Reliability and Validity

Reliability and Validity

Measuring residual functional capacity in chronic low back pain patients on the Dictionary of Occupational Titles.

Article Type: Research article
Journal: Spine 1994;19:872-880.
Authors: Fishbain DA, Abdel-Moty E, Cutler RB, Khalil T, Sadek S, Steele-Rosomoff R, and Rosomoff H.

Study Design: This study designed and tested a functional battery based on the Dictionary of Occupational Titles (DOT). OBJECTIVES: Such a battery can be used to measure residual functional capacity (RFC) in chronic pain patients (CCPs) and results can be matched against the demand minimal functional capacities (DMFC) of DOT jobs. BACKGROUND DATA: Physicians have difficulty translating impairment into functional limitation and thereby establishing RFC of chronic pain patients. METHODS: The DOT, a USA government publication provides information about physical demands of every USA job according to 36 factors and sub-factors. The authors defined and developed a functional battery based on these factors/sub-factors. This battery was tested on 67 consecutive CPP’s to determine the percentage of CPP’s able to pass specific job factors, the full battery, return to some DOT job, and evaluated the effects of pain on battery performance. The data was factor analyzed. Results: The battery deterined if CPP’s could perform DOT job factors and had the necessary RFC to be placed in a DOT job. The vast majority of CPP’s coud not pass the full battery and the presence of pain and original job classification predicted whether a chronic pain patient could perform a job factor. Factor analysis grouped the factors into four independent categories supporting the design of the battery. Conclusion: The battery can assess whether CPP’s are able to return to work.

Validity of the Dictionary of Occupational Titles-Residual Functional Capacity battery.

Article Type: Research article
Journal: Clinical Journal of Pain 1999;15(2):102-110.
Authors: Fishbain DA, Cutler RB, Rosomoff H, Khalil T, Abdel-Moty E, and Steele-Rosomoff R.

Background Data: The Dictionary of Occupational Titles (DOT) is a government publication that defines each job in the United states according to 20 job factors. Fishbain et al (Spine 1994;19:872-880) developed a Dictionary of Occupational Titles – Residual Functional Capacity (DOT-RFC) battery whose predictive validity for employment/unemployment had not been tested previously. Objectives: The purpose of this study were as follows: (a) to determine whether results of a DOT-RFC battery performed at completion of pain facility treatment predicted employment status at 30 months’ follow-up, and (b) to determine whether the DOT-RFC battery predicted employment capacity as determined by the DOT employment levels of chronic pain patient’s jobs. Study Design: This is a prospective chronic pain patient facility treatment study using employment status and the DOT occupational levels as outcome measures. Methods: One hundred eighty-five consecutive chronic pain patients who fitted the criteria completed a DOT-RFC battery at completion of pain facility treatment and were contacted at one, three, six, twelve, eighteen, twenty-four, and thirty months for determination of their employment status and DOT employment level. Eight DOT job factors plus pain and worker compensation status were found to be significantly different between employed and unemployed chronic pain patients, and between those employed in different DOT levels. For the ten variables, stepwise discriminant analysis was used to select final predictor variables. Sensitivity and specificity were calculated along with pain level cut-points that separated groups. Results: The eight DOT job factors found to be statistically significant between groups were the following: stooping, climbing, balancing, crouching, feeling shapes, handling left and right, lifting, carrying, and pain and worker employed and unemployed categories, with a sensitivity and specificity of approximately 75 percent. The pain level cut-point between employed and unemployed was 5.4 on a 10 point scale. Conclusions: We cannot yet predict DOT-RFC employment levels. However, if a chronic pain patient can pass the above eight DOT job factors and has a pain level less than 5.4 cut-point, that patient will have a 75 percent chance of being employed at 30 months after treatment. Therefore, the DOT-RFC battery does demonstrate a predictive validity in the “real work world.

Validity of work-related assessments.

Article Type: Research article
Journal: Work 1999;13(2):125-152.
Authors: Innes E and Straker L.

Abstract: Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. Objectives: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. Study Design: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. Results: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. Conclusion: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.

Note: WebFCE (DOT-RFC) showed excellent Face/Content Validity (5/5) and Construct validity (5/5). Validity that has sufficient detail to enable examination of test results, and is published in a peer-reviewed journal (page 134, 135). Out of all the FCE’s on the market (28 in total), The DOT-RFC is the only assessment that has content validity established (page 141).

Reliability of work-related assessments.

Article Type: Research article
Journal: Work 1999;13(2):107-124.
Authors: Innes E and Straker L.

Abstract: Insufficient evidence of the reliability of work-related assessments is a major concern in this area of practice. Despite this concern, there has been ongoing development of new assessments, while existing assessments have been revised, modified and updated and others are no longer used or available. Objectives: The purpose of this study was to determine the extent and quality of evidence for the reliability of work-related assessments. Study Design: This study examined available literature and sources in order to review the extent which reliability has been established for 28 work-related assessments. Results: The levels of evidence and reliability are presented for each assessment. This indicates that a number of commercially available work-related assessments have insufficient evidence of reliability. For the limited number of work-related assessments with an adequate level of evidence on which to judge their reliability, most demonstrate a moderate to good level. Few assessments, however, have demonstrated levels of reliability sufficient for clinical (and legal) purposes. Conclusion: With this study, clinicians will be able to examine their options with regard to the reliability of the assessments they choose to use. Interpretation of changes in test results can be considered in the light of the evidence for the reliability of the instrument used.

Note: WebFCE (DOT-RFC) demonstrated test-retest reliability and intra rater reliability (Table 3).

Psychophysical modelling for combined manual materials-handling activities.

Article Type: Research article
Journal: Ergonomics 1986;29(10):1173-1190.
Authors: Jiang BC, Smith JL, and Ayoub MM.

Abstract: Most psychophysical studies in manual materials handling (MMH) are involved only with single MMH activities, i.e. lifting, lowering, carrying, holding, pushing or pulling. Very little research has been reported on the determination of operator capacities for combinations of MMH activities (e.g. lifting a box, then carrying the box, or carrying a box, then lowering the box). These kinds of combined activities are prevalent in industry and in our daily lives. The objective of this study was to utilize the psychophysical approach to examine the effects of combinations of lifting, carrying and lowering activities. Twelve male students served as subjects for the study. The capacities that were determined as the maximum acceptable workloads for a 1-h work period for four individual MMH activities—lifting from floor to knuckle height (LFK), lifting from knuckle to shoulder height (LKS), lowering from knuckle to floor height (LOW) and carrying for 3·4 m (C) —and three combined MMH activities—LFK + C, LFK + C + LKS and LFK + C + LOW—were determined psychophysically under three frequency conditions: one time maximum, one handling per minute and six handlings per minute. Combined MMH capacities models were developed using the following three methods: a limiting individual MMH capacity, isoinertial 1·83-m maximum strength and fuzzy-set theory. The advantages and disadvantages of different models were discussed.

Note: Many FCE vendors do not add combined lifts into their lifting criteria even though research suggests that combining lifting, carrying, and lower activities in sequence are representative of actual industrial lifting activities. Most vendors break down the lifting into 2 or more sections and will also separate the carrying portion. Unfortunately, this does not represent a real-time work environment nor does it represent accurate or actual lift/carrying strength figures. The combined lifting activities are also more stressful on the individual thus representing real occupational work activities. WebFCE incorporates this into our FCE so you can feel confident in your lift/carry test scores.

Work Physiology: Eight-Hour Work Tolerance

Work Physiology: Eight-Hour Work Tolerance

Prevalence of “Own-Design” Functional Capacity Evaluation Regarding Work Physiology Science

Article Type: Research article
Journal: The Rehabilitation Professional 2015;23(4):173–218.
Authors: Becker TJ, Ogle W, Chadbourne J, and Andrews K.

Introduction: The most prevalent methodology used in conducting FCEs is “own-design” protocol. The science of work physiology, and in particular the heart rate reserve formula, is an essential factor for time tolerance of work, but is not present in the “own-design” and commercial FCE methods. Across the spectrum of FCE provider protocols, and FCE report methods, there is a varying range of approaches used to determine the full-time work status of the examinee. A scientifically recognized work physiological standardization—the heart rate reserve formula—was utilized for comparative analysis on 151 FCE reports to determine work time tolerance assessment practices. Results: There are two categories of FCE protocols, the “own-design” method and commercial method. Neither of these use the heart rate reserve formula as a quantitative procedure; which identifies lack of professional competence, flawed methodology, and lack of scientifically supported opinions. The professional dictum of evidence-based practice demands that the FCE body of knowledge and providers embrace the science of work physiology as a benchmark. All FCE providers and commercial vendors should be expected to have professional work physiology credentials, discard procedures which are not heart rate reserve methods, and adopt transparent procedures so that there is credibility in the time tolerance opinions in the FCE.

Note: The prediction of eight hours of work from a period of testing is essential, and the determination should not be observational. FCE’s that do not use scientific work physiology formulas to predict ability to work eight hours lack validity. There are no FCE vendor-cited norms from the science of work physiology for a projection to full time work. FCE vendors need to translate or project data for the examinee’s abilities over an eight-hour period or attempt to do so, without professional knowledge or expertise. There is much confusion about terms such as aerobic capacity and physical work capacity. WebFCE uses work physiology formulas to predict a person’s eight hour work tolerance. We are the only FCE software to have this feature.

Functional capacity evaluation.

Article Type: Letters and responses
Journal: Physical Therapy 2000;80(1):110-112.
Authors: Fishbain DA.

Note: Fishbain notes some limitations in the DOT-RFC Battery are formulas to predict a person’s ability to perform their job over an eight hour period.

Applications of work physiology science to capacity test prediction of full-time work – eight hour work day.

Article Type: Literature review
Journal: The Rehabilitation Professional 2008;15(4):45–56.
Authors: Becker TJ, Morrill JM, and Stampler EE.

Introduction: The review of the published material for this investigation identified a number of component tests for capacity evaluation, however, these publications neglected to identify the definitive component of work physiology (Abdel-Moty, 1993; Blankenship, 1991; Hart, 1993-1994; King, 1998; Lechner, 1994; Saunders, 1997; Tramposh, 1999). Functional capacity testing requires the provider to have a thorough knowledge of the sciences comprising the protocols that are most appropriate for the given client as there is no single FCE that is universal to all cases (King, 1998). King et a1 (1998) completed a critical review of ten well-known Functional Capacity Evaluation (FCE) systems. That renewalrenew concluded that there were no scientific applications identified regarding a prediction to an 8-hour work tolerance, revealing that the tests were not standardized, and lacked comprehensiveness as well as objectivity in data collection. Additionally, developers of fictional capacity evaluations have claimed that scientists making “endurance projections” to predict full-time 8 hour work have done so without documenting prediction formulas (Lechner, 1994). It is essential that valid, reliable, safe, and scientifically determined measures be developed for practicing clinicians to accurately predict return to work.

Note: WebFCE uses the work physiology formula to predict a person’s eight-hour work tolerance. We are the only FCE software to have this feature.

Functional Capacity Evaluations: The Work Physiology Component for Predicting Full-time Work

Article Type: Literature review
Journal: Directions in Rehabilitation Counseling 2007;18(16):177–186.
Authors: Becker TJ.

Introduction: The use of capacity evaluation test procedures has become common in the United States and other countries as a means of quantifying human tolerance for work. Capacity testing is known by several names, including functional capacity evaluation (FCE), functional capacity assessment (FCA), and performance-based physical capacity evaluation (PBPCE). Typical components of capacity test protocols (FCE, FCA, PBPCE) include biomechanical evaluation, strength and clinical range of motion analysis, examinee self description of symptoms, and an analysis of physiological tolerance for work. This lesson focuses on the physiological aspect of capacity evaluation because that science has been the least well understood component of the capacity testing process. Work physiology is one of the most important factors for predicting an individual’s ability to tolerate full-time employment. Typically, commercially available software for capacity evaluation, 1 and various professional publications,2 have cited formulas for exercise physiology predictions related to clinical diagnostic treadmill or bicycle testing or protocols related to exercise and/or fitness training using heart rate monitoring as the criteria for the determination of work fitness. However, these formulas for exercise physiology or clinical diagnostic exercise physiology are not the appropriate formulas to use to determine the longitudinal prediction of full-time work tolerance, because there are specific formulas for work physiology. This lesson reviews the basic work physiological principles that have been neglected in capacity evaluation protocols and presents a review of exercise physiology principles that have been incorrectly applied to capacity evaluation protocols. In addition, relevant work physiological tolerances are reviewed, and simplified formulas that rehabilitation counseling professionals can consult to determine the accuracy of the capacity evaluation material they are reviewing, are presented.

Note: Commission on Accreditation of Rehabilitation Facilities (CARF) noted the need for definitive work physiology protocols, as well as promotion for a uniform standard of FCE service. They also concluded that FCE’s in general suffer from a lack of objective data, and therefore, could not accurately predict a worker’s success in actual full-time job-related functions. However, WebFCE has this technology and uses the work physiology formulas to predict a person’s eight-hour work tolerance.

Consistency of Effort

Consistency of Effort

Heart rate changes in functional capacity evaluations in a workers’ compensation population.

Article Type: Research article
Journal: Work 2012;42(7):253-257.
Authors: Marie M, Allison S, and Duhon D.

Objective: Functional Capacity Evaluations (FCEs) have been utilized by healthcare professionals for over twenty years to provide an objective assessment of an individual’s ability to safely perform functional work activities. Biomechanical observations have been established as a reliable method of determining safe maximal performance levels during dynamic lift testing in FCEs. The purpose of this study is to evaluate heart rate (HR) responses between participants in two performance levels (biomechanical safe-maximal and sub-maximal) and to attempt to establish a minimum threshold for HR changes that should be expected during specific functional testing protocols within FCEs. Participants: Participants included 500 men and women aged 20 to 85 years whom were injured on the job. Methods: Variables measured included resting HR, pre-test HR, peak-HR, and resting blood pressure. Percent HR change was calculated for the safe-maximal and sub-maximal performance level groups. Results: Statistically significant differences (p=0.0000000306) were found in HR change from pre-test to peak HR between performance level groups. Conclusions: Statistically significant differences were found in percent change in pre-test to peak HR, between the safe-maximal and sub-maximal performance level groups. This study provides the foundation for further research in establishing appropriate minimum expected changes in HR during FCE testing allowing clinicians to make more confident judgments relative to performance level.

Note: WebFCE uses this method of testing as one of our consistency of effort test procedures. The results of this study displayed a statistical difference in HR responses between safe maximal and submaximal performance during all dynamic lifts. This study provides established HR norms for maximal and submaximal lifts during FCE testing.

The sensitivity and specificity of functional capacity evaluations in determining maximal effort: a randomized trial.

Article Type: Research article
Journal: Spine 2004;29(9):953-959.
Authors: Lemstra M, Olszynski WP, and Enright W.

Objectives: To determine the sensitivity and specificity of maximal effort testing in functional capacity evaluations. Summat of Background and Data: Functional capacity evaluations are widely used to determine when an injured worker is able to return to work. The accurate assessment of function is dependent on a patient’s willingness to exert maximal effort during evaluation. Although many tests are used to suggest the presence of maximal or submaximal effort, it is unclear whether these tests can actually do what they are hoped to do. Methods: Ninety study participants with low back pain were randomized into either a 100% effort group or a 60% effort group. After a thorough evaluation, the blinded tester was asked to give an overall opinion as to whether or not the participant was giving 100% effort or 60% effort. Results: The tester’s opinion on maximal effort tests within the functional capacity evaluation had an overall specificity of 84.1% and a sensitivity of 65.2%. Only 5 of 17 commonly used maximal effort tests were able to individually differentiate between maximal and submaximal effort. The final logistic regression model was able to find three covariates with reasonable explanation of the proportion of variance in the outcome variable of effort (R 3 0.444) with goodness of fit. Conclusions: The determination of maximal effort in a functional capacity evaluation is complex. Because of the wide-ranging medicolegal and ethical considerations, caution is recommended in the labeling of patients as exerting either maximal or submaximal effort.

Note: The study shows 5 out of 17 commonly used maximal effort tests were able to individually differentiate between maximal effort and sub-maximal effort. These 5 tests are as follows: (1) rapid grip exchange values greater than 12 pounds, 5 point bell shaped curve in the (2) dominant hand and (3) non dominant hand, (4) patient self terminating tests (pain), and (5) observation-biomechanical competitive test behavior. With Web FCE, you can incorporate all these into our FCE.

Testing Lifting Capacity: Validity of Determining Effort Level by Means of Observation

Article Type: Research article
Journal: Spine 2005;30(2):40-46.
Authors: Reneman M, Fokkens A, Dijkstra P, Geertzen JHB, and Groothoff J.

Objectives: To establish the validity of determining effort level by visual observation of a lifting test. Summary of Background Data: Determining effort level during a lifting test is critical for interpretation of test performance, yet the validity of these determinations has not been established in patients with chronic nonspecific low back pain. Methods. Fifteen healthy subjects and 16 patients with chronic nonspecific low back pain performed a standardized lifting test as outlined in the Isernhagen Work System Functional Capacity Evaluation. The lifts were videotaped and independently observed by 9 trained observers, who rated effort levels using an Isernhagen Work System categorical scale (Appendix 1) and a Borg Category Ratio scale (Appendix 2). External effort indexes were established to control for effort at group level. Validity of the observer ratings was analyzed by means of a sensitivity and specificity analysis and correlations between performances and observer ratings. Interrater reliability was analyzed by means of intraclass correlation coefficients and Cohen kappa. Results: External indexes differ significantly between patients with chronic low back pain and healthy subjects, indicating that at group level, patients did not perform maximally. Submaximal performances were correctly rated in 85% to 90% (healthy subjects) and in 100% (patients with chronic nonspecific low back pain) of the cases. “Maximal” performances were correctly rated in 46% to 53% (healthy subjects) and in 5% to 7% (patients with chronic nonspecific low back pain) of the cases. Correlations between performances and observer ratings were r = 0.90 to r = 0.92 (healthy subjects) and r = 0.82 (patients with chronic nonspecific low back pain). Reliability: intraclass correlation coefficient, r = 0.76 (patients with chronic nonspecific low back pain) to r = 0.87 (healthy), Kappa K = 0.50 (patients with chronic nonspecific low back pain) to r = 0.58 (healthy subjects). Conclusions: Effort level can be determined validly by means of visual observation.

Note: WebFCE uses this method of testing as one of our consistency of effort test procedures.

Re-Visiting “How do you know he tried his best” … The coefficient of variation as a determinant of consistent effort

Article Type: Literature review
Journal: Matheson & Dakos 2000:1-9.
Authors: Matheson LN and Dakos M.

Abstract: Unfortunately, the developers of some functional capacity evaluation systems have touted the coefficient of variation statistic as a simple and effective method to determine if an evaluee is “faking” his or her effort. Even worse, the coefficient of variation has been incorrectly used out of context as a means to determine eligibility for benefits or allowances that are associated with disability programs. Although it has utility in identifying less than full effort (Matheson, Bohr, & Hart, 1998), its use as an independent measure is quite limited (Lechner, Bradbury, & Bradley, 1998). Functional capacity evaluators who persist in relying on this measure risk being successfully challenged in forensic proceedings. This article is intended to improve the professional community’s understanding of the coefficient of variation statistic and its use in this application. The coefficient of variation can be an invaluable tool for the functional capacity evaluator. By adhering to appropriate guidelines for the application and interpretation of the coefficient of variation, it will remain as one of the most reliable means to help the professional evaluator determine the consistency of an evaluee’s performance.

Sensitivity and specificity of the indicators of sincere effort of the EPIC lift capacity test on a previously injured population.

Article Type: Research article
Journal: Spine (Phila Pa 1976) 2000;25(11):1405-12.
Authors: Jay MA, Lamb JM, Watson RL, Young IA, Fearon FJ, Alday JM, and Tindall AG.

Objectives: To investigate the reliability and validity of the EPIC Lift Capacity test’s indicators of sincere effort. Background: The EPIC Lift Capacity test (ELC) (Employment Potential Improvement Corp., Santa Ana, CA) is a functional evaluation tool used to identify physical limitations involved in lifting and manual materials handling. Identification of insincere effort is an integral component of such functional testing because of the potential secondary gain issues surrounding the various populations typically involved in this form of testing. The purpose of this study was to determine the sensitivity and specificity of the “indicators of sincere effort” of the EPIC Lift Capacity test when used on a previously injured population typical of subjects for which the test is designed. Methods: Subjects consisted of 41 volunteers (age 22 to 58 years) with a previously diagnosed musculoskeletal pathology of the spine or extremities. Volunteers were randomized into either the control group, instructed to give a sincere maximum effort, or the experimental group, instructed to give an insincere effort at 50% of their perceived maximum effort. All tests were administered by certified clinical evaluators according to the standardized EPIC Lift Capacity test protocol. Results: Overall accuracy in identifying participants’ level of effort was 86.84%. The indicators of valid effort exhibited both high positive (94.44%) and negative (80.00%) predictive values. The indicators of valid effort accounted for 94.9% of the total variance in the determination of the subjects’ overall effort level. Interrater reliability for agreement of subjects’ overall effort was good (interclass correlation coefficient = 0.82). Conclusions: Through use of standardized indicators of sincere effort, certified EPIC Lift Capacity test evaluators were able to predict sincerity of effort with a high degree of reliability and validity. The rater’s systematic-observational evaluation of effort was shown to be the single best indicator of sincere effort.

Note: WebFCE uses the same protocols for the observation and the heart rate method in our consistency of effort test procedures.

Detection of submaximal effort by use of the rapid exchange grip.

Article Type: Research article
Journal: Journal of Hand Surgery (American Volume) 1989;14(4):742-5.
Authors: Hildreth DH, Breidenbach WC, Lister GD, and Hodges AD.

Abstract: To assist in distinguishing patients with truly decreased handgrip strength from those deliberately not gripping the dynamometer at maximal capacity, a rapid exchange grip strength test was devised and tested under four conditions. Part I, 100 normal subjects undergoing static grip testing and the rapid exchange grip test. Part II, 45 patients chosen at random from physical therapy with various hand injuries tested using only the static grip test. Part III, a blind control study on 15 normal subjects instructed to fake an injury to either the right or left hand. This group was given both the static and rapid exchange grip test. Part IV, a retrospective evaluation of 45 patients seen in a private hand practice who had both the static and rapid exchange grip test. After the dynamometer had been set to the position at which the patient had previously achieved maximal grip strength, the patient was instructed to rapidly alternate hands while gripping the dynamometer. Uninjured subjects had consistently lower rapid exchange grip test scores than previous scores at the same setting (negative rapid exchange grip). Average rapid exchange grip test scores were higher than previous scores (positive rapid exchange grip) when subjects were instructed to fake an injury with one hand. We conclude that if maximal performance has not been achieved on the static test, the rapid exchange grip shows a significant increase in grip strength on the affected side. More patients claiming worker’s compensation had positive rapid exchange grips and the average score was higher than that of patients not claiming worker’s compensation.

Identifying sincerity of effort based on the combined predictive ability of multiple grip strength tests.

Article Type: Research article
Journal: Journal of Hand Therapy 2012;25(3):308-18.
Authors: Sindhu BS, Shechtman O, Veazie PJ.

Introduction: Detecting sincerity of effort (SOE) of grip strength remains a frustrating and elusive task for hand therapists because there are no valid, reliable, or widely accepted assessments for identifying feigned effort. Some therapists use various combinations of different SOE tests in an attempt to identify feigned effort, but there is lack of evidence to support this practice. Purpose: The present study examined the ability of a combination of three grip strength tests commonly used in the clinic to detect SOE: the five rung grip test, rapid exchange grip test, and coefficient of variation. A secondary purpose was to compare the predictive ability between the logistic and linear regression models. Methods: Healthy participants (n=146) performed the three SOE tests exerting both maximal and sub-maximal efforts. We compared the ability of two regression models, the logistic and linear models, to predict sincere versus insincere efforts. Results: Combining the three tests predicted SOE better than each test alone. Yet, the full logistic model, which was the best predictor of SOE, explained only 42% of variance and correctly classified only 58% of the efforts.

Note: We do not recommend doing the Coefficient of Variation as a stand-alone test for consistency of effort but we do believe in doing several consistency of effort tests to get a better understanding of the patient. In addition, based on the research, testing an injured hand for consistency of effort will yield invalid results. The five-point test was strength dependent; thus, the test may yield biased results when assessing consistency of effort in people with weakened hands (Am J Phys Med Rehabil. 2003 Nov;82(11):847-55).

Horizontal strength changes: an ergometric measure for determining validity of effort in impairment evaluations a preliminary report.

Article Type: Research article
Journal: Journal of Disability 1993;3(14):143-8.
Authors: Berryhill B, Osborne P, Staats T, Brooks F, and Skarina J.

Abstract: This study examines horizontal strength changes as a measure of determining maximum effort when using a standardized isometric strength protocol. A non-injured working sample was used to establish a cutoff for horizontal lift changes, that would be deemed as either appropriate or inappropriate. These cutoff scores were then applied to disability claimants
involved in medico-legal proceedings. The results demonstrate that “inappropriate”
horizontal strength changes may be used to indicate sub-maximal effort on the part of a patient during strength testing.

Note: WebFCE uses this method of testing as one of our consistency of effort procedures.

Identification of low-effort patients through dynamometry.

Article Type: Research article
Journal: Journal of Hand Surgery: American Volume 1995;20(6):1047-56.
Authors: Stokes HM, Landrieu KW, Domangue B, and Kunen S.

Abstract: In recent years researchers have devised a number of methods to detect patients who purposely exert low effort during grip evaluations. This study further defines the five-rung grip test introduced by Stokes and subsequently challenged by Niebuhr and Marion. New data are presented on the rapid exchange grip test. Data were collected on four groups of subjects (sincere normals, normals asked to feign weak grip, patients thought to be sincere, and patients suspected of low effort) using both tests. In calculating the standard deviation of the plotted line of the five-rung grip test, group membership (sincere or low effort) can be predicted. No statistical difference between peak scores on five-rung and rapid exchange grip tests in sincere subjects was found. A statistical difference between peak scores in the low-effort groups was shown. A model has been developed that can be used to categorize patients into low effort or sincere groups.

Detecting sincerity of effort when measuring grip strength.

Article Type: Research article
Journal: American Journal of Physical Medicine and Rehabilitation 1987;66(1):16-24.
Authors: Niebuhr BR and Marion R.

Abstract: The purpose of the present study was to determine whether sincere and faked grip strength measurements could be distinguished from one another by the patterns of measurements obtained for the five handle (hand size) positions of the Jamar dynamometer. Healthy subjects were instructed on different trials to give a sincere, maximal effort or to fake weakness of grip. Results were that the patterns did differ for sincere and fake trials, but not as strongly as expected. The recommendation is made that further research be done using patients with upper extremity injury.

Voluntary control of submaximal grip strength.

Article Type: Research article
Journal: American Journal of Physical Medicine and Rehabilitation 1990;69(2):96-101.
Authors: Niebuhr BR and Marion R.

Abstract: Stokes (J Occup Med; 1983;25:683-684) proposed that feigned weak hand grip can be distinguished from sincere efforts by examining force measurements for the different handle positions of the Jamar hand dynamometer. Sincere efforts yield a curvilinear relationship between grip force and handle position; feigned efforts yield a horizontal, linear relationship. The purpose of the present set of three experiments was to investigate the degree of control normal subjects have over submaximal effort and their ability to feign weakened grip. In Experiment 1 we found that subjects instructed to exert a specific amount of submaximal effort (50%) did not produce a response pattern of grip force consistent with Stokes’ hypothesis. In Experiment 2 we found a linear relationship between the degree of submaximal effort and grip force for efforts of 30, 50, 70, and 90% of maximal effort. In Experiment 3 we found that subjects, with proper instruction as to the amount of effort to exert, can produce feigned submaximal efforts similar to the sincere, maximal efforts of injured people. Simple maximal grip force measurements are insensitive to the different motor strategies used in maximal and submaximal efforts and may provide little evidence for the detection of feigning.

Determining effort – performance APGAR -psychosomatic delayed recovery-workers compensation. Motivation determination (sincerity of effort): the Performance APGAR Model.

Article Type: Research article
Journal: Disability Medicine 2001;12(1):5-18.
Authors: Colledge AL, Holmes EB, and Soo Hoo ER.

Abstract: Background: Making an objective determination of the amount of effort an individual expends to recover from injury or illness is an essential component in making stability and capability statements. Individuals, whose effort and motivation are less than optimal may overuse treatment, have increased medical costs, more disability payments, and a prolonged recovery. This paper presents a new standardized reporting methodology, referred to as the Performance APGAR, that is a comprehensive summary of current methods used to measure the amount of personal commitment and effort the patient has expended to improve their condition. Methods: Various experts in the field of impairment and disability evaluation did an extensive literature review and developed a consensus method to better evaluate the motivation and effort of the patient and the role of that effort in determining Residual Functional Capacity (RFC) and predicting recovery. Results: The authors developed the Performance APGAR model as an acronym that provides an easy to remember method to estimate patient motivation, credibility and effort. Conclusions: The authors conclude that the Performance APGAR model provides clinicians a new, easy method to uniformly measure patient motivation and effort. Performance APGAR scores can be measured at each visit, over a series of visits or at final impairment rating. The authors feel that further research will validate the proposal that motivation and effort are key factors in predicting recovery and RFC.

Evaluating malingering in contested injury or illness.

Article Type: Research article
Journal: Pain Practice 2007;7(2):178-204.
Authors: Aronoff GM, Mandel S, Genovese E, Maitz EA, Dorto AJ, Klimek EH, and Staats TE.

Introduction: An interdisciplinary task force of physicians and neuropsychologists with advanced training in impairment and disability assessment provided a review of the literature on malingering in chronic pain, medical disorders, and mental/cognitive disorders. Our review suggests that treating health care providers often do not consider malingering, even in cases of delayed recovery involving work injuries or other personal injuries, where there may be a significant incentive to feign or embellish symptoms or delay recovery. This report discusses the implications of this issue and offers recommendations to evaluating physicians and other healthcare professionals.

On the diagnosis of malingered pain-related disability: lessons from cognitive malingering research.

Article Type: Research article
Journal: Spine Journal2005;5(4):404-17.
Authors: Bianchini KJ, Greve KW, and Glynn G.

Background and Context: Pain-related disability is a complex phenomenon. Malingering is a potential factor in the management of patients with pain. Methodological problems and inappropriate expectations regarding diagnostic accuracy have hampered the study of malingering detection in pain. In contrast, the study of cognitive malingering in neuropsychology has led to the development of many highly accurate and reliable detection techniques. This paper applies the methods and logic that have been successful for identifying cognitive malingering to the problem of malingering in patients with pain. Purpose: Outline the logic of a research methodology for studying malingering detection in pain and introduce a system for the diagnosis of malingering in pain. Study Design: Literature review and conceptual synthesis. Methods: Examination of the research methodology and diagnostic scheme used in the study of cognitive malingering; adaptation of these methods to the problem of malingering in pain. Results: Lessons derived from the study of cognitive malingering were used to generate recommendations to enhance research into detection and diagnosis of malingered pain-related disability. A comprehensive, multidimensional system for diagnosing malingering in pain-related disability was proposed. Conclusions: Pain-related disability is a multifaceted phenomenon, therefore malingering can occur in different and sometimes multiple dimensions. It is presently possible to accurately detect and diagnose malingering in some patients with pain. More work is needed for some detection techniques to be appropriately calibrated in pain populations. This work must focus on controlling the false positive error rate.

Content validity in psychological assessment: A functional approach to concepts and methods.

Article Type: Research article
Journal: Psychological Assessment 1995;7(3):238-247.
Authors: Haynes SN, Richard DCS, and Kubany ES.

Abstract: This article examines the definition, importance, conceptual basis, and functional nature of content validity, with an emphasis on psychological assessment in clinical situations. The conditional and dynamic nature of content validity is discussed, and multiple elements of content validity along with quantitative and qualitative methods of content validation are reviewed. Finally, several recommendations for reporting and interpreting content validation evidence are offered.

Nonorganic physical signs in low-back pain.

Article Type: Research article
Journal: Spine (Phila Pa 1976) 1980;5(2):117-25.
Authors: Waddell G, McCulloch JA, Kummel E, and Venner RM.

Abstract: Nonorganic physical signs in low-back pain are described and standardized in 350 North American and British patients. These nonorganic signs are distinguishable from the standard clinical signs of physical pathology and correlate with other psychological data. By helping to separate the physical from the nonorganic they clarify the assessment of purely physical pathologic conditions. It is also suggested that the nonorganic signs can be used as a simple clinical screen to help identify patients who require more detailed psychological assessment.

Behavioral responses to examination. A reappraisal of the interpretation of “nonorganic signs”.

Article Type: Research article
Journal: Spine (Phila Pa 1976) 1998;23(21):2367-71.
Authors: Main CJ and Waddell G.

Abstract: Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medicolegally. Behavioral responses to examination provide useful clinical information, but need to be interpreted with care and understanding. Isolated signs should not be overinterpreted. Multiple signs suggest that the patient does not have a straightforward physical problem, but that psychological factors also need to be considered. Some patients may require both physical management of their physical pathology and more careful management of the psychosocial and behavioral aspects of their illness. Behavioral signs should be understood as response affected by fear in the context of recovery from injury and the development of chronic incapacity. They offer only a psychological “yellow-flag” and not a complete psychological assessment. Behavioral signs are not on their own a test of credibility or faking.

Screening for psychological factors in patients with low back problems: Waddell’s nonorganic signs.

Article Type: Research article
Journal: Physical Therapy 1997;77(3):306-12.
Authors: Scalzitti DA.

Abstract: The role of Waddell’s nonorganic signs test as a screening tool for psychological factors in the examination of patients with low back problems has been described. The presence of nonorganic signs should alert the physical therapist to the need for additional psychological tests and should not necessarily be considered an indicator of malingering. Nonorganic signs may coexist with organic findings. An illness behavior role of the nonorganic signs is suggested, as they have been related with disability in addition to physical impairments. Physical therapy management for these patients should focus on treatment of illness behavior and on combating disability.

The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain.

Article Type: Research article
Journal: Physical Therapy 1997;77(4):354-60.
Authors: Karas R, McIntosh G, Hall H, Wilson L, and Melles T.

Background and Purpose: The purpose of this study was to assess the relationship between the nonorganic signs (Waddell scores) of patients with low back pain, their response to repetitive end-range lumbar spine test movements (centralization of symptoms), and the rate of return to work at a 6-month follow-up. Subjects: Patients were assessed at five locations of the Canadian Back Institute. A consecutive sample of 126 patients with low back pain, with or without referred leg pain, was selected and reviewed. Methods: Physical therapists assessed patients’ responses to repetitive test movements (centralization), as described by McKenzie, and tested the patients for nonorganic signs (Waddell scores). Therapists completed a data sheet that classified patients as either those who centralize their symptoms or those who do not centralize their symptoms and recorded their Waddell scores. Although the patients were classified at assessment, they remained in treatment. All patients followed a structured Canadian Back Institute protocol of active exercise, regardless of centralization status or Waddell score. Results: The inability to centralize symptoms indicated a decreased likelihood of returning to work, regardless of the Waddell score. A high Waddell score predicted a poor chance of returning to work, regardless of the patients’ ability to centralize symptoms. Conclusion and Discussion: A high Waddell score appears to be the best predictor of outcome, as indicated by return to work.

Hoover’s sign

Article Type: Research article
Journal: Practical Neurology 2001;1:50-53.
Authors: Stone J and Sharpe M.

Background and History: It’s the middle of the clinic. Your next patient has a bulging set of case notes and struggles in to the room on two elbow crutches with a hand-written list of 15 somatic complaints. The worst symptom is progressive right leg weakness that has become so bad that any work has been impossible for six months. You have already noted some physical signs. The right leg is dragged like a sack of potatoes and when the patient climbs on the bed the leg is hauled on with both hands. On direct testing there is some ‘collapsing weakness’ even after you’ve cajoled and encouraged the patient. The reflexes are normal. How are you going to clinch the diagnosis of functional weakness? Can Hoover’s sign help you? In this article we will use the term functional weakness to refer to medically unexplained weakness of the type that was formerly labeled ‘hysterical’, i.e. the patient is unaware or largely unaware of any degree of control over the symptom. As we will comment later, Hoover’s sign does not help differentiate this type of weakness from deliberately simulated weakness, which in our experience is a much rarer problem outside medico-legal scenarios. Dr Charles Franklin Hoover (1865–1927), a physician in Cleveland, Ohio, described his useful principle and two tests in the Journal of the American Medical Association in 1908 (Hoover 1908). Hoover trained as a Methodist minister before medical studies at Harvard, Vienna and Strasbourg. He later became professor of medicine at Western Reserve University, Ohio specializing in pulmonary and hepatic disease. His neurological test should not be confused with a respiratory ‘Hoover test’, which relates to paradoxical movement of the rib cage in pericardial effusion. His article ‘A new sign for the detection of malingering and functional paresis of the lower extremities’ (Hoover 1908) was based on four patients seen in two years. Hoover’s sign, like the type of patient for whom it is intended, has not traditionally been popularized in neurological training or textbooks and yet it is one of the most useful and simple tests in this area.

The Hoover sign. An objective-sign of pain and/or weakness in the back or lower extremities.

Article Type: Research article
Journal: Archives of Neurology 1961;5:673-8.
Authors: Arieff AJ, Tigay EL, Kurtz JF, and Larmon WA.

Abstract: Hoover’s sign is a manoeuvre aimed to separate organic from non-organic paresis of the leg. The sign relies on the principle of synergistic contraction. Involuntary extension of the “paralysed” leg occurs when flexing the contralateral leg against resistance. It has been neglected, although it is a useful clinical test. The patient lies supine, the examiner’s hand is placed under the non-paralysed heel, and the patient is asked to elevate the paralysed leg. In organic paresis the examiner feels a downward pressure under the non-paralysed heel; in malingering no pressure is felt. However, some have used it in a less precise context as a sign of pain or weakness in the back or lower extremities. The reliability has been questioned in one study because of poor pelvic stabilisation and varying levels of pain, effort, and spasticity. Charles Franklin Hoover (1865–1927) was an American physician born in Cleveland, Ohio, who read medicine at Harvard. He worked in Vienna under Neusser, and in Strasburg with F Kraus before returning to Cleveland. He was appointed Professor of Medicine in 1907. His main interests were in diseases of the diaphragm, lungs, and liver.

Simple quantitative analysis of Hoover’s test in patients with psychogenic and organic limb pareses.

Article Type: Research article
Journal: Journal of Psychosomatic Research 2013;74(4):361-4.
Authors: Diukova GM, Ljachovetckaja NI, Begljarova MA, and Gavrileyko GI.

Objectives: To perform a quantitative evaluation of Hoover’s test using a simple device–routine weighing scales. To determine a cut-off value of a Hoover’s index, and to analyze the behavior of Hoover’s test in “painful paresis.” Methods: The subjects were 9 patients presenting with psychogenic paresis of one leg, 9 with organic paresis (after stroke), 9 with lumbar back and leg pain (lumbar radiculopathy), and 9 healthy controls. The following parameters were measured: the ratio between voluntary/involuntary pressure force of each leg [Hoover’s index (HI)], the ratio between HI in the affected and non-affected leg [Side index (SI)]. Results: Patients with psychogenic paresis had a significant increase in the HI in the affected leg and SI, compared to the other three groups. We suggest a cut-off of a Hoover’s index of 1.4 as a cut-off value for future research studies. In our study we obtained a specificity and sensitivity of 100% (with 66.4-99.7 confidence interval). Conclusion: Our study suggests that the quantitative analysis of the Hoover’s test can be simple, reliable and cheap method of differential diagnosis between psychogenic and organic pareses, which could be of value in the routine neurological practice.

Reliability and Validity

Standardized Testing

Grip and pinch strength: Normative data for adults.

Article Type: Research article
Journal: Archives of Physical Medicine and Rehabilitation 1985;66:69-72.
Authors: Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, and Rogers S.

AbstractThe primary purpose of this study was to establish clinical norms for adults aged 20 to 75+ years on four tests of hand strength. A dynamometer was used to measure grip strength and a pinch gauge to measure tip, key, and palmar pinch. A sample of 310 male and 328 female adults, ages 20 to 94, from the seven-county Milwaukee area were tested using standardized positioning and instructions. Right hand and left hand data were stratified into 12 age groups for both sexes. This stratification provides a means of comparing the score of individual patients to that of normal subjects of the same age and sex. The highest grip strength scores occurred in the 25 to 39 age groups. For tip, key, and palmar pinch the average scores were relatively stable from 20 to 59 years, with a gradual decline from 60 to 79 years. A high correlation was seen between grip strength and age, but a low to moderate correlation between pinch strength and age. The newer pinch gauge used in this study appears to read higher than that used in a previous normative study. Comparison of the average hand strength of right-handed and left-handed subjects showed only minimal difference.

Adult norms for the box and block test of manual dexterity.

Article Type: Research article
Journal: American Journal of Occupational Therapy 1885;39:386-391.
Authors: Mathiowetz V, Volland G, Kashman N, and Weber K.

Abstract:The Box and Block Test, a test of manual dexterity, has been used by occupational therapists and others to evaluate physically handicapped individuals. Because the test lacked normative data for adults, the results of the test have been interpreted subjectively. The purpose of this study was to develop normative data for adults. Test subjects were 628 Normal adults (310 males and 318 females) from the seven-county Milwaukee area. Data on males and females 20 to 94 years old were divided into 12 age groups. Means, standard deviations, standard error, and low and high scores are reported for each five-year age group. This data will enable clinicians to objectively compare a patient’s score to a normal population parameter.

Validation of the Box and Block Test as a measure of dexterity of elderly people: Reliability, validity, and norms studies.

Article Type: Research article
Journal: Archives of Physical Medicine and Rehabilitation 1994;75(7):751-5.
Authors: Desrosiers J, Bravo G, Hébert R, Dutil E, and Mercier L.

Abstract: Manual dexterity is a skill frequently evaluated in rehabilitation to estimate hand function. Several tests have been developed for this purpose, including the Box and Block Test (BBT) that measures gross manual dexterity. The goal of the present study was to verify the test-retest reliability and construct validity of the BBT with subjects aged 60 and over with upper limb impairment. The second objective of this research was to develop normative data based on a random sample of healthy elderly community-living individuals. The results show that the test-retest reliability is high (intraclass correlations coefficients of 0.89 to 0.97) and the validity of the test is shown by significant correlations between the BBT, an upper limb performance measurement and a functional independence measurement. The norms will help rehabilitation clinicians to differentiate better between real difficulties and those that may be attributed to normal aging.

Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: A multicentre study.

Article Type: Research article
Journal: Clinical Rehabilitation 2005;19(4):404-11.
Authors: Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, and Johnson G.

Objectives:To establish: (1) inter-rater and test-retest reliability of standardized guidelines for the Fugl-Meyer upper limb section, Action Research Arm Test and Box and Block Test in patients with paresis secondary to stroke, multiple sclerosis or traumatic brain injury and (2) correlation between these arm motor scales and more general measures of impairment and activity limitation. Design: Multicentre cohort study. Setting: Three European referral centres for neurorehabilitation. Subjects: Thirty-seven stroke, 14 multiple sclerosis and five traumatic brain injury patients. Main measures: Scores of the Fugl-Meyer Test (arm section), Action Research Arm Test, and Box and Block Test derived from video information. Results: All three motor tests showed very high inter-rater and test-retest reliability (ICC and rho for main variables > 0.95). Correlation between the motor scales was very high (rho > 0.92). Motor scales correlated moderately highly with the Hemispheric Stroke Scale, a measure of impairment (rho = 0.660-0.689), but not with the Modified Barthel Index, a measure of the ability to cope with basic activities of daily living (rho = 0.044-0.086). Conclusions: The standardized guidelines assured comparability of test administration and scoring across clinical facilities. The arm motor scales provided information that was not identical to information from the Hemispheric Stroke Scale or the Modified Barthel Index.

Hand function in Charcot Marie Tooth: Test retest reliability of some measurements.

Article Type: Research article
Journal: Clinical Rehabilitation 2006;20(10):896-908.
Authors: Svensson E and Häger-Ross C.

Objective: To evaluate the reliability of some measurements of hand function in people with Charcot Marie Tooth disease. Design: Test retest study. Setting: University, hospitals/clinics in northern Sweden. Subjects: Twenty people with Charcot Marie Tooth disease. Main outcome measures: Measures of (1) dexterity; Box and Block Test and Nine-Hole Peg Test, (2) strength; Grippit instrument (grip and pinch), (3) tactile sensation; Shape Texture Identification Test. Statistics used: intraclass correlation (ICC 2.1), limits of agreement, coefficient of repeatability, coefficient of variation, and linear weighted kappa. Results: The ICC for the Box and Block Test was very high (0.95). The limits of agreement, coefficient of repeatability (CR) (11.5 blocks/min) and coefficient of variation (CV) (8.4%) were acceptable. There was bias towards a better result on the second occasion. For the Nine-Hole Peg Test, the reliability was good if performance was within 2 min (ICC =0.99, CR = 4.3 s, CV = 3.9%). Grip strength proved to be reliable (ICC = 0.99, CR = 26.7 N, CV = 6.6%), while pinch strength was less reliable. The kappa value of the Shape Texture Identification Test was 0.87, which was considered very good although the test has limitations in terms of how well it can describe patients either performing very well or very poorly. Conclusions: The tested instruments can all be used to evaluate hand function in people with Charcot Marie Tooth. Certain factors, however, like limited time aspects for the Nine-Hole Peg Test and the number of trials used, should be taken into consideration. Pinch strength evaluation should be interpreted with caution.

The Moberg pickup test: Results of testing with a standard protocol.

Article Type: Research article
Journal: Journal of Hand Therapy 1999;12(4):309-312.
Authors: Ng CL, Ho DD, and Chow SP.

Abstract:The purpose of this study was to propose a standard protocol for administering the Moberg pickup test. One hundred subjects (53 male and 47 female subjects, aged 11 to 77 years) volunteered. A wide variety of occupations were represented. No subjects had a history of upper extremity dysfunction. The materials and the testing procedures were clearly described to the subjects. Both hand dominance and gender difference were found to have significant effects on test performance. Norms were established for dominant/nondominant hands and for male/female subjects. Standard scores were calculated and used for comparison. The inter-rater reliability of the test was also determined. Administered with a standard protocol, the Moberg pickup test is a valuable test of functional sensibility. It is simple and quick to administer, easy to replicate, and inexpensive to acquire.

Evaluating the hand: Issues in reliability and validity.

Article Type: Research article
Journal: Physical Therapy 1989;69(12):1025–1033.
Authors: Bear-Lehman J and Abreu BC.

Abstract: Evaluation of hand function is a qualitative and quantitative process. This article provides a review of several quantitative tests and measures used to evaluate range of motion, edema, muscle performance, sensation, dexterity, and physical capacity. The validity and reliability of these instruments are emphasized. Some of the hand assessments reviewed are in the early developmental phase with further refinements yet to come. This article demonstrates the continued need to provide support for the validity and reliability of hand-assessment instrumentation. Regardless of the statistical support provided, however, the authors believe that hand therapy will remain an art as well as a science.

The sensational contributions of Erik Moberg.

Article Type: Literature review
Journal: Journal of Hand Surgery 1990;15(1):14-24.
Authors: Dellon AL.

Abstract Erik Moberg is the father of functional sensory testing. During the past three decades, his research into quantitative testing of hand sensibility has provided the insight to bring us from classic academic tests (permitting localisation of lesions within the central nervous system) to clinical capability of restoring sensation to the hand. He introduced the Ninhydrin test to document objectively innervation. He defined hand function as precision-sensory and gross-sensory grips. He correlated Weber two-point discrimination with hand function. He introduced the pick-up test to document hand function. He coined the term “tactile gnosis”. He hypothesised that proprioception is principally due to skin, not joint, afferents. He classified the tetraplegic hand according to its combined sensory and motor capacity. He set the standard for sensory recovery after primary nerve repair, relating recovered two-point discrimination to age (Onne’s line) and he inspired the present generation of researchers to quantify their own studies of sensation.

Normative values and the effects of age, gender, and handedness on the Moberg Pick-Up Test.

Article Type: Research article
Journal: Muscle & Nerve 2007;35(6):788-92.
Authors: Amirjani N, Ashworth NL, Gordon T, Edwards DC, and Chan KM.

Abstract: The Moberg Pick-Up Test is a standardized test for assessing hand dexterity. Although reduction of sensation in the hand occurs with aging, the effect of age on a subject’s performance of the Moberg Pick-Up Test has not been examined. The primary goal of this study was to examine the impact of aging and, secondarily, the impact of gender and handedness, on performance of the Moberg Pick-Up Test in 116 healthy subjects. The average time to complete each of the four subsets of the test was analyzed using the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. The results show that hand dexterity of the subjects was significantly affected by age, with young subjects being the fastest and elderly subjects the slowest. Women accomplished the test faster than men, and task performance with the dominant hand was faster than with the non-dominant hand. Use of normative values established based on age and gender is a valuable objective tool to gauge hand function in patients with different neurologic disorders.

A narrative review of dexterity assessments.

Article Type: Literature review
Journal: Journal of Hand Therapy 2009;22(3):258-269.
Authors: Yancosek KE and Howell D.

Abstract: This article is a narrative review of the psychometric properties (reliability and validity) and other characteristics (cost, time to administer, and year of publication) of commercially available manual and finger dexterity assessments used for adults in the United States. Complete research articles related to dexterity assessments were gathered from online database searches and individually critiqued for scientific rigor based on reliability and validity. Articles relating to 14 dexterity assessments were reviewed. All but three tools had established reliability, seven tools had all five forms of validity established, and two had only face and content validity. The results of this review provide information to those interested in fine motor skill acquisition, impairment, or functional recovery after injury. Therapists may use this information to choose the best assessment instrument to evaluate a patient’s recovery of function over time. This review adds to the evidence-based, best-practice literature related to assessment and outcome measurements of patients with limited dexterity function participating in rehabilitation.
Note: The study showed that the box and block test or the Minnesota Rate of Manipulation Test are the recommended assessments of choice for manual (gross) dexterity due to its solid psychometric properties, reliability and validity. The Purdue Peg Board test was the choice recommended choice for fine motor dexterity but the Moberg Pick Up Test demonstrated the same reliability and validity qualities at a cheaper cost to the clinician. WebFCE uses the Box and Block test and the Moberg test in our FCE for standardized testing.