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ABILHAND

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Purpose

The ABILHAND questionnaire assesses bimanual ability as an interview-based test focused on the patient's perceived difficulty. The ABILHAND-KIDS questionnaire is filled in by the parent of the child by rating the child’s perceived difficulty of bimanual activities.

Link to Instrument

Instrument Details

Area of Assessment

Activities of Daily Living
Dexterity
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Online analysis is currently free on the instrument website

Key Descriptions

  • Bimanual ability is defined as the capacity to manage daily activities that require the use of both hands, whatever the strategies involved (Penta 1998, 2001; Arnould 2004). It refers to the Activity domain of the ICF.
  • 3 level response scale for each item, rated as ‘Impossible=0, Difficult=1, Easy=2, Not applicable=missing data.'
  • 4 level response scale for each item for unilateral upper-limb amputation, rated as ‘Impossible=0, Difficulty=1, Easy=2, Very Easy=3, Not applicable=missing data.’
  • The Rasch Measurement Theory converts raw scores of an ordinal scale into an interval scale. Both the ability of the patients and the difficulty of the items are rated on the same interval scale with logit units or log-odds unit. Rasch analysis is used to verify whether the data fit the model, i.e. that people with lower ability score lower on the scale and that scoring increases when the ability of the patients increases.
  • This transformation can be done even when some items have not been answered. The advantage of Rasch transformed scores on an interval scale is that parametric statistics can be used to calculate pre-post scores, leading to more accurate evaluation of change due to treatment.
  • The http://www.rehab-scales.org/abilhand-online-rasch-analysis.html provides the Rasch-transformed scores both in logits and in percentage (0-100 scoring).

Number of Items

Chronic Stroke: 23 items
Rheumatoid Arthritis: 27 items
Systemic Sclerosis: 26 items
Neuromuscular Disorders: 22 items

ABILHAND-KIDS:
English: 21 items
Portuguese: 21 items
Turkish: 18 items

Equipment Required

  • Paper Questionnaire
  • Response scale to be presented to patient or parent of the child
  • Online access for scoring

Time to Administer

10 minutes

Required Training

Reading an Article/Manual

Age Ranges

Children (ABILHAND-KIDS)

6 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Reviewed by: Namrata Grampurohit, PhD, OTR/L, Jefferson University; Majd Jarrar, MS, OTR/L, University of Washington; Ann Van de Winckel, PhD, MS, PT, University of Minnesota, March 2018.

Body Part

Upper Extremity

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Considerations

 
  • Bimanual Activities

  • Rasch analysis report is generated by entering scores online

Stroke

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Standard Error of Measurement (SEM)

Chronic stroke:

(Ekstrand 2014; n=43; mean age=64 ± 8 years, range 45-81 years of age; time post-stroke=16 ± 8 months)

  • SEM for the entire group (n=43): 21%

  • SEM after removing 4 outliers (n=39): 15%

Minimally Clinically Important Difference (MCID)

Subacute - Chronic Stroke:

(Wang 2011; n=51, mean age=55.26 ± 10.31 years, time post-stroke=17.57 ± 13.43 months)

  • MCID: 0.26 to 0.35 logits

Cut-Off Scores

Stroke:

(Simone 2011; n=150, stroke = 83, multiple sclerosis=17, cerebellar ataxia=13, spinal cord injury=10, Parkinson Disease=3, healthy=24); age range = 15-89 years)

  • Normative cut off >79 on 100 (sensitivity 92%; specificity 80%)

Test/Retest Reliability

 

Chronic stroke:

(Ekstrand 2014; n=43; mean age=64 ± 8 years, range 45-81 years of age; time post-stroke=16 ± 8 months)

  • Excellent test-retest reliability for the entire sample (n=43)
    (ICC=0.85)

  • Excellent test-retest reliability after removing 4 outliers (n=39) (ICC=0.91)

Internal Consistency

Chronic Stroke:

(Basilio 2016; n=107; mean age=58 ± 12 years; time post-stroke=64 months, range 6-380 months post-stroke)

  • Excellent Person separation index=0.91

Chronic stroke:

(Penta 2001; n=103; mean age=63 years, range 24-84 years of age; time post-stroke=38 months, range 6-253 months post-stroke)

  • Excellent Person separation index (comparable to Coefficient alpha)=0.90

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Stroke

(Krumlinde-Sundholm 2017; n=144; mean age=53 ± 11.45 years, range 19-86 years of age)

  • Excellent concurrent validity with Adult-Assisting Hand Assessment Stroke): the “Sandwich” task (Spearman rho=0.77, p<0.05), and the “Present” task (Spearman rho=0.80, p<0.05)

Subacute - Chronic stroke:

(Wang 2011; n=51, mean age=55.26 ± 10.31 years, time post-stroke=17.57 ± 13.43 months post-stroke)

  • Adequate concurrent validity with Stroke Impact Scale – physical domains (r =0.54-0.66, p<0.01)

  • Poor to Adequate concurrent validity with Functional Independence Measure–motor domain

  • Poor to Adequate concurrent validity with the Nottingham Extended Activities of Daily Living Scale (r =0.28-0.48, p<0.01)

 Predictive Validity:

Stroke - evaluated at 1 months, 3 months and 6 months post-stroke:

(Bouffioulx 2011; n=45; mean age=69 ± 10.7 years, range 45-93 years of age)

  • During the chronic phase, ABILHAND was the strongest predictor of perceived satisfaction reported with the SATIS-stroke questionnaire. It accounted for 35% of the variance.

Subacute - Chronic stroke:

(Wang 2011; n=51, mean age=55.26 ± 10.31 years, time post-stroke=17.57 ± 13.43 months)

  • Excellent predictive validity with the Stroke Impact Scale-physical function (r=0.66, p<0.01)

  • Adequate predictive validity with the Functional Independence Measure – motor domain (r=0.43, p<0.01)

  • Adequate predictive validity with an accelerometer (r=0.45, p<0.01)

  • Poor predictive validity with the Nottingham Extended Activities of Daily Living Scale (r=0.29, p<0.05)

Construct Validity

Chronic Stroke:

(Bertrand 2015; n=34; mean age=57 ± 13.7 years)

  • Excellent convergent validity with the Motricity Index obtained at weeks 2 (r=0.71), 4 (r=0.80), 8 (r=0.69), and 12 (r=0.82)

Stroke - evaluated at 1 months, 3 months and 6 months post-stroke:

(Bouffioulx 2011; n=45; mean age=69 ± 10.7 years, range 45-93 years of age)

  • Poor to adequate convergent validity with Satisfaction with activity and participation SATIS-Stroke questionnaire at 1 week (r=0.23, p>0.05), 3 months (r=0.34, p<0.05), and 6 months post-stroke (r=0.66, p<0.05)

Stroke   

(Krumlinde-Sundholm 2017; n=144; mean age=53 ± 11.45 years, range 19-86 years of age)

  • Excellent convergent validity with the Jebsen-Taylor Hand Function test (Spearman rho=0.86, p<0.05)

Chronic Stroke:

(Meyer 2016, n=32; median age at stroke onset=68.3 years, interquartile range 61.3-80.1 years; evaluated at 6 months post-stroke)

  • Excellent convergent validity with the “perceptual threshold of  touch” test (Spearman rho=-0.67)

  • Poor convergent validity with the exteroceptive somatosensation evaluated by the Erasmus MC modification of the (revised) Nottingham sensory assessment (Em-NSA):

  • Em-NSA - light touch (cotton wool) (Spearman rho=0.20)

  • Em-NSA - pressure (index finger) (Spearman rho =0.20)

  • Em-NSA - pinprick (toothpick) (Spearman rho=0.20)

  • Poor to Adequate convergent validity with proprioceptive somatosensation:

  • Em-NSA - movement sense (Spearman rho=0.24)

  • thumb finding test (Spearman rho=-0.35)

  • Poor to Adequate convergent validity with cortical somatosensation

  • Em-NSA - sharp/dull discrimination (Spearman rho=0.03)

  • Em-NSA – stereognosis (Spearman rho=0.46)

  • two-point discrimination  (Spearman rho=-0.19)

Subacute (n=5), Chronic (n=12) Stroke:

(Michielson 2009)

  • Excellent convergent validity with the Stroke Upper Limb Assessment (Spearman rho=0.64)

Chronic Stroke:
(Penta 2001; n=103; mean age=63 years, range 24-84 years of age; time post-stroke=38 months, range 6-253 months)

  • Excellent convergent validity with upper limb motor function as measured by Brunnstrom motor assessment (r=0.73; p<0.001)

  • Adequate convergent validity with paretic limb grip strength on the Jamar dynamometer (r=0.56; p<0.001)

  • Adequate convergent validity with the Box and block test, assessing dexterity (r=0.60; p<0.001)

Stroke:

(Simone 2011; n=150, stroke = 83, multiple sclerosis=17, cerebellar ataxia=13, spinal cord injury=10, Parkinson Disease=3, healthy participants=24); age range = 15-89 years)

  • Adequate convergent validity with the Jamar Dynamometer (r=0.377, p=0.001)

  • Adequate convergent validity with the Box and Block (r=0.481, p<0.001)

  • Adequate convergent validity with the Purdue Pegboard (r=0.493, p<0.001)

  • Adequate convergent validity with the Nine Hole Peg Test (r=-0.370, p=0.007)

Subacute - Chronic stroke:

(Wang 2011; n=51, mean age=55.26 ± 10.31 years, time post-stroke=17.57 ± 13.43 months)

  • Adequate convergent validity with an accelerometer (r =0.45-0.54, p<0.01)

Discriminant validity:

Chronic Stroke:
(Penta 2001; n=103; mean age=63 years, range 24-84 years of age; time post-stroke=38 months, range 6-253 months post-stroke)

 
  • Poor discriminant validity with the Geriatric Depression Scale (Spearman rho=-0.213; p=0.03)

Content Validity

Chronic Stroke:

(Penta 2001; n=103; mean age=63 years, range 24-84 years of age; time post-stroke=38 months, range 6-253 months)

Fit to the  Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the  Rasch Measurement Theory model, 23 bimanual items fit the model and were retained. The items ranged on the interval scale from -2.18 to 1.72 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities.

  • Unimanual items were removed as they were the easiest for patients with chronic stroke and least related to the manual ability construct (point-measure correlation coefficient <0.50). Also, three additional items were deleted as they were not commonly practiced among the calibrating sample.

  • Four levels of scoring (0=impossible; 1=very difficult; 2=difficult, 3=easy) were collapsed into three levels (0=impossible; 1=any difficulty; 2=easy)

  • Differential item functioning (DIF) evaluates whether subgroups respond differently in terms of hierarchy of item difficulty. Twelve subgroups were tested for DIF: (1) sex (male versus female); (2) country (Belgium versus Italy); (3) age (<60 versus ≥60 years); (4) affected side (dominant versus non-dominant); (5) delay since cerebrovascular accident (CVA) (<2 versus ≥2 years); (6) level of depression (<score 10 versus ≥10); (7) dexterity of the unaffected upper limb (less versus more dexterity, split on the median score); (8) manual ability (less versus more able, split on the median manual ability measure); (9, 10, 11) grip strength, dexterity, sensitivity of the affected upper limb (less versus more deficit, computed as the difference between affected and unaffected side, split on the median difference); and (12) motor function of the affected upper limb (less versus more motor function, split on the median motor function score). The hierarchy of the items (from easy to difficult) is maintained across subgroups of adults with stroke except for “shelling hazel nuts” which appears to be more difficult for women than for men, while “tearing open a pack of chips” appears to be more difficult for patients older than 60 years than for younger patients

Face Validity

Chronic Stroke:

(Penta 2001; n=103; mean age=63 years, range 24-84 years of age; time post-stroke=38 months, range 6-253 months post-stroke)

  • Four occupational therapists were independently asked to classify each item according to the involvement of the affected hand in the activity as (1) not requiring affected limb; (2) requiring affected limb to stabilize object; (3) requiring precision grip, grip strength, dexterity or any digital activity from affected side. The authors reported agreement among content experts

Responsiveness

Chronic Stroke:

(Penta 2001; n=103; mean age=63 years, range 24-84 years of age; time post-stroke=38 months, range 6-253 months post-stroke)

  • Least measurable difference (similar to minimal detectable change) = 0.13 logits in the center of the scale indicating a high sensitivity to change.

Subacute - Chronic stroke:

(Wang 2011; n=51, mean age=55.26 ± 10.31 years, time post-stroke=17.57 ± 13.43 months)

  • Standard response mean = 1.27 logits

Arthritis

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Minimally Clinically Important Difference (MCID)

Rheumatoid arthritis:

(Batcho 2011; n=88; mean age=57.53 ± 11.87 years; disease duration=13.13 ± 10.47 years; re-testing time=1 year after use of disease modifying drugs)

  • MCID

    • Small change: 0.47 logits; Moderate change: 1.18 logits; Large change: 1.89 logits

    • Deteriorated group: -1.23 ± 1.53 logits

    • Improved group: 1.22 ± 2.06 logits

    • Stable group: 0.48 ± 1.09 logits

 

Test/Retest Reliability

Rheumatoid arthritis:

(Durez 2007; n=35)

  • Adequate test-retest reliability (ICC=0.74)

Rheumatoid arthritis:

(Batcho 2011; n=88; age=57.53 ± 11.87 years)

  • Excellent test-retest reliability (ICC=0.86

Internal Consistency

Rheumatoid arthritis:

(Penta 1998; n=18; Age range 38-77 years; time since diagnosis range 7-41 years; time since wrist arthrodesis surgery mean=7 years, range 0.5 to 15 years)

  • Excellent item separation reliability=0.90

  • Excellent person separation reliability=0.96

Construct Validity

Convergent validity:

Rheumatoid arthritis:

(Durez 2007; n=112; mean age=55 years, range 25-82 years; mean disease duration=10.7 years, range 0.5-44.5 years)

    • Excellent with Health assessment questionnaire (on which higher scores mean worse health) (Spearman rho=- 0.784, p<0.001)
    • Dominant hand
      • Adequate convergent validity for grip strength with Jamar dynamometer (r=0.542, p<0.001)
      • Adequate convergent validity for pinch strength with Pinch gauge (r=0.422, p=0.01),
      • Adequate convergent validity for digital dexterity with Purdue pegboard (r=0.559, p<0.001)
    • Non-dominant hand
      • Adequate convergent validity for grip strength with Jamar dynamometer (r =0.541, p<0.001),
      • Adequate convergent validity for pinch strength with pinch gauge (r =0.464, p<0.01)
      • Adequate convergent validity for digital dexterity with Purdue pegboard (r=0.534, p<0.001)

Content Validity

Rheumatoid arthritis:

(Penta 1998; n=18; Age range 38-77 years; time since diagnosis 7-41 years; time since wrist arthrodesis surgery mean=7 years, range 0.5-15 years)

  • Unidimensionality established for ABILHAND 23-item version (difficulty range of the items =-2.36-1.82 logits)

Rheumatoid arthritis:

(Durez 2007; n=112; mean age=55 years, range 25-82 years; mean disease duration=10.7 years, range 0.5-44.5 years)

Fit to the Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the Rasch Measurement Theory model, 27 bimanual items fit the model on a 3-point scale (0=impossible; 1=any difficulty; 2=easy). The items ranged on the interval scale from -2.18 to 2.65 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities.

  • Differential item functioning (DIF) evaluates whether subgroups respond differently in terms of hierarchy of item difficulty. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. The exceptions were items such as (b) screwing on a nut, (e) hammering a nail and (m) handling a stapler presented greater difficulty for women than for men. Such activities require more strength and are more commonly performed by men, suggesting that the lack of invariance might reflect cultural factors

Rheumatic Disease

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Test/Retest Reliability

Systemic Sclerosis:

(Vanthuyne 2009; n = 156, mean disease duration 9.7 years; French (n=67) and Dutch versions (n=89) of ABILHAND were used)

  • Excellent reliability (ICC=0.96 – 0.98)

Internal Consistency

Systemic Sclerosis:

(Vanthuyne 2009; n = 156, mean disease duration 9.7 years; French (n=67) and Dutch versions (n=89) of ABILHAND were used)

  • Excellent reliability index = 0.97

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Systemic Sclerosis:

(Vanthuyne 2009; n = 156, mean disease duration 9.7 years; French (n=67) and Dutch versions (n=89) of ABILHAND were used)

  • Health assessment score > 0.5 (p<0.001) and total disease severity score > 5 (p=0.04) predicted poor manual ability (logit <2.14)

Construct Validity

Convergent validity:

Systemic Sclerosis:

(Vanthuyne 2009; n = 156, mean disease duration 9.7 years; French (n=67) and Dutch versions (n=89) of ABILHAND were used)

  • Poor convergent validity with disease duration (Spearman rho= - 0.28, p<0.001)

  • Excellent convergent validity with Health assessment questionnaire score (Spearman rho= - 0.73, p<0.001)

Discriminant validity:

Systemic Sclerosis:

(Ahrens 2016; n=106; mean age=52 ± 15 years; Mean duration of disease=11.3 ± 10.1 years)

  • No correlation between Digital Ulcers Score and ABILHAND (r= -0.138, p=0.22)

Content Validity

Systemic Sclerosis:

(Vanthuyne 2009; n = 156, mean disease duration 9.7 years; French (n=67) and Dutch versions (n=89) of ABILHAND were used)

  • 56 original ABILHAND scores were tested + 25 additional manual tasks considered difficult for this particular population.

Fit to the Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the Rasch Measurement Theory model, 26 bimanual items (among which 6 of the extra items) fit the model on a 3-point scale (0=impossible; 1=any difficulty; 2=easy). The items ranged on the interval scale from -2.59 to 2.41 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities.

  • Differential item functioning (DIF) evaluates whether subgroups respond differently in terms of hierarchy of item difficulty. The item-difficulty hierarchy was stable across 12 patient-related factors and over time, with two exceptions: activities requiring more manual strength (i.e., opening a screw-top jar and shelling hazelnuts) were considered to be more difficult for women than for men.

Floor/Ceiling Effects

Systemic Sclerosis:

(Vanthuyne 2009;  n = 156, mean disease duration 9.7 years;  French (n=67) and Dutch versions (n=89) of ABILHAND were used)

  • Adequate ceiling effect (12%)

Neuromuscular Conditions

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Standard Error of Measurement (SEM)

Neuromuscular conditions:

Turkish Version

(Öksüz 2017; n= 93; mean age = 9.5± 2.6 years, range 6-15 years, ABILHAND-KIDS)

  • SEM= 2.6 for total score

 

Minimal Detectable Change (MDC)

Neuromuscular conditions:

Turkish Version

(Öksüz  2017; n=93; mean age=9.5± 2.6 years, range 6-15 years; ABILHAND-KIDS)

  • MDC=7.1

Test/Retest Reliability

Neuromuscular disorders:

Turkish Version

(Öksüz 2017; n= 93; mean age=9.5± 2.6 years, range 6-15 years; ABILHAND-KIDS)

  • Excellent test-retest reliability (ICC=0.94)

Internal Consistency

Neuromuscular conditions:

(Vandervelde 2010; n=248, adults=124, children with parent reporting=124; mean age adults=47 years, mean age children =10 years, French and Dutch versions of ABILHAND were used)

  • Excellent reliability index=0.95

Duchene Muscular Dystrophy:

(Janssen 2018; mean age=13 years, range 1-35 years)

  • Excellent internal consistency, Cronbach’s alpha: 0.97 (Gross hand function, n=16), 0.98 (Fine hand function, n=10)

Neuromuscular disorders:

Turkish Version

(Öksüz 2017; n= 93; mean age=9.5± 2.6 years, range 6-15 years)

  • Excellent: Cronbach alpha=0.81

  • Adequate separation reliability=0.73

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Duchene Muscular Dystrophy:

(Janssen 2018; mean age=13 years, range 1-35 years)

  • Excellent concurrent validity of Capabilities of the Upper Extremity Questionnaire with
    • gross hand function factor of ABILHAND: r=0.81 to 0.91
    • fine hand function factor of ABILHAND: r=0.75 to 0.91
  • Adequate concurrent validity of Stiffness Scale of the University of Michigan Upper Extremity Questionnaire with
    • gross hand function factor of ABILHAND: r=-0.46 to -0.50
    • fine hand function factor of ABILHAND: r=-0.40 to -0.45
  • Poor concurrent validity of the Pain Scale of the University of Michigan Upper Extremity Questionnaire with
    • gross hand function factor, r=- 0.16 to – 0.37
    • fine hand function factor of ABILHAND, r=-0.17 to -0.36

Construct Validity

Convergent validity:

Neuromuscular conditions:

(Vandervelde 2010; n=248, adults=124, children with parent reporting=124; mean age adults=47 years, mean age children =10 years; French and Dutch versions of ABILHAND were used)

  • Unidimensionality of the 22-item scale (item difficulty range 2.27 to -2.25 logits)

  • Adequate convergent validity with grip strength using Jamar dynamometer (right hand r=0.36, p<0.001; left hand r=0.40, p<0.001)

  • Excellent convergent validity with ACTIVLIM (r=0.76, p<0.001)

Duchene Muscular Dystrophy:

(Janssen 2018; mean age=13 years, range 1-35 years)

  • Principal component analysis: Two factors:

    • Gross hand function: Eigen value=19.7, explained 75.7% of variance

    • Fine hand function: Eigen value=1.2, explained 4.7% of variance

Neuromuscular disorders:

Turkish Version

(Öksüz 2017; n= 93; mean age = 9.5± 2.6 years, range 6-15 years; ABILHAND-KIDS)

  • Eighteen items were appropriate to the Rasch model for the Turkish ABILHAND-Kids (Total item chi square (36) = 128.32 p < .001). The mean item fit residual was -0.242 ± 0.900

  • Item difficulty ranged from 1.52 to -1.04 logits. Majority of the items fit the inside the recommended range -2.50 to +2.50. “Opening a pack of biscuits” was the only exception which displayed a different level of fit to the other items (82.05) and had a significant probability (p=0.001)

  • Moderate correlation between the Turkish version of ABILHAND-Kids and Wee-Functional Independence Measure (Wee-FIM) (r=0.67, p<0.01)

  • Moderate to weak correlation between the Turkish version of ABILHAND-Kids and Brooke Upper Extremity Functional Classification (BUEFC) (r= -.37,p<0.01)

Neuromuscular disorders 

(Vandervelde 2012; n=148 (adults= 124, children= 124); mean age for children=10 years, range 6-16 years; mean age for adults= 47, range 16-80 years)

  • Poor correlation with grip strength (r=0.36, p < 0.001 for right and r = 0.40, p<0.001 for the left hand) and with age (r=0.14, p=0.03)

  • Strong correlation between ABILHAND-kids and the ACTIVLIM measures (r =0.76, p<0.001)

Content Validity

Neuromuscular conditions:

(Vandervelde 2010; n=248, adults=124, children with parent reporting=124; mean age adults=47 years, mean age children =10 years; French and Dutch versions of ABILHAND were used)

Fit to the Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the Rasch Measurement Theory model, 22 bimanual items (4 children specific items; 4 adult specific items and 14 items commonly applicable to both children and adults) fit the model on a 3-point scale (0=impossible; 1=any difficulty; 2=easy). The items ranged on the interval scale from -2.25 to 2.27 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities.

  • Differential item functioning (DIF) evaluates whether subgroups respond differently in terms of hierarchy of item difficulty. The item-difficulty hierarchy was stable across 6 patient-related factors.

Floor/Ceiling Effects

Neuromuscular conditions:

(Vandervelde 2010; n=248, adults=124, children with parent reporting=124; mean age adults=47 years, mean age children =10 years; French and Dutch versions of ABILHAND were used)

  • Adequate ceiling effect for children (15%)

  • Poor ceiling effect for adults (29%)

Neuromuscular disorders:

Turkish Version ABILHAND-KIDS

(Öksüz 2017; n= 93; mean age = 9.5 ± 2.6 years, range 6-15 years)

  • Adequate floor effect (1.1%)

  • Adequate ceiling effect (11.8%)

Non-Specific Patient Population

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Content Validity

Non-specific patient population:

(Arnould 2012; n = 762, children = 113, adults=103, rheumatoid arthritis=112, systemic sclerosis=156, neuromuscular disorders children=124, neuromuscular disorders adults=124)

Principal component analysis:

  • 57% of the variance in the item difficulty between diagnoses was explained by the symmetric or asymmetric nature of the disorders.

Fit to the Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the Rasch Measurement Theory model, 52 out of the original 83 manual activities shared by at least 2 diagnostic groups were retained. These 52 items were composed of 11 bimanual items which shared a common difficulty among diagnoses while 41 items displayed a category-specific location depending on the asymmetric (27 items) or symmetric nature (14 items) of the disorders. The items ranged on the interval scale from -3.93 to 3.60 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities

Face Validity

Epidermolysis Bullosa:

(Eismann 2014; n=71, Epidermolysis bullosa=17, Junctional EB=10, Dominant Dystrophic EB=12, Recessive epidermolysis bullosa=32; mean age=8.9 ± 4.2 years)

  • The ABILHAND-Kids questionnaire demonstrated face validity with children of the above mentioned diagnoses. Children with more severe Epidermolysis Bullosa subtypes reported worse hand function.

Floor/Ceiling Effects

Epidermolysis Bullosa:

(Eismann 2014; n=71, Epidermolysis bullosa=17, Junctional EB=10, Dominant Dystrophic EB=12, Recessive epidermolysis bullosa=32; mean age=8.9 ± 4.2 years)

  • No floor effect (0%)

  • Adequate ceiling effect (less than 10%)

Limb Loss and Amputation

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Internal Consistency

Unilateral upper-limb amputation:
(Burger 2009; n=72; mean age=57 ± 16.9 years; time since amputation=33 ± 17.4 years)

  • Excellent item separation index =0.98

  • Excellent person separation index =0.92

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Unilateral upper-limb amputation:

(Burger 2009; n=72; mean age=57 ± 16.9 years; time since amputation=33 ± 17.4 years)

  • Excellent concurrent validity with Upper extremity Functional Status Module of the Orthotics and Prosthetics User Survey (r=0.71)

Content Validity

Unilateral upper-limb amputation:

(Burger 2009; n=72; mean age=57 ± 16.9 years; time since amputation=33 ± 17.4 years)

Fit to the Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the Rasch Measurement Theory model, 22 of the 46 original items fit the model on a 4-point scale (0=impossible; 1=difficult; 2=easy; 3=very easy). The items ranged on the interval scale from -2.75 to 3.36 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities.

  • Differential item functioning (DIF) evaluates whether subgroups respond differently in terms of hierarchy of item difficulty. The item-difficulty hierarchy was stable across 5 patient-related factors

Multiple Sclerosis

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Cut-Off Scores

Multiple Sclerosis:

(Simone 2011; n=150, stroke = 83, multiple sclerosis=17, cerebellar ataxia=13, spinal cord injury=10, Parkinson Disease=3, healthy=24); age range = 15-89 years)

  • Normative cut off >79 on 100 (sensitivity 92%; specificity 80%)

Interrater/Intrarater Reliability

Multiple Sclerosis:

(Barrett 2013; n=300; mean age=52 ± 12 years)

  • Excellent Person Separation Index=0.95

Internal Consistency

Multiple Sclerosis:

(Barrett 2013; n=300; mean age=52 ± 12 years)

  • Excellent Cronbach’s alpha=0.98

Construct Validity

Multiple Sclerosis:

(Barrett 2013; n=300; mean age = 52 ± 12 years)

  • Excellent convergent validity with Disabilities of the Arm Shoulder and Hand (r=-0.89)

  • Excellent convergent validity with the Multiple Sclerosis Impact Scale-29 (physical impact, r=-0.75)

  • Adequate convergent validity with Multiple Sclerosis Walking Scale-12 (r=-0.55)

Multiple Sclerosis:

(Ruth 2017; n=7463; mean age=57.4 ± 10.2 years)

  • Adequate convergent validity for higher levels of disability with lower scores on ABILHAND (r=- 0.50)

Cerebral Palsy

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Test/Retest Reliability

Cerebral Palsy:

(Arnould 2004; n=113, tetraplegia=35, diplegia=24, hemiplegia=54; mean age=10 years, range 6-15 years; ABILHAND-KIDS)

  • Excellent test-retest reliability (Pearson correlation coefficient (r=0.91)

Cerebral Palsy:

(De Jong 2017; n= 27; mean age=10 ± 4 years, range 4-18 years)

  • Parents’ perception-based rating from memory

    • Excellent test-retest reliability for parents using performance-based ratings (ICC=0.81)

  • Capacity based ratings by physicians, parents, and occupational therapist rated the children after watching two video recordings that was made by the children’s own occupational therapist performing the 21 tasks

    • Excellent test-retest reliability for physicians (ICC= 0.98), occupational therapists (ICC= 0.97), parents (ICC= 0.97), video recording session one (ICC= 0.91), video recording session two (ICC= 0.91), and combined session one and two (ICC= 0.92)

Cerebral Palsy:

(Kamonseki 2017; n=21, quadriplegia=4, diplegia=15, hemiplegia=4; mean age = 13.1±4.6 years; ABILHAND-KIDS)

Portuguese version:

  • Excellent test-retest reliability (ICC=0.91)

Interrater/Intrarater Reliability

Cerebral Palsy:

(Kamonseki 2017; n=21, quadriplegia=4, diplegia=15, hemiplegia=4; mean age = 13.1±4.6 years; ABILHAND-KIDS)

Portuguese version:

  • Excellent inter-rater reliability (ICC=0.97)

Cerebral Palsy:   

(De Jong 2017; n=27; mean age=10 ± 4 years, range 4-18 years)

  • Intra-rater coefficient for parents’ perception-based rating from memory (ICC=0.81)

Capacity based ratings for physicians, parents, and occupational therapist rated the children after watching two video recordings that was made by the children’s own occupational therapist performing the 21 tasks

  • Intra-rater coefficient for all capacity ratings (ICC=0.92), video recording session one (ICC =0.91), video recording session two (ICC =0.91), physician (ICC =0.98), occupational therapist (ICC =0.97), parents (ICC =0.97)

Internal Consistency

Cerebral Palsy:

(Arnould 2004; n=113, tetraplegia=35, diplegia=24, hemiplegia=54; mean age=10 years, range 6-15 years; ABILHAND-KIDS)

  • Excellent separation reliability for the parents=0.94 and children=0.87

Cerebral Palsy:

(Kamonseki 2017; n=21, quadriplegia=4, diplegia=15, hemiplegia=4; mean age=13.1 ± 4.6 years; ABILHAND-KIDS)

Portuguese version:

  • Excellent internal consistency (Cronbach’s alpha=0.99)

Construct Validity

Convergent validity:

Cerebral Palsy:

(Bleyeheuft 2017; n= 98; mean age=11.8 ± 3.3 years, range 6-19 years ABILHAND-KIDS)

  • Adequate convergent validity with Pediatric Evaluation of Disability Inventory (Spearman rho=0.430, p=0.003)

  • Poor convergent validity with Assisted Hand Assessment (Spearman rho= 0.430, p=0.49). Jebsen-Taylor Test of Hand Function more affected side(r=-0.03, p=0.86), and less affected side (r=-0.05, p=0.75)

Cerebral palsy:

(Ohrvall 2012; n=91, mean age= 9.8 ± 3 years, range 5-17 years; ABILHAND-KIDS)

  • Excellent convergent validity with Manual Ability Classification System (r=−0.88, p<0.05)

Cerebral palsy:

(Kirkpatrick 2013; n=76, mean age=9.09 ± 2.94 years, range 4-15 years; ABILHAND-KIDS)

  • Poor convergent validity with motor planning (r=0.10, p=0.45)

Cerebral palsy:

(Klingels 2012; n=81; mean age=9.11 years, range 5-15 years; ABILHAND-KIDS)

  • Poor convergent validity with passive range of motion overall (r=-0.15, p<0.01), shoulder (r=-0.06, p<0.01), elbow (r=-0.12, p<0.01), wrist (r=-0.23, p < 0.01)

  • Excellent convergent validity with muscle tone (r= 0.61, p<0.001), muscle strength (r= 0.71, p<0.001), muscle strength at shoulder (r=0.64, p<0.001), grip strength (r=0.64, p<0.001), two- point discrimination (r= 0.64, p<0.001), and stereognosis (r= 0.70, p<0.001)

  • Adequate convergent validity with muscle tone at shoulder (r=0.47, p<0.001), elbow (r=0.54, p < 0.001), wrist (r= 0.54, p<0.001), muscle strength (r=0.46, p<0.001), exteroception (r= 0.40, p<0.01), and proprioception (r= 0.38, p<0.01)

Cerebral Palsy:

(Geerdink 2014; n=40; mean age=8.2 years, range 5-17.6 years; ABILHAND-KIDS)

  • Adequate convergent validity with Modified House Classification (r=0.558, p<0.001)

Cerebral Palsy:

(Makki 2014; n=100; mean age=10.3 years, range 6 -12 years; ABILHAND-KIDS)

  • Excellent convergent validity with Manual Ability Classification System (r=-0.82, p<0.001) and Gross Motor Function Classification System (r=-0.74 p<0.001)

Cerebral Palsy:

(Koltz 2014; n=23; mean age=13 years, range 9-17 years; ABILHAND-KIDS)

  • Excellent convergent validity with Manual Ability Classification System (r=0.872, p<0.001)

Cerebral Palsy:

(Van Meeteren 2007; n=26; mean age=20.6 ± 1.2 years; ABILHAND-KIDS)

  • Adequate convergent validity with grip strength (r= 0.35, p<0.05), muscle coordination (r=-0.45, p<0.05), and Melbourne Assessment (r=0.49, p<0.05)

  • Poor convergent validity with Static Fatigue Index (r=0.23, p< 0.05)

Cerebral Palsy:

(Van Meeteren 2010; n=83; mean age=19.9 years; ABILHAND-KIDS)

  • Adequate convergent validity with Manual Ability Classification System (r=-0.53, p<0.001)

Cerebral Palsy:

(Kamonseki 2017; n=21, quadriplegia=4, diplegia=15, hemiplegia=4; mean age=13.1±4.6 years; ABILHAND-KIDS)

Portuguese version:

  • Excellent convergent validity with Box and Blocks Test dominant hand (r=0.611, p<0.003)

  • Adequate convergent validity with grip strength (r=0.431, p< 0.05), Box and Blocks Test non-dominant hand (r=0.334, p<0.139), Purdue Pegboard Test dominant hand (r=0.588, p<0.005), both hands (r=0.504, p<0.020), and assembly task (r=0.572, p<0.007)

Content Validity

Cerebral Palsy:

(Arnould 2004; n=113, tetraplegia=35, diplegia=24, hemiplegia=54, mean age=10 years, range 6 -15 years; ABILHAND-KIDS)

Fit to the Rasch Measurement Theory (item fit, reversed thresholds, Differential Item Functioning)

  • Using the Rasch Measurement Theory model, 21 mostly bimanual items rated by parents were selected out of the 74 original items. The 21 items fit the model on a 3-point scale (0=impossible; 1=difficult; 2=easy). The items ranged on the interval scale from -3.23 to 3.00 log-odds units, called ‘logits’, with higher logit values indicating more difficult activities.
  • Differential item functioning (DIF) evaluates whether subgroups respond differently in terms of hierarchy of item difficulty. The item-difficulty hierarchy was stable across age, sex, or handedness, but DIF was identified for school education, type of CP, and the GMFCS. Children in mainstream schools had a higher manual ability than children in special education; children with diplegy and hemiplegy had a higher manual ability than children with tetraplegia; and a higher independence in gross motor function was associated with a higher manual ability. The four items that presented DIF were “Zipping-up trousers” and “Putting on a hat”  which were estimated to be more difficult by the parents than by the experts, while “Unwrapping a chocolate bar”; and “Switching on a bedside lamp” were estimated to be more difficult by the experts than by the parents.

Floor/Ceiling Effects

Cerebral Palsy:

(Arnould 2004; n=113, tetraplegia=35, diplegia=24, hemiplegia=54, mean age=10 years, range 6 -15 years; ABILHAND-KIDS)

  • Adequate floor effect (3.5%)

  • Adequate ceiling effect (7.1%)

Responsiveness

Cerebral Palsy:

(Bleyeheuft 2017; n=98; mean age=11.8 ± 3.3 years, range 6-19 years, ABILHAND-KIDS)

Children (6-12 years)

  • Large effect size= 0.92; logit change = 1.06 after intensive intervention

  • Small effect size=0.16; logit change = 0.15 at follow-up

Adolescents (13-19 years)

  • Moderate effect size=0.44; logit change = 0.71 after intensive intervention

  • Small effect size=0.12; logit change = 0.21 at follow-up

Limb Deficiency

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Standard Error of Measurement (SEM)

Transverse upper limb reduction deficiencies:

(Buffart 2007a; n=20, children with prosthesis=10, children without prosthesis=10; mean age=8.7 ± 2.9 years, range 4-12 years, ABILHAND-KIDS)

  • SEM=1.7

Radius deficiencies:

(Buffart 2007b; n=20; mean age=7.6 ± 2.4 years, range 4-12 years, ABILHAND-KIDS)

  • SEM=1.9

Minimal Detectable Change (MDC)

Transverse upper limb reduction deficiencies:

(Buffart 2007a; n=20, children with prosthesis=10, children without prosthesis=10; mean age=8.7 ± 2.9 years, range 4-12 years, ABILHAND-KIDS)

  • MDC=6.7 (CI95%)

Radius deficiencies:

 (Buffart 2007b; n=20; mean age=7.6±2.4 years, range 4-12 years, ABILHAND-KIDS)

  • MDC=4.8 (CI90%)

Test/Retest Reliability

Transverse upper limb reduction deficiencies:

(Buffart 2007a; n=20, children with prosthesis=10, children without prosthesis=10; mean age=8.7 ± 2.9 years, range 4-12 years, ABILHAND-KIDS)

  • Excellent test-retest reliability (ICC=0.89, CI95%=0.66–0.94)

Radius deficiencies:

(Buffart 2007b; n= 20; mean age=7.6±2.4 years, range 4-12 years, ABILHAND-KIDS)

  • Excellent test-retest reliability (ICC=0.91, CI95%=0.69–0.98)

Construct Validity

Convergent validity:

Transverse upper limb reduction deficiencies:

(Buffart 2007a; n=10 children with prosthesis; mean age=8.7 ± 2.9 years, range 4-12 years, ABILHAND-KIDS)

  • Adequate convergent validity with prosthetic wearing time for (Spearman rho=0.43, p<0.05), usefulness of prosthesis (Spearman rho= -0.43, <0.05), parent satisfaction with prosthetic functioning (Spearman rho=0.39, p<0.05)

  • Poor convergent validity with age of the child (Spearman rho=0.30, p<0.05), gender (Spearman rho=0 63, p<0.05)

Radius deficiencies:

(Buffart 2007b; n=20; mean age=7.6 ± 2.4 years, range 4-12 years, ABILHAND-KIDS)

  • Poor convergent validity with the severity of radial deficiency (Spearman rho= -0.18, p< 0.05), functional hand grip (Spearman rho=0.04, p<0.05)

  • Adequate convergent validity with grip force (Spearman rho=0.46, p<0.05), lateral pinch force (Spearman rho=0.41, p<0.05), parents’ satisfaction with their child’s hand function (Spearman rho= 0.49, p<0.05), and age of child (Spearman rho=0.43, p<0.05)

Transverse upper limb reduction deficiencies:

(Buffart 2007a; n=20, children with prosthesis=10, children without prosthesis=10; mean age=8.7 ± 2.9 years, range 4-12 years, ABILHAND-KIDS)

  • Children with prosthesis

    • Poor convergent validity with the Unilateral Below Elbow Test (Spearman rho=-0.12, p<0.05)

    • Adequate convergent validity with the therapist’s global assessment (Spearman rho=0.37, p<0.05), Unilateral Below Elbow Test (Spearman rho=0.49, p<0.05), and Assisting Hand Assessment (Spearman rho=0.32, p<0.05)

  • Children without prosthesis

    • Poor convergent validity with the therapist’s global assessment (Spearman rho=0.19, p<0.05)

    • Adequate convergent validity with the Unilateral Below Elbow Test (Spearman rho=0.56, p<0.05), Assisting Hand Assessment (Spearman rho=0.41, p<0.05), and Prosthetic Upper extremity Functional Index (Spearman rho=0.53, p<0.05)

Radius deficiencies:

(Buffart 2007b; n= 20; mean age= 7.6±2.4 years, range 4-12 years, ABILHAND-KIDS)

  • Adequate convergent validity with the therapist’s global assessment (Spearman rho=0.34, p<0.05), Unilateral Below Elbow Test (UBET) (Spearman rho=0.54, p<0.05), and Prosthetic Upper extremity Functional Index (PUFI) (Spearman rho=0.56, p<0.05)

  • Poor convergent validity with the Assisting Hand Assessment (Spearman rho=0.08, p<0.05)

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