Closed Kinetic Chain Upper Extremity Stability Test

Last Updated

October 29, 2015

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Purpose

The Closed Kinetic Chain Upper Extremity Stability Test is a low-cost performance test that provides quantitative data (scores) for an upper extremity task in closed kinetic chain with no need for high technology to be realized in sportive or clinical settings. It can help to determine deficits in closed kinetic chain upper extremity functional performance.

Link to Instrument

Instrument Details

Acronym CKCUEST

Area of Assessment

Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Sports & Musculoskeletal Injuries

Mixed Populations

Patients assume the push-up position, with hands set 36 inches apart, and are scored based on the number of times the patient is able to pick one hand up and swing it across their hand stance and touch the supporting hand in a 15 second period.
Females can perform the test in a modified (kneeling) push up position.

Number of Items

Tape
Stopwatch

4 minutes

Required Training

No Training

Adult

18 - 64

years

Instrument Reviewers

Monica Austin, SPT; Aaron Rygiel, SPT; Purvi Vayas, SPT MacKenzie Eldridge, SPT; Ashlee Kim, SPT; Jamie Grainger, SPT;Ashlee Price, SPT; Maddie Nagy, SPT; Alexis Meister, ATC, SPT; Sarah Foley, ATC, SPT; Scott Peters, ATC, SPT.

Body Part

Upper Extremity

ICF Domain

Body Function

Measurement Domain

Motor

Considerations

Goldbeck & Davies, 2000
- Contraindications to perform the test include elderly age and patients with wrist/ elbow pathologies or posterior instabilities of the shoulder.
Hegedus, 2014
- Reproducibility, validity, and responsiveness are not established. Caution should be exercised in the clinical interpretation of CKCUEST in relationship to risk assessment or as a stand-alone diagnostic tool for upper extremity sports-related injury.
Roush, 2007
- Patients with comorbidities of the upper extremities may have difficulty performing the task. The older geriatric population may be unable to perform the test, and patients who are at risk of fracture may have an increased risk due to the force of impact.

Tucci, 2014
- Some healthy subjects reported pain after the test even with no pain reported before the test, thus clinicians should have care when the test is considered in the initial evaluation of a subject with shoulder injury.

Standard Error of Measurement (SEM)

Active Females (Tucci, 2014; n=20; mean age= 21.75 (1.37) years)

Number of touches: SEM= 2.76
Power: SEM= 12.94
Normalized Score: SEM= 0.04

Active Males (Tucci, 2014; n=20; mean age= 23.15 (2.48) years):

Number of touches: SEM= 2.0
Power: SEM= 20.03
Normalized score: SEM= 0.03

Females with Subacromial Impingement Syndrome (Tucci (2014; n=15; mean age 49.87 (5.87) years):

Number of touches: SEM=1.89
Power: SEM= 6.02
Normalized Score: SEM= 0.03

Male with Subacromial impingement syndrome (Tucci, 2014; n=13; mean age= 45.15 (12.59) years):

Number of touches: SEM=1.95
Power: SEM= 7.50
Normalized score: SEM= 0.03

Male College Students (Goldbeck & Davies, 2000; n= 24; mean age 20.3 years)

Number of touches: SEM= 0.49 (calculated from SD listed on p. 41)

Sedentary Female (Tucci, 2014; n=20; mean age= 22.65 (3.00) years)

Number of touches: SEM= 2.43
Power: SEM= 12.94
Normalized score: SEM= 0.04

Sedentary Male (Tucci, 2014; n=20; mean age=24.95 (2.45) years)

Number of touches: SEM= 1.45
Power: SEM= 12.45
Normalized score: SEM= 0.02

Minimal Detectable Change (MDC)

Active Females (Tucci, 2014)

Number of touches: MDC= 3.91
Power: MDC= 18.30
Normalized Score: MDC= 0.06

Active Males (Tucci, 2014)

Number of touches: MDC= 2.82
Power: MDC= 28.32
Normalized score: MDC= 0.04

Female with Subacromial Impingement Syndrome (Tucci, 2014)

Number of touches: MDC= 2.67
Power: MDC= 8.52
Normalized Score: MDC= 0.04

Males with Subacromial Impingement Syndrome (Tucci, 2014)

Number of touches: MDC= 2.76
Power: MDC= 10.61
Normalized score: MDC= 0.04

Males College Students (Goldbeck &Davies, 2000)

Number of touches: MDC= 1.35 (calculated from SD on p. 41)

Sedentary Females (Tucci, 2014)

Number of touches: MDC= 3.43
Power: MDC= 18.30
Normalized score: MDC= 0.05

Sedentary Males (Tucci, 2014)

Number of touches: MDC= 2.05
Power: MDC= 17.79
Normalized score: MDC= 0.03

Cut-Off Scores

Athletes (Hegedus, 2014)

In a small, single-center trial, a cut score of <=24 discriminated between non-injured and injured collegiate baseball players with upper extremity sport-related injury. However, this cut score has poor diagnostic utility (sensitivity=0.72, specificity=0.69, positive likelihood ratio=2.3, negative likelihood ratio=0.39).

Normative Data

College-aged Males (Hegedus, 2014)

Number of touches: 27.8 ± 1.8

Collegiate Male Baseball Players (Roush (2007; n=77, mean age 19.03 (1.22) years)

Number of touches: 30.41 ± 3.87

Female Reference Values (Tucci, 2014)

Number of touches: 20.5
Power: 135
Normalized score: 0.31

Male Reference Values (Tucci, 2014)

Number of touches: 18.5
Power: 150
Normalized score: 0.26

Test/Retest Reliability

Active Female (Tucci, 2014)

Number of touches: Excellent test-retest reliability (ICC= 0.85)
Power: Excellent test-retest reliability (ICC= 0.82)
Normalized Score: Excellent test-retest reliability (ICC= 0.87)

Active Male (Tucci, 2014)

Number of touches: Excellent test-retest reliability (ICC=0.89)
Power: Excellent test-retest reliability (ICC= 0.84)
Normalized score: Excellent test-retest reliability (ICC= 0.90)

Female with subacromial impingement syndrome (Tucci, 2014)

Number of touches: Excellent test-retest reliability (ICC= 0.93)
Power: Excellent test-retest reliability (ICC= 0.94)
Normalized Score: Excellent test-retest reliability (ICC= 0.94)

Male with subacromial impingement syndrome (Tucci, 2014)

Number of touches: Excellent test-retest reliability (ICC= 0.91)
Power: Excellent test-retest reliability (ICC= 0.93)
Normalized score: Excellent test-retest reliability (ICC= 0.92)

Male College Students (Goldbeck &Davies, 2000)

Excellent test-retest reliability (ICC=0.922)

Sedentary Female (Tucci, 2014)

Number of touches: Excellent test-retest reliability (ICC= 0.92)
Power: Excellent test-retest reliability (ICC= 0.96)
Normalized score: Excellent test-retest reliability (ICC= 0.92)

Sedentary Male (Tucci, 2014)

Number of touches: Excellent test-retest reliability (ICC= 0.96)
Power: Excellent test-retest reliability (ICC= 0.96)
Normalized score: Excellent test-retest reliability (ICC=0.96)

Responsiveness

College-aged Men and Women (Schulte-Edelmann et al., 2005; n=30)

Moderate Responsiveness (ES= 0.58463, calculated from Table 4 on p. 132)

Bibliography

Goldbeck TG, Davies GJ. (2000). Test-retest reliability of the Closed Kinetic Chain Upper Extremity Stability Test: a clinical field test. J Sport Rehabil. 9:35-45.

Hegedus EJ, Vidt, ME & Tarara, DT. (2014). The best combination of physical performance and self-report measures to capture function in three patient groups. Physical Therapy Reviews. 19(3), 196-203.

Roush, J. R., Kitamura, J., & Waits, M. C. (2007). Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball Players. North American Journal of Sports Physical Therapy : NAJSPT. 2(3), 159–163.

Schulte-Edelman, J, Davies, GJ, Kernozek, TW, & Gerberding, ED. (2005). The Effects of Plyometric Training of the Posterior Shoulder and Elbow. Journal of Strength and Conditioning Research. 19(1), 129-134.

Tucci, HT, Martins, J, Carvalho Sposito, G, Camarini, PM, Siriani de Oliveria, A. (2014). Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome. BMC Musculoskeletal Disorders. 15(1), 1-9.