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Capabilities of Upper Extremity Instrument

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Purpose

The CUE measures upper extremity functional limitations in individuals with tetraplegia.

Link to Instrument

Instrument Details

Acronym CUE

Area of Assessment

Functional Mobility

Assessment Type

Patient Reported Outcomes

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • 32-item questionnaire with items in 7 domains:
    1) 15 Unilateral (left and right) items
    2) 2 Bilateral items
    3) 3 Reaching items
    4) 4 Pulling/Pushing items
    5) 2 Wrist items
    6) 6 Hand and Finger items
    7) 2 Bilateral items
  • Scored on 7-point scale representing self-perceived difficulty:
    1 = "Totally limited, can't do at all"
    7 = "Not at all limited"
    Minimum score = 32
    Maximum score = 224 (higher score = greater function)
  • Left and right scores can be assessed separately.
  • Self-reported measure performed by interview.

Number of Items

32

Time to Administer

30 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by Cara Leone Weibsach PT, DPT; Wendy Romney, PT, DPT, NCS; and the SCI EDGE task force of the Neurology Section of the APTA in 3/2012.

Body Part

Upper Extremity

ICF Domain

Body Function

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

R

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

R

R

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

Yes

Yes

Not reported

Considerations

High internal consistency (0.96) suggests there may be redundancy in items however this can only be determined after items are assessed for sensitivity to change (Marino, Shea, Stineman, 1998) It was determined that a chest strap can be used for the item “lifting a 5lb object overhead” (Marino, Shea, Stineman 1998). Measure assesses upper limb function including proximal arm and hand function, not strictly hand function.

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Spinal Injuries

back to Populations

Standard Error of Measurement (SEM)

Cervical SCI:
(Marino, Shea, Stineman, 1998, n = 154; mean age = 36.7; motor complete (AIS A or B) or incomplete (AIS C or D); 68% were motor complete)

  • SEM = 12.2 (95% CI indicating true score is within 23.9 points of score obtained)

Minimal Detectable Change (MDC)

Cervical SCI:
(Marino, Shea, Stineman, 1998)

  • MDC = 33.82

Normative Data

Cervical SCI:

(Marino, Shea, Stineman, 1998)

CUE Scores in Participants with Cervical SCI

Item

Mean (SD)

 

Right

Left

Arm Function

   

Reach 1

4.5 (2.0)

5.4 (2.1)

Reach 2

4.6 (2.4)

4.5 (2.5)

Reach 3

3.2 (2.5)

3.2 (2.5)

Pull/push 1

5.9 (1.9)

5.7 (2.1)

Pull/push 2

5.1 (2.2)

5.0 (2.2)

Pull/push 3

5.8 (2.1)

5.5 (2.3)

Pull/push 4

4.9 (2.3)

4.6 (2.3)

Wrist 1

5.0 (2.5)

4.8 (2.5)

Wrist 2

5.2 (2.3)

5.2 (2.3)

     

Hand Function

   

Hand 1

3.0 (2.3)

3.0 (2.3)

Hand 2

3.8 (2.5)

3.7 (2.4)

Hand 3

3.9 (2.5)

3.8 (2.5)

Hand 4

2.8 (2.3)

2.7 (2.3)

Hand 5

2.4 (2.0)

2.2 (2.0)

Hand 6

3.6 (2.6)

3.5 (2.6)

 

Bilateral

Reach down

   

Bilateral 1

4.7 (2.4)

Bilateral 2

3.8 (2.6)

Test/Retest Reliability

Cervical SCI:

(Marino, Shea, Stineman, 1998)

  • Excellent Test-Retest Reliability for total test (ICC = 0.94)
  • Good agreement of individual items: Weighted kappa coefficient > 0.60 for all but 3 items (reaching forward w/right k = 0.58; manipulating objects w/right k = 0.55; lifting a 5lb object overhead k = 0.57)

Internal Consistency

Cervical SCI:

(Marino, Shea, Stineman, 1998)

  • Excellent internal consistency of full scale (Chronbach’s α = 0.96)
  • Poor to adequate internal consistency of Item-total correlation was between 0.49 for “reaching down with right arm” and 0.78 for “pushing heavy items away with left arm”

Criterion Validity (Predictive/Concurrent)

Cervical SCI:

(Marino, Shea, Stineman, 1998)

  • Excellent correlation (for total sample and motor complete) to Upper Extremity Motor Score (UEMS) & Functional Independence Measure (FIM)
  • Excellent correlation for motor incomplete with both UEMS & FIM

Correlations Between Motor Completeness, CUE, UEMS, and FIM Scores in Participants with SCI

 

Total Sample

(= 154)

Motor Complete

(= 105)

Motor Incomplete

(n = 49)

 

UEMS

FIM

UEMS

FIM

UEMS

FIM

Pearson Correlations

           

CUE

0.782

0.738

0.798

0.753

0.683

0.672

UEMS

 

0.741

 

0.772

 

0.593

Spearman's Correlations

           

CUE

0.798

0.798

0.815

0.822

0.650

0.719

UEMS

 

0.803

 

0.825

 

0.580

(none is significantly different from another at the p < 0.05 level)

  • CUE is a better predictor of the FIM than the UEMS
  • CUE explains 73% of the variance in the FIM
  • UEMS explains 67% of the variance in the FIM
  • CUE and UEMS together still explain only 73% of the variance in FIM; therefore CUE was able to explain more of the variance in the FIM than the UEMS

Chronic Tetraplegia:

(Kalsi-Ryan et al, 2012)

  • Excellent correlation of sensation subtest of GRASSP with CUE (r = 0.77)
  • Excellent correlation of strength subtest of GRASSP and CUE (r = 0.76)
  • Excellent correlation of prehension performance subtests of GRASSP with CUE (r = 0.83)

Construct Validity

Cervical SCI:

(Marino, Shea, Stineman, 1998)

Discriminant Validity

  • CUE scores increased with motor level
  • Post hoc Tukey tests indicated mean CUE scores were significant (p ≤ 0.001) between motor levels > 1 level apart (except for C7 and T1 on right side) – therefore CUE is able to discriminate among individuals 2 motor levels apart (This was measured by side of body - comparing right or left motor level with 15 unilateral items score for right or left side)

CUE Scores by Motor Level for Participants with SCI

 

n

Mean (SD)

p*

Right Motor Level

   

< 0.001

C2-4

7

28.9 (20.2)

a

C5

39

43.3 (21.4)

a

C6

53

64.1 (17.2)

 

C7

31

78.3 (12.9)

b

C8

13

92.2 (8.5)

b

T1

11

93.9 (12.1)

b

Left Motor Level

   

< 0.001

C2-4

6

19.0 (9.8)

 

C5

41

43.4 (20.9)

 

C6

58

63.9 (20.0)

c

C7

27

75.1 (15.4)

c,e

C8

14

91.0 (9.8)

d,e

T1

8

100.2 (4.2)

d

*Letters in column p indicated that mean values were not statistically significant (p < 0.05) between levels marked with the same letter.

Floor/Ceiling Effects

Cervical SCI:
(Marino, Shea, Stineman, 1998)

  • Borderline floor effect on 1 item (Hand 5 on Left) - manipulating small objects

Bibliography

Kalsi-Ryan, S., Beaton, D., et al. (2012). "The Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity." J Neurotrauma 29(5): 905-914. Find it on PubMed

Marino, R. J., Shea, J. A., et al. (1998). "The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia." Archives of Physical Medicine and Rehabilitation 79(12): 1512-1521. Find it on PubMed

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