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RehabMeasures Instrument

Van Lieshout Test - Short Version

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Purpose

10-item assessment of hand function in persons with cervical spinal cord injuries.

Link to Instrument

Instrument Details

Acronym VLT

Area of Assessment

Dexterity
Functional Mobility
Range of Motion

Assessment Type

Performance Measure

Administration Mode

Computer

Cost

Not Free

Actual Cost

$1230.00

Cost Description

CD ROM and Test Kit: 1130.50 Euros (available from the Rehabilitation Foundation Limburg)
https://www.adelante-zorggroep.nl/redirects/default-asp/?id=402&parent=0&template=algemeen.htm&sitecat=10

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • Assesses basic arm functions and advanced hand functions of varying difficulties
  • Item-level scores range from 0-5, determined by the ability to perform the assessed activity
  • Mean of all items are scored with a maximum score of 50

Number of Items

10

Equipment Required

  • Vertical semicircular plastic tube
  • Bottle
  • Cylindrical objects of different sizes
  • Small and large tin
  • Coin to pick up in 10 different thumb positions
  • Jug with water
  • Cup
  • Pen and paper
  • Open a bottle with crown cork using an opener
  • Matches

Time to Administer

30-45 minutes

Required Training

Training Course

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Wendy Romney, PT, DPT, NCS, Cara Weisbach, PT, DPT, and the SCI EDGE task force of the Neurology Section of the APTA in 7/2012; updated by Amber DeWeese, OTR/L, CHT in 11/2016.

Body Part

Upper Extremity

ICF Domain

Body Structure
Body Function
Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations from the Neurology Section of the American Physical Therapy Association’s StrokEDGE Taskforce, MSEDGE Taskforce, SCI EDGE Taskforce, and the TBI EDGE Taskforce 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)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

NR

NR

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

NR

NR

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)

Is this tool appropriate for use in intervention research studies? (Y/N)

SCI EDGE

No

No

Yes

Considerations

  • Two versions available

    • The VLT-SV; short / research version is composed of 10 items 

    • The VLT long versions composed of 19 items

  • The VLT is available in three languages:

    • English

    • Dutch

    • German

  • Clinical utility is decreased secondary to difficulty obtaining measure. 

  • Information about the VLT can be found on the Rehabilitation Foundation Limburg's website

Spinal Injuries

back to Populations

Standard Error of Measurement (SEM)

Tetraplegia: (Post et al., 2006; n = 12; mean age = 43.2(12.7) years; mean time since injury 13.0(11.2) years; AIS A, B, D)

  • SEM = 0.13

Minimal Detectable Change (MDC)

Tetraplegia: (Post et al., 2006)

  • MDC = 0.767

Normative Data

Tetraplegia: (Post et al., 2006) 

 

Left hand, mean (SD) Right hand, mean (SD)
Forward reaching 3.4 (1.7) 3.5 (1.6)
Arch task 3.4 (1.9) 3.5 (1.9)
Thumb closure 2.9 (1.8) 3.1 (1.7)
Grip function thumb 2.3 (1.7) 2.2 (1.6)
Thumb strength 2.7 (1.5) 3.1 (1.3)
Finger closure 3.0 (1.8) 3.1 (1.8)
Finger strength 3.0 (1.9) 3.5 (1.7)
Pen gripa 1.6 (1.8) 3.1 (1.4)
Lighting a match 1.6 (1.9) 3.1 (1.8)
Opening a bottle 1.4 (1.8) 2.7 (1.4)
Mean total VLT score 2.6 (1.3) 3.1 (1.3)

Test/Retest Reliability

Tetraplegia: (Berardi et al., 2018; n=61; Mean Age=47 (14.76); ASIA A (25), ASIA B (15), ASIA C (15), ASIA D (6); Italian sample).
  • Excellent test-retest reliability (ICC=.90 for left hand, right hand, and total score).

Interrater/Intrarater Reliability

Tetraplegia: (Post et al., 2006) 

  • Excellent interrater reliability (ICC = 0.98 for right hand; ICC = 0.99 for left hand)

  • Excellent interrater agreement of 9 out of 10 item scores (weighted kappa = 0.74-0.99) 

  • Adequate interrater agreement for 1 item score (weighted kappa = 0.47 for right, 0.48 for left for “writing” item score)

Internal Consistency

Tetraplegia: (Post et al., 2006, n = 55) 

  • Excellent internal consistency (Cronbach’s α: 0.88 left hand; 0.94 right hand)
 

Tetraplegia: (Berardi et al., 2018)

  • Excellent internal consistency (Chronbach’s α=.95, p<0.01 for both right and left hand).

Criterion Validity (Predictive/Concurrent)

Tetraplegia: (Post et al., 2006)

  • Very good (r = 0.87 and 0.90) with probability of finding less than good criterion validity in the population (r < 0.60).
 

Concurrent Validity

Tetraplegia: (Berardi et al., 2018)

  • Correlation with dynamometer was analyzed by item, ranging from r=0.42-0.66 on the right hand and r=0.29-0.64 on the left hand
  • Item correlation with Jebsen Taylor Hand function test (JTHFT) ranged from r= -0.96 – -0.15 on the right hand and r=-0.79 – -0.138 on the left hand with many of the fine motor items showing high correlation with the fine motor items of the JTHFT

Construct Validity

Convergent Validity

Tetraplegia: (Post et al., 2006; n = 55)

  • Correlations between VLT-SV total score and ASIA Impairment Scale motor level and classification, International Classification for surgery of the hand in Tetraplegia (ICSoHT), Grasp and Release Test (GRT) and FIM scores for self-care and transfers (Spearman)

VLT-SV Total Score Correlations:

 

 

 

Left Hand

Right Hand

AIS motor level

0.58a

0.65a

AIS classification

0.35b

0.69a

ICSoHT

0.67a

0.85a

GRT

0.87

0.90

FIM – self-care

0.61a

0.69a

FIM – transfer

0.71a

0.72a

a = excellent convergent validity
b = adequate convergent validity

 

 

  • Authors anticipated lower correlation for these tests compared to the GRT as they measure different ICF domains.
 

Tetraplegia: (Berardi et al., 2018)

  • Adequate convergent validity between the VLT-SV-IT and the Level of Injury (r=0.51),
  • Poor convergent validity between the VLT-SV-IT and the AIS (r=0.18),
  • Poor convergent validity with the SCIMS III (r=0.07).

Floor/Ceiling Effects

Tetraplegia: (Spooren et al., 2013)

  • Floor effect (4%)

  • Ceiling effect (11%)

Responsiveness

Tetraplegia: (Spooren, 2006, n = 34, AIS A and B; n = 26, AIS C and D; Assessed at start of active rehabilitation and at discharge, mean = 288 days)

  • Highly Responsive at detecting changes from start of active rehabilitation to discharge for Motor Complete (AIS A and B) and Motor Incomplete (AIS C and D) (SRM = 1.1)

  • Moderately sensitive (effect size (ES) = 0 .71) 

Tetraplegia: (Spooren, 2006, n = 34, AIS A and B; n = 26 AIS C and D; assessed start of rehabilitation to 3 months, mean = 93 days)

  • Highly responsive at detecting change from start of rehabilitation to 3 months for Motor Complete (AIS A and B) and Motor Incomplete (AIS C and D) (SRM = 0.95)

  • Moderately Sensitive (ES = 0.54)

Bibliography

Berardi, A., Biondillo, A., Màrquez, M.A. et al. Validation of the short version of the Van Lieshout Test in an Italian population with cervical spinal cord injuries: a cross-sectional study. Spinal Cord 57, 339–345 (2019). https://doi.org/10.1038/s41393-018-0226-4

Post, M. W., Van Lieshout, G., et al. (2006). "Measurement properties of the short version of the Van Lieshout test for arm/hand function of persons with tetraplegia after spinal cord injury." Spinal Cord 44(12): 763-771. Find it on PubMed

Spooren, A. I., Arnould, C. et al. (2013). “Improvement of the Van Lieshout hand function test for Tetraplegia using a Rasch analysis”. International Spinal Cord Society. 51, 739-744; doi: 10.1038/sc.2013.54. Find it on PubMed

Spooren, A.I., Arnould, C. et al. (2013). “Reference values for the transformed Van Lieshout hand function test for tetraplegia”. International Spinal Cord Society. 51, 745-749; doi: 10.1038/sc.2013.73. Find it on PubMed

Spooren, A. I., Janssen-Potten, Y. J., et al. (2006). "Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test." Spinal Cord 44(12): 772-779. Find it on PubMed

VLT: Hand Function Test for People with Tetraplegia - Adelante. Rehabilitation Foundation Limburg (Adelante), n.d. Web. 6 Nov. 2016. <https://kenniscentrum.adelante-zorggroep.nl/en/research-programme/vlt-hand-function-test-for-people-with-tetraplegia/>.

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