Jebsen Hand Function Test

Last Updated

October 26, 2012

Purpose

To assess a broad range of uni-manual hand functions required for activities of daily living (ADLs).

Link to Instrument

instrument details

Acronym JHFT

Area of Assessment

Activities of Daily Living
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

A test kit is sold commercially through multiple vendors, which usually includes instructions, all items needed to perform seven subtests, a carrying bag, and pad of 50 blank record forms. Cost is generally in the $300+ range.

Diagnosis/Conditions

Arthritis + Joint Conditions
Brain Injury Recovery
Spinal Cord Injury
Stroke Recovery

Stroke

Non-Specific Patient Population

7 subtests, performed on both non-dominant and dominant hands:
1) Writing a 24-letter, 3rd grade reading level difficulty sentence
2) Card turning
3) Picking up small common objects (e.g. pennies, paper clips, bottle caps) and placing them in a container
4) Stacking checkers
5) Stimulated feeding
6) Moving light objects (e.g. empty cans)
7) Moving heavy objecst (e.g. 1lb weighted cans)
Subtest score = time (seconds) to complete task
Total score = sum of times for each subtests
Max time allotted per subtest is 120 seconds
Lower score = greater function
Each item performed with each hand separately – non-dominant hand first.
Measures unilateral hand function.
Assesses speed, not quality of performance.

Number of Items

Stopwatch
Chair (18” seat height), desk/table (30” high)
Black ball point pen, four 8x11” sheets of unruled white paper stacked and fastened to a clipboard
Sentences typed in all capital letters and centered on a 5x8” index card on a bookstand
Five 3x5” index cards (ruled on one side only)
Empty 1 pound coffee can
Two 1” paper clips
2 regular sized bottle caps (1” diameter)
2 U.S. pennies
5 kidney beans (~5/8” long)
1 regular teaspoon
Wooden board (41 ½” long, 11 ¼” wide, ¾” thick), “C” clamp, plywood (20” long, 2” wide, ½” thick) glued to the board (see Jebsen 1969 for details)
Four standard size (1 ¼” diameter) red wooden checkers
Five No. 303 cans

15 minutes

Required Training

Reading an Article/Manual

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Dorian Rose, PT, PhD and the StrokEdge task force of the Neurology Section of the APTA in 2011 and Cara Leone Weibsach, PT, DPT, Wendy Romney, PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 4/2012

Body Part

Upper Extremity

ICF Domain

Participation

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 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

StrokEDGE

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

Recommendations based on SCI AIS Classification:

	AIS A/B	AIS C/D
SCI EDGE	LS	LS

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	No	Yes	Not reported
StrokEDGE	No	Yes	Yes	Not reported

Considerations

Bovend’ Eerdt et al 2004 reports validity and reliability of a modified Jebsen Test (3 of the subtest combined into 1 test).
Assesses hand function with understanding that proximal upper extremity function will influence ability to place and position the hand. Proximal weakness and forearm rotation limitations may influence hand function outcomes.
Jebsen is not recommended for use in hand neuroprosthesis outcomes for individuals with C5 tetraplegia.
May not detect changes of intrinsic hand muscles and allows for compensatory trunk and shoulder movement to complete tasks.

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Normative Data

Normal:

(Hackel et al, 1992; n = 121 “normal” men and women living independently in the community; mean age = 74.6(7.7) years)

Mean Subtest Scores for women in seconds (± standard deviation) by age group

Subtest	60-69 years (n = 19)		70-79 years (n = 31)		80-89 years (n = 19)
	Dominant	Non-dominant	Dominant	Non-dominant	Dominant	Non-dominant
Writing	12.41±2.82^a	35.99±11.28^a	13.43±2.64^a	40.13±7.84^a	18.19±4.83	60.39±26.16
Card turning	4.79±1.26^a	5.62±1.84^b	5.33±1.06^b	6.05±1.07^b	6.28±1.78	7.25±2.15
Small, common objects	6.62±2.10	6.73±1.31^b	6.91±1.29	7.07±1.44^b	7.44±1.56	8.09±1.70
Simulated feeding	6.94±1.21^c,d	8.05±1.38^a,c	8.07±1.76	10.23±2.99	7.92±1.49	10.09±3.14
Checkers	4.55±1.30^b	5.21±1.47	4.64±1.01^b	5.41±1.24	5.56±1.45	5.94±1.24
Large, light objects	3.85±0.72^b,d	4.01±0.74^a,d	4.35±0.81	4.64±0.87	4.39±0.79	4.88±1.03
Large, heavy objects	3.84±0.74^a	4.04±0.76^a,d	4.26±0.82	4.63±0.87	4.51±0.66	4.91±0.81

^a significant difference from 80-89 years age group (p < 0.01)
^b significant difference from 80-89 years age group (p < 0.05)
^c significant difference from 70-79 years age group (p < 0.01)
^d significant difference from 70-79 years age group (p < 0.05)

Mean Subtest Scores for Men in seconds (± standard deviation) per age group

Subtest	60-69 years (n = 17)		*70-79 years (n =* 20)**		80-89 years (n = 15)
	Dominant	Non-dominant	Dominant	Non-dominant	Dominant	Non-dominant
Writing	15.31±5.38^a	36.56±9.87^a	17.22±4.59^b	43.29±10.27^b	20.53±4.69	54.54±28.21
Card turning	4.74±1.20^a	5.71±1.60^a	5.25±1.18^a	6.35±1.60^b	7.108±2.56	7.90±3.38
Small, common objects	6.72±1.39^a	7.48±2.20	7.10±1.03^a	7.92±1.39	9.17±3.00	8.34±1.67
Simulated feeding	7.32±0.99^a	9.24±1.72^b	7.64±0.86^a	9.49±1.28^b	9.39±2.02	11.28±2.49
Checkers	4.19±0.93^a	5.46±2.83^b	4.55±0.91^a	5.27±0.81^a	6.69±2.09	6.72±1.56
Large, light objects	3.69±0.71^a,c	3.94±0.69^a	4.20±0.70^a	4.53±0.82^b	4.96±0.88	5.31±1.35
Large, heavy objects	3.62±0.73^a	4.03±0.78^a	4.00±0.76^a	4.39±0.67^a	4.90±0.90	5.23±1.01

^a significant difference from 80-89 years age group (p < 0.01)
^b significant difference from 80-89 years age group (p < 0.05)
^c significant difference from 70-79 years age group (p < 0.05)

(Jebsen et al 1969; n = 360; age 20-94 years)
Mean Subtest Score for Women in seconds (± standard deviation) by age group

Subtest	20-59 years (n=120)		60-94 years (n=30)
	Dominant	Non-dominant	Dominant	Non-dominant
Writing	11.7±2.1	30.2±8.6	15.7±4.7	38.9±14.9
Card turning	4.3±1.4	4.8±1.1	4.9±1.2	5.5±1.1
Small, common objects	5.5±0.8	6.0±1.0	6.6±1.3	6.6±0.8
Simulated feeding	6.7±1.1	8.0±1.6	6.8±1.1	8.7±2.0
Checkers	3.3±0.6	3.8±0.7	3.6±0.6	4.4±1.0
Large, light objects	3.1±0.5	3.3±0.6	3.5±0.6	3.4±0.6
Large, heavy objects	3.2±0.5	3.3±0.5	3.5±0.6	3.7±0.7

Mean Subtest Scores for Men in seconds (± standard deviation) by age groups

Subtest	20-59 years		60-94 years
	Dominant	Non-dominant	Dominant	Non-dominant
Writing	12.2±3.5	32.3±11.8	19.5±7.5	48.2±19.1
Card turning	4.0±0.9	4.5±0.9	5.3±1.6	6.1±2.2
Small, common objects	5.9±1.0	6.2±0.9	6.8±1.2	7.9±1.9
Simulated feeding	6.4±0.9	7.9±1.3	6.9±0.9	8.6±1.5
Checkers	3.3±0.7	3.8±0.6	3.8±0.7	4.6±1.0
Large, light objects	3.0±0.4	3.2±0.6	3.6±0.7	3.9±0.7
Large, heavy objects	3.0±0.5	3.1±0.4	3.5±0.7	3.8±0.7

Test/Retest Reliability

Stable hand disorders due to tetraplegia:

(Jebsen, 1969; n = 26; n = 6, post poliomyelitis n = 1, cerebral palsy n = 4, stroke n = 5, rheumatoid arthritis n = 4, burn n = 1, congenital anomaly n = 2, trauma n = 1, polyneuropathy n = 1, severe degenerative joint disease n = 1)

Excellent Test-Retest Reliability for all subtests for dominant hand except writing (r = 0.91-0.99) and non-dominant hand except feeding and large, light objects (r = 0.78-0.92)
Adequate Test-Retest Reliability for dominant hand writing (r = 0.67) and non-dominant hand feeding (r = 0.60) and large light objects (r = 0.67)
Absent practice effect (p < 0.05)

Correlation Coefficients for Test-Retest Reliability

Test	Dominant Hand	Non-dominant Hand
Writing	0.67	0.84
Card turning	0.91	0.78
Small, common object	0.93	0.85
Simulated Feeding	0.92	0.60
Checkers	0.99	0.91
Large, light objects	0.89	0.67
Large, heavy objects	0.89	0.92

All significant at the p < 0.01 level

Interrater/Intrarater Reliability

Normal:

(Hackel et al,1992)

Excellent Intra-rater reliability (r = 0.84 and 0.85, p < 0.05) for 2 raters
Excellent Inter-rater reliability (ICC = 0.82 – 1.00)

Subtest	Dominant Hand	Non-dominant Hand
Writing	1.00	1.00
Card turning	0.82	0.98
Small, common objects	0.95	1.00
Feeding	0.99	1.00
Checkers	0.99	0.98
Large, light objects	0.99	0.99
Large, heavy objects	0.99	0.99

Criterion Validity (Predictive/Concurrent)

Status Post Hand Surgery:

(Sears and Chung, 2010; n = 111 (RA n = 37, OA n = 10, CTS n = 18, and Fx n = 46); evaluated preoperatively and 9-12 months post op; Michigan Hand Function Test (MHQ) used as reference standard)

Poor correlation with MHQ total scores for RA, OA, CTS, Fx (r =0.19, 0.04, 0.59, 0.36, respectively)
Poor correlation with MHQ subtests(ADL, function, work, satisfaction) for RA, OA, Fx (r = 0.10-0.41) and CTS for work & satisfaction (r = 0.38, 0.56 respectively)
Adequate correlation moderate for CTS for ADL and function (r = 0.68, 0.69, respectively)

Construct Validity

Discriminant Validity:

(Sears and Chung, 2010)

Poor discriminative validity for predicting positive or negative outcomes in hand function as measured by the MHQ outcomes (positive = change in MHQ score > 20; negative = change in MHQ score ≤ 20) for RA, OA, CTS, and Fx (ROC area under curve = 0.52, 0.58, 0.66, 0.59, respectively)
Poor discriminative validity for discriminating individuals with high or low MHQ scores (high = MHQ >75; low = MHQ ≤ 75) for RA, OA, and CTS all conditions except distal radius fracture (ROC area under curve = 0.48, 0.0, 0.65, respectively with 95% CI)
Adequate discriminative validity for determining high versus low score on MHQ (ROC area under curve = 0.76), indicating a 76% probability of predicting high or low test score on the MHQ

Responsiveness

Effect Size:

(Davis Sears, 2010)

Small change for CTS (ES = 0.05)
Moderate change for Fx, RA, and OA (ES = 0.35, 0.47, 0.67, respectively)
Effect size was greater for detecting change in and hand function following hand surgery using the MHQ (0.74-1.30) for all groups than Jebsen

Test/Retest Reliability

Stroke:

(Beebe and Lang, 2009)

Moderate responsiveness between 1‐3 mo post‐stroke (0.69) and between 1‐6 mo post‐stroke (0.73)

Responsiveness

Stroke:

(Beebe and Lang, 2009)

Moderate responsiveness between 1‐3 mo post‐stroke (0.69) and between 1‐6 mo post‐stroke (0.73)

Bibliography

Agnew, P. J. and Maas, F. (1982). "Hand function related to age and sex." Archives of Physical Medicine and Rehabilitation 63(6): 269-271. Find it on PubMed

Beebe, J. A. and Lang, C. E. (2009). "Relationships and responsiveness of six upper extremity function tests during the first 6 months of recovery after stroke." Journal of neurologic physical therapy: JNPT 33(2): 96. Find it on Pubmed

Bovend'Eerdt, T. J., Dawes, H., et al. (2004). "Evaluation of the Modified Jebsen Test of Hand Function and the University of Maryland Arm Questionnaire for Stroke." Clinical Rehabilitation 18(2): 195-202. Find it on PubMed

Colyer, R. A. and Kappelman, B. (1981). "Flexor pollicis longus tenodesis in tetraplegia at the sixth cervical level. A prospective evaluation of functional gain." Journal of Bone and Joint Surgery 63(3): 376-379. Find it on PubMed

Davis Sears, E. and Chung, K. C. (2010). "Validity and responsiveness of the Jebsen-Taylor Hand Function Test." J Hand Surg Am 35(1): 30-37. Find it on PubMed

Hackel, M. E., Wolfe, G. A., et al. (1992). "Changes in hand function in the aging adult as determined by the Jebsen Test of Hand Function." Physical Therapy 72(5): 373-377. Find it on PubMed

Kinnucan, E., Van Heest, A., et al. (2010). "Correlation of motor function and stereognosis impairment in upper limb cerebral palsy." J Hand Surg Am 35(8): 1317-1322. Find it on PubMed

Smith, B. T., Mulcahey, M. J., et al. (1992). "The application of a modified neuroprosthetic hand system in a child with a C7 spinal cord injury. Case report." Paraplegia 30(8): 598-606. Find it on PubMed

Taylor, N., Sand, P. L., et al. (1973). "Evaluation of hand function in children." Archives of Physical Medicine and Rehabilitation 54(3): 129-135. Find it on PubMed

Last Updated

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Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

Body Part

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Responsiveness

Test/Retest Reliability

Responsiveness

Bibliography

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