Comparative study of STEF (Simple

Test for Evaluating Hand Function)

and 3 other hand evaluation tools in hand

injured cases

Kent, Jui-Kun Chang, Chuan-Man Chu, Jyh-Jong Chang*OT, Reh Dept, Kaohsiung Chang Gung Memorial Hospital, Taiwan

*Dept of OT, Kaohsiung Medical University, Taiwan

Introduction

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9th Congress of APFSSH 5th APFSHT Congress

2012 Bali Indonesia

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Assessment of hand dexterity

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(Greenhalgh J, 1998)

→ to measure the functional improvements → to set up intervention plans and goals

Assessment of dexterity is important for patients with hand injury

(Jennifer Gallus, 2003)

Dexterity of hands is associated with the quality of using instruments in ADLs, work and leisure.

Assessment of hand dexterity

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(Rudman & Hannah, 1998)

While selecting an assessment tool:

DexterityFine (motor) Dexterity

Manual Dexterity

Assessment tools

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Fine Dexterity NHP、PPT

Manual Dexterity BBT、FDT、MRMT

Fine + Manual Dexterity

JTHTARATSTEF

Assessment tools

• Nine Hole Peg Test （NHP）• Fine Dexterity• 1 subtest

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Assessment tools

• Perdue Pegboard Test （PPT）• Fine Dexterity• 4 subtests

• R hand• L hand• Both hand• Assembly

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Assessment tools

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Fine Dexterity NHP、PPT

Manual Dexterity BBT、FDT、MRMT

Fine + Manual Dexterity

JTHTARATSTEF

Assessment tools

• Box and Block Test（BBT）• Manual Dexterity• a wooden box divided in two compartments by

a partition and 150 blocks.

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Assessment tools

• Functional Dexterity Test (FDT)• Manual Dexterity• 3-jaw chuck prehension between the fingers

and the thumb. • Test involves turning 16 pegs over as quickly as

possible in a sequential manner.

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Assessment tools

• Minnesota Rate of Manipulation Test (MRMT)• Manual Dexterity• 5 distinct subtests

• Placing• Turning• Displacing• one-hand turning and placing• two-hand turning and placing

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Assessment tools

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Fine Dexterity NHP、PPT

Manual Dexterity BBT、FDT、MRMT

Fine + Manual Dexterity

JTHTARATSTEF

Assessment tools

• Jebsen-Taylor Hand Function Test（JTHT）• Fine Dexterity, Manual Dexterity• 7 subtests

• Writing• Card turning• Small objects• Simulated feeding• Checkers• Large, light objects• Large, heavy objects

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Assessment tools

• Action Research Arm Test（ARAT）• Fine Dexterity, Manual Dexterity• 4 subtests

• Grasp (6 items)• Grip (4 items)• Pinch (6 items)• Gross movement (3 items)

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Assessment tools

• Simple Test for Evaluating Hand Function (STEF)• Fine Dexterity, Manual Dexterity• STEF was designed and developed by Kaneko et al.

in 1974 in Japan to objectively evaluate the speed of motion of each upper arm and hand.

• 10 subtests: • three kinds of spheres (big, moderate, small)• two kinds of disks (moderate, small)• rectangular box• two kinds of cubes (moderate, small) • inserting sticks into holes • turning over cloths

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STEF – 10 objects for grasp or pinch

STEF – transferring procedure

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Spearman’s ranking correlation coefficient r=.907

They used PPT and STEF to assess the non-affected hand of 27 elder stroke patients. The correlation between them is strong.

Maiko komine et al., 2012

• The STEF score strongly correlated with the ARAT, FMA (Fugl-Meyer Assessment), MAL(Motor Activity Log) scores and moderately with the FIM (Functional Independence Measure) score.

• This study indicates that the STEF is reliable, valid and sensitive to changes when applied to patients with sub-acute stroke.

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Purpose of this study

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Concurrent validity

Discriminant validity

Test-Retest reliability

Jebsen Test of Hand Function（JHFT）

Purdue Pegboard Test（PPT）

Action Research Arm Test（ARAT）

Methods

Participants

• Inclusive Criteria：• Hand injured patients• Aged 18-65• Getting injured within 10-30 weeks• Accept to receive 4 assessments and is willing to be

re-evaluated after 1 week

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Demographic characteristics of patients

33 participants in study

Age 18 y/o – 65 y/o mean 39.88±11.7

Gendermale 22

female 11

Injured handR 16

L 17

Injured area

finger 24

wrist (forearm) 6

elbow 2

shoulder (upper arm) 1

Major injury

fracture 19

tendon 8

amputee 5

nerve 123

Method

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Jebsen Test of Hand Function（JHFT）

Purdue Pegboard Test（PPT）

Action Research Arm Test（ARAT）

Test-Retest reliability

Concurrent validity Discriminant validity

Analysis

• Intra-class correlation coefficients(ICC) → to analyze test-retest reliability

• Pearson’s correlation coefficient→ to analyze concurrent validity

• Partial eta square (η2)→ to analyze discriminant validity

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Result

• Test-retest reliability

• Concurrent validity between assessment tools

• Correlation of classified types of distal hand functions between assessment tools

• Discriminant Validity between injured and non-injured hand

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Research results

1、Test-Retest reliability of STEF

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Subtest r ranged from .64 to .97

Test-retest reliability

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large-sized ballmiddle-sized balllarge boxmiddle-sized boxeswooden discsmall boxesturning clothssmall metal discsmall metal ballPinsTotal score

(upper bounds) (lower )

Research results

1、Test-Retest reliability of STEF

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Subtest r ranged from .64 to .97

Total score: r= .94

Strong test-retest reliability.

Research results

2、Concurrent validity of STEF and JTHT, PPT , ARAT

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Concurrent validity between assessment tools

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Research results

2、Concurrent validity of STEF and JTHT, PPT , ARAT

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STEF has strong correlation with all three tests.

JTHT (r = -.65, p= .000)PPT (r = .823, p= .000)ARAT (r = .912, p = .000 )

Research results

3、Concurrent validity of STEF and JTHT, PPT , ARAT

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Divided sub-tests into Grasp、Grip、Pinch、Turning

Classified by type of hand performance

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BoxesSpheres

Small metal discsSmall balls Pins

Cloth turning

Card turningSmall objectsSimulated feedingCheckers

Large light objectsLarge heavy objects

Pins

Research results

3、Concurrent validity of STEF and JTHT, PPT , ARAT

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Divided sub-tests into Grasp、Grip、Pinch、Turning

Reached moderate to strong correlation ( r =.57 to .82 )

Correlation in 4 types of hand performance

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Pinch performancePPT>ARAT>JTHT

Research results

4、Discriminant validity between STEF and JTHT, PPT , ARAT

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Cohen(1988) Partrial eta square

Small effect .01≤ η2 ≤.058Medium effect .058 ≤ η2 ≤.138Large effect .138 ≤ η2

Discriminant Validity

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eta square

Research results

4、Discriminant validity between STEF and JTHT, PPT , ARAT

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PPT (η2＝.516，p﹤.001) > STEF (η2＝.342，p﹤.001) > ARAT (η2＝.317,p﹤.001) > JTHT (η2＝.225，p=.001)

Discussion

Clinical values of the results

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STROKE

Hand injured patient

→ Good validity and reliability

→ Provide a new way for communications between professions.

Limitations and suggestions

• Limitations：• Not enough cases with different hand injuries• Lack of specific norm for Taiwanese

• In the future：• Establish a norm for Taiwanese • Increase the amounts of enrolled samples• Classify enrolled datas to more specific

components, such as injured severity/complexity

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Acknowledgement

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APFSHT presidentProf. Seiji Nishimura (Japan)