1. This model and process incorporate the literature search and review strategy instituted by Michener and Leggins7 and mirror the development model of the DASH38 and

Results

The study sample provided 214 responses from 139 subjects for both the ULFI and DASH with nine subjects and their responses being excluded providing a final total of 205 responses from 130 subjects. The UEFS had 64 responses from 32 subjects with one subject and his or her responses excluded to provide a total of 62 responses from 31 subjects (Table 1). The demographic data on all subjects are detailed in Table 2.

Data distribution demonstrated substantial variance in all values for the three

Discussion

This prospective study investigated the ULFI as a new regional upper limb SROM tool analyzing its concurrent performance compared to advocated measures, the DASH and the UEFS. The results demonstrated that the ULFI has both methodological and practical characteristic advantages for measuring upper extremity disorders. Reliability, internal consistency, criterion and construct validity, sample size, error measurement, and responsiveness have been demonstrated to be comparable to the properties

Conclusions

This study achieved its two primary objectives. It validated the ULFI and demonstrated that its essential psychometric properties of reliability, validity, responsiveness, error measurement, and internal consistency approximate or exceed those of the DASH and UEFS. The latter advocated tools are shown to be self-limiting in determining maximum impairment and have practical restraints that affect clinical utility, limitations that may also by implication be present in the UEFI. The ULFI's

Quiz: Article #039

Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.

  • #1.

    The ULFI includes:

    • a.

      a Moberg pick-up test

    • b.

      an SAT

    • c.

      a VALPAR

    • d.

      a VAS

  • #2.

    The following stat was used to determine the reliability of the ULFI:

    • a.

      Kappa

    • b.

      ANOVA

    • c.

      ICC

    • d.

      student T test

  • #3.

    Missing responses are:

    • a.

      anticipated in all SROMs

    • b.

      not seen in the ULFI

    • c.

      not seen in the DASH

    • d.

      not seen in the UEFS

  • #4.

    The authors claim that compared to the DASH and UEFS, the ULFI is:

    • a.

      less practical

    • b.

      higher in

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