Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
May 9–10
Live and Online
Offered by Academy, Shirley Ryan AbilityLab
The WMFT is a quantitative measure of upper extremity motor ability through timed and functional tasks.
21
35 minutes
Adult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Jason Raad MS and the Rehabilitation Measures Team; Updated by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Heather Anderson and Rie Yoshida of the StrokEdge II task force in 2016.
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
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations for use based on acuity level of the patient:
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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) |
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StrokEDGE |
R |
R |
R |
Recommendations based on level of care in which the assessment is taken:
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Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
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StrokEDGE |
R |
R |
R |
R |
R |
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TBI EDGE |
NR |
LS |
LS |
LS |
NR |
Recommendations for use based on ambulatory status after brain injury:
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Completely Independent |
Mildly dependant |
Moderately Dependant |
Severely Dependant |
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TBI EDGE |
N/A |
N/A |
N/A |
N/A |
Recommendations for entry-level physical therapy education and use in research:
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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) |
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StrokEDGE |
No |
Yes |
Yes |
Not reported |
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TBI EDGE |
No |
No |
Yes |
Not reported |
Observer plots were a less stable method of scoring the WMFT, suggesting relatively higher measurement error for the WMFT than for the ARAT (Nijland et al., 2010).
Chronic Stroke: (Fritz et al. 2009; n = 96; mean age = 62.3 (range, 19–90) years)
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Reliability Indices for WMFT: |
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Item No. |
Item Description |
SEM |
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Average WMFT time score |
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0.2 |
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1 |
Forearm to table |
0.8 |
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2 |
Forearm to box |
0.6 |
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3 |
Extend elbow |
0.6 |
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4 |
Extend elbow with weight |
0.8 |
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5 |
Hand to table (front) |
0.5 |
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6 |
Hand to box (front) |
0.7 |
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7 |
Weight to box (lbs) |
1.9 |
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8 |
Reach and retrieve |
1.2 |
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9 |
Lift can |
1.2 |
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10 |
Lift pencil |
1.1 |
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11 |
Lift paper clip |
0.8 |
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12 |
Stack checkers |
1.1 |
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13 |
Flip cards |
0.4 |
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14 |
Grip strength (lbs) |
0.0 |
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15 |
Turn key in lock |
0.4 |
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16 |
Fold towel |
0.4 |
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17 |
Lift basket |
0.7 |
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Average WMFT FAS |
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0.1 |
Chronic Stroke: (Fritz et al, 2009)
Average for timed items: 0.7 seconds
Average for WMFT Functional Ability Scale: 0.1 points
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Reliability Indices for WMFT: |
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Item No. |
Item Description |
95% MDC |
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Average WMFT time score |
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0.7 |
|
1 |
Forearm to table |
2.1 |
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2 |
Forearm to box |
1.6 |
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3 |
Extend elbow |
1.7 |
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4 |
Extend elbow with weight |
2.4 |
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5 |
Hand to table (front) |
1.5 |
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6 |
Hand to box (front) |
1.9 |
|
7 |
Weight to box (lbs) |
5.2 |
|
8 |
Reach and retrieve |
3.4 |
|
9 |
Lift can |
2.0 |
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10 |
Lift pencil |
3.0 |
|
11 |
Lift paper clip |
2.2 |
|
12 |
Stack checkers |
3.2 |
|
13 |
Flip cards |
1.2 |
|
14 |
Grip strength (lbs) |
0.1 |
|
15 |
Turn key in lock |
1.0 |
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16 |
Fold towel |
1.2 |
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17 |
Lift basket |
2.0 |
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Average WMFT FAS |
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0.1 |
Acute Stroke: (Lang et al, 2008; n = 52; mean age = 64 (14) years; < 28 days post-stroke)
MCID (Functional Ability):
1.0 points (Dominant Side Affected)
1.2 points (Non-dominant Side Affected)
17% change (Dominant Side Affected)
20% change (Non-dominant Side Affected)
MCID (time):
-19.0 seconds (Dominant Side Affected)
16% change (Dominant Side Affected)
Chronic Stroke: (Wing et al, 2006; n = 35; mean age = 60.2 (14.1) years; rehab = 3–6 hours/day, 4–5 days/week, ≥ 2 weeks; mean time since stroke = 40.9 (29.1) months)
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Outcome measure: |
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Measure |
n |
Pretest mean |
Posttest mean |
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Wolf Motor Function Test (mean) |
29 |
55.6 s |
45.2 s |
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TUG |
30 |
31.0 s |
20.2 s |
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Berg Balance |
32 |
46.5 |
47.2 |
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Fugl-Meyer (m) |
34 |
31.8 |
37.0 |
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Box and Block |
11 |
11.2 |
18.0 |
s = seconds; all means were significant; TUG = Timed Up & Go Test; Fugl-Meyer (m) = 66-point Fugl-Meyer motor assessment
Chronic Stroke: (Morris et al, 2001; n = 24; mean age 61; mean time since one set = 6 years; Whithall et al, 2006; n = 66; mean age = 58 (14) years; >6 months post-stroke)
Excellent test-retest reliability, Functional ability and performance tests (r= 0.95; 0.90, respectively)
Excellent overall total score (n = 66; ICC = 0.97)
Chronic Stroke: (Morris et al, 2001; Whithall, 2006; Wolf et al, 2001; n = 19, mean age = 61.4 (9.5) years; mean time since stroke = 4.9 (6.4) years)
Excellent inter-rater reliability:
Study1: n = 24: ICC = 0.93; 0.99, functional ability and performance test, respectively.
Study 2: n = 10; ICC = 0.99
Study 3: n = 19: ICC = 0.97
Chronic Stroke: (Morris et al, 2001)
Chronic Stroke: (Wolf et al, 2001; Whithall et al, 2006)
Adequate concurrent validity with:
Upper Extremity Fugl-Meyer Assessment
Study 1: n = 19 (r = - 0.57)
Study 2: n = 66 (r = - 0.88)
Wolf et al (2001) evaluated whether the WMFT was able to distinguish between individuals with impairment secondary to stroke (n = 19) from those without impairment (n = 19).
Known group's validity, as calculated using Wilcoxon test, showed that the WMFT scores for the dominant and the non-dominant hand of individuals without impairment were significant higher when compared to the most and to the least affected upper extremities of clients with stroke.
Acute Stroke: (Hsieh et al, 2009; n = 57; mean age = 54.56 (11.52) years; Taiwanese sample)
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Responsiveness of 3 Outcome Measures: |
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Scale Name |
SRM (95% CI) |
Wilcoxon Test Z-Value |
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WMFT-TIME |
0.38 (0.22, 0.59) |
5.97* |
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WMFT-FAS |
1.30 (1.03, 1.67) |
5.59* |
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FIM-total |
0.36 (0.17, 0.59) |
3.39* |
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FIM-motor |
0.37 (0.17, 0.58) |
3.18* |
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FMA |
1.42 (1.19, 1.80) |
6.33* |
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ARAT |
0.95 (0.75, 1.20) |
4.64* |
*p < 0.001; WMFT-TIME = performance time of the Wolf Motor Function Test; WMFT-FAS = functional ability scale of the Wolf Motor Function Test; FIM = Functional Independence Measure; FMA = Fugl-Meyer Assessment; ARAT = Action Research Arm Test; SRM = standardized response mean; CI = confidence interval
Chronic Traumatic Brain Injury: (Shaw et al., 2005; n = 22; Mean age = 39.3 (14.4) years, onset at least 1 year prior to assessment; relative hemiparesis)
Chen, H. F., Lin KC, Wu CY, Chen CL. Rasch validation and predictive validity of the action research arm test in patients receiving stroke rehabilitation. Arch Phys Med Rehabil. 2012;93(6):1039-1045. Find it on PubMed
Edwards, D. F., Lang, C. E., Wagner, J. M., Birkenmeier, R., Dromerick, A. W. An evaluation of the Wolf Motor Function Test in motor trials early after stroke. Arch Phys Med Rehabil. 2012 93(4): 660-668. Find it on PubMed
Fritz, S. L., Blanton, S., et al. (2009). "Minimal detectable change scores for the Wolf Motor Function Test." Neurorehabil Neural Repair 23: 662-667. Find it on PubMed
Lang, C. E., Edwards, D. F., et al. (2008). "Estimating minimal clinically important differences of upper-extremity measures early after stroke." Arch Phys Med Rehabil 89(9): 1693-1700. Find it on PubMed
Lin, K.-C., Hsieh, Y.-W., et al., (2009). “Minimum detectable change and clinically important difference of the Wolf Motor Function Test in stroke patients.” Neurohabilitation and Neural Repair 23(5): 429-434. Find it on PubMed
Morris, D. M., Uswatte, G., et al. (2001). "The reliability of the wolf motor function test for assessing upper extremity function after stroke." Arch Phys Med Rehabil 82: 750-755. Find it on PubMed
Nijland, R., van Wegen, E., et al. (2010). "A comparison of two validated tests for upper limb function after stroke: The Wolf Motor Function Test and the Action Research Arm Test." J Rehabil Med 42(7): 694-696. Find it on PubMed
O’Dell, M. W., Grace, K., et al., (2013). “A psychometric evaluation of the Arm Motor Ability Test.” J Rehabil Med 45(6): 519–527. Find it on PubMed
Shaw, S. E., Morris, D. M., et al. (2005). "Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury." J Rehabil Res Dev 42(6): 769-778. Find it on PubMed
Whitall, J., Savin, D. N., Jr., et al. (2006). "Psychometric properties of a modified Wolf Motor Function test for people with mild and moderate upper-extremity hemiparesis." Arch Phys Med Rehabil 87(5): 656-660. Find it on PubMed
Wing, K., Lynskey, J. V., et al. (2008). "Whole-body intensive rehabilitation is feasible and effective in chronic stroke survivors: a retrospective data analysis." Top Stroke Rehabil 15(3): 247-255. Find it on PubMed
Wolf, S. L., Catlin, P. A., et al. (2001). "Assessing Wolf motor function test as outcome measure for research in patients after stroke." Stroke 32: 1635-1639. Find it on PubMed
Woodbury, M., Velozo C. A., et al., (2010). “Measurement structure of the Wolf Motor Function Test: Implications for motor control theory.” Neurorehabil Neural Repair 24(9): 791–801. Find it on PubMed
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.