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Subject of the scale: Impairment: prehension

Wolf Motor Function Test (WMFT)

 

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Comment:

Initially developed by Wolf in 1987 [1], it was later modified by Taub [9]. The WMFT quantifies the ability to move the upper limb by simple or multi-joint movements and timed functional tasks in patients in post-stroke chronic phase [7, 11] or sub-acute [12] phase.

It is frequently used to assess motor recovery of the upper member of a brain-injured patient.

Tasks are listed in order of complexity, progressing from the participation of proximal joints to the more distal, and testing overall movements and speed of movement.

This assessment requires few tools and minimal training to run the test [11] and thus avoid ambiguity in how each performance can be scored [8].

All tasks are performed on the same side as quickly as possible and are limited to 120 seconds.

There are 15 tasks and 2 trials of strength.

There are 2 different scores: the WMFT -Time (time required to complete the tasks) and WMFT -FAS (functional Ability Scale, where a score of 6 points is used to assess the functional capacity of each task: 0 indicating that the patient cannot attempt the task, and 5 where the movement seems normal) [5].

It takes a period of 30 to 45 minutes to complete the entire test [2].

There is no difference between the use of video and direct observation by evaluators [10].

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Psychometric properties:

Criteria

Psychometric properties

References

Validity

Face validity

 

Content validity

 

Criterion validity

Concurrent validity

[2] [3] [6] [8] [10] [11] [12]

Predictive validity

[2] [5] [6]

Construct validity

Convergent validity

[3] [5] [11]

Divergent validity

[3] [5] [11]

Discriminant validity
(sensitivity and distinctiveness)

[3] [5] [11]

Reliability

Intra-rater reliability

[4] [8]

Inter-rater reliability

[2] [4] [5] [6] [7] [8] [11]

Test-retest

[5] [6] [7] [10]

Internal consistency (alpha)

[2] [3] [7] [8] [11]

Responsiveness

[3] [5] [6]

General comment on reliability:

The WMFT is a highly reliable tool [2, 7] (ICC between 0.96 and 0.98) [4]. Internal consistency [2, 7, 8, 11] and inter and intra-judge reproducibility [2, 6, 8, 11] is high. However, according to Nijland [8], the inter-judge reproducibility is worse than intra judge reproducibility, hence the need to train observers for better standardisation of the test.
Post acute stroke, WMFT has an acceptable internal coherence, validity and sensitivity to change. However, compared to the ARAT, the burden of training and testing is not compensated by the much higher psychometric advantages [3].
If we look at the different components of the test: moderate predictive validity for the WMFT Time (compared to the FIM score) and good built validity. For the WMFT FAS, average built validity and low predictive validity. Sensitivity to change is better for the WMFT-FAS than TIME [5]. For WMFT -Time, MDC is 0.7 seconds. For the WMFT -FAS, the MDC is 0.1 percentage point [4].
Concurrent validity is raised using as criterion against the FMA [2, 6, 11] or ARAT [8]. Satisfactory predictive validity [6].
Sensitivity to change is moderate [6]
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by a measure which corresponds to a significant change) is satisfactory for the ARAT and FMA, hence the usefulness of the 2 tests in a clinical setting with respect to the WMFT [6].

Reference update:

To notify us of a missing reference, please use: contact@scale-library.com

More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Thibaud Honoré : honore.thibaud@gmail.com

References:

Inaugural references:

[1] Wolf SL, Lecraw DE, Barton LA, Jann BB. "Forced use in hemiplegic upper extremities to reserve the effect of learned nonuse among chronic stroke and headinjured patients". Exp Neurol. 1989 May;104(2):125-32.

Psychometric references:

[2] Bürge E, Kupper D, Badan Bâ M, Leemann B, Berchtold A. "Qualities of a French version of the Wolf Motor Function Test: a multicenter study." nn Phys Rehabil Med. 2013 May;56(4):288-99. doi: 10.1016/j.rehab.2013.03.003. Epub 2013 Mar 28.

[3] Edwards DF, Lang CE, Wagner JM, Birkenmeier R, Dromerick AW. "An evaluation of the Wolf Motor Function Test in motor trials early after stroke." Arch Phys Med Rehabil. 2012 Apr;93(4):660-8. doi: 10.1016/j.apmr.2011.10.005. Epub 2012 Feb 13.

[4] Fritz SL, Blanton S, Uswatte G, Taub E, Wolf SL. "Minimal detectable change scores for the Wolf Motor Function Test." Neurorehabil Neural Repair. 2009 Sep;23(7):662-7. doi: 10.1177/1545968309335975. Epub 2009 Jun 4.

[5] Hsieh YW, Wu CY, Lin KC, Chang YF, Chen CL, Liu JS. "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke. 2009 Apr;40(4):1386-91. doi: 10.1161/STROKEAHA.108.530584. Epub 2009 Feb 19.

[6] Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, Hsieh CL. "Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke." Phys Ther. 2009 Aug;89(8):840-50. doi: 10.2522/ptj.20080285. Epub 2009 Jun 25.

[7] Morris DM, Uswatte G, Crago JE, Cook EW 3rd, Taub E. "The reliability of the wolf motor function test for assessing upper extremity function after stroke." Arch Phys Med Rehabil. 2001 Jun;82(6):750-5.

[8] Nijland R, van Wegen E, Verbunt J, van Wijk R, van Kordelaar J, Kwakkel G. "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. 2010 Jul;42(7):694-6. doi: 10.2340/16501977-0560.

[9] Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, Connell JS, Crago JE. "Technique to improve chronic motor deficit after stroke". Arch Phys Med Rehabil. 1993 Apr;74(4):347-54.

[10] Whitall J, Savin DN Jr, Harris-Love M, Waller SM. "Psychometric properties of a modified Wolf Motor Function test for people with mild and moderate upper-extremity hemiparesis." Arch Phys Med Rehabil. 2006 May;87(5):656-60.

[11] Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. "Assessing Wolf motor function test as outcome measure for research in patients after stroke." Stroke. 2001 Jul;32(7):1635-9.

[12] Wolf SL, Thompson PA, Morris DM, Rose DK, Winstein CJ, Taub E, Giuliani C, Pearson SL. "The EXCITE trial: attributes of the Wolf Motor Function Test in patients with subacute stroke." Neurorehabil Neural Repair. 2005 Sep;19(3):194-205.

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Subject of the scale: Impairment: prehension

Box and Blocks Test (BBT)

 

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Description:

The BBT was created originally for adult patients with cerebral palsy, to be a measure of gross dexterity. This test was then validated in patients within the framework of a stroke, a CT, MS and other neurological disorders [5], such as Charcot Marie Tooth disease [14], and also in the elderly [7].

It has recently been evaluated in fibromyalgia [2].

This test was patented in 1957 by Patricia Buehler Holser and Elizabeth Fuchs.

It goes like this: The patient is seated at a table in front of him with a wooden box with 2 compartments of equal size (25 x 15 x 7.5 cm). At the beginning of the test, all coloured wooden cubes (150 in number, 2.5 cm edge) are placed in a compartment. The aim is to move the most cubes possible, cube after cube, from one compartment to another, in 60 seconds, and with one hand.
The examiner is opposite the patient.

The total score is the number of cubes located in the initially empty compartment. [1].

Norms in healthy [9] and healthy adult children were defined. And for adults under 50, the average score is higher than 80, between 50 and 70 years it is between 70 and 80, and for patients older than 70 years it is between 64 and 69 [1].

The total time for performing the test is less than 5 minutes. A complete kit costs about 250-300 Euros.

> Access to the scale is free

Psychometric properties:

Criteria

Psychometric properties

References

Validity

Face validity

 

Content validity

 

Criterion validity

Concurrent validity

[3] [6] [8]

Predictive validity

 

Construct validity

Convergent validity

[7] [10]

Divergent validity

[7] [10]

Discriminant validity
(sensitivity and distinctiveness)

[7] [10]

Reliability

Intra-rater reliability

[3]

Inter-rater reliability

[4] [9] [10]

Test-retest

[6] [7] [9] [10] [12]

Internal consistency (alpha)

 

Responsiveness

[3] [8]

General comment on reliability:

Very good inter-judge reproducibility [10] and high test-retest reliability [4, 7, 10, 12].
The BBT has a sensitivity to change ranging from high [3] to moderate [8] as well as excellent concurrent validity with the ARAT.
It can effectively evaluate the function of paretic MS [3].
The ARAT also seems more appropriate for evaluating dexterity than the Nine Hole Peg Test [8].
The significant correlations between the BBT, upper limb performance and functional independence measurements show the validity of BBT [7].
Also strong correlations with ARAT and FMA but different ceiling and floor effects between these 3 tests [10].
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by measuring and representing a significant change) is quite high: for the most affected side, 5.5 cubes / min and the least affected side 7.8 cubes/min [4].
A literature review was performed [5] to examine the psychometric properties and clinical utility of various assessment tools of the upper limbs in people with motor disabilities of neurological origin in order to provide recommendations for practice. Of a total of 31 tools identified, only two measures meet the psychometric properties and clinical utility criteria: the BBT and ARAT.
Among fibromyalgia patients, the BBT is a reliable measurement of upper extremity function and is able to reveal a reduction of upper limb function in these patients compared to healthy individuals and standard scores [2].

Reference update:

To notify us of a missing reference, please use: contact@scale-library.com

More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Thibaud Honoré : honore.thibaud@gmail.com

References:

Inaugural references:

[1] Mathiowetz V, Volland G, Kashman N, Weber K. "Adult norms for the Box and Block Test of manual dexterity." Am J Occup Ther. 1985 Jun;39(6):386-91.

Psychometric references:

[2] Canny ML, Thompson JM, Wheeler MJ. "Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia." Am J Occup Ther. 2009 Jul-Aug;63(4):506-10.

[3] Chanubol R, Wongphaet P, Ot NC, Chira-Adisai W, Kuptniratsaikul P, Jitpraphai C. "Correlation between the action research arm test and the box and block test of upper extremity function in stroke patients." J Med Assoc Thai. 2012 Apr;95(4):590-7.

[4] Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL.. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair. 2009 Jun;23(5):435-40. doi: 10.1177/1545968308331146. Epub 2009 Mar 4.

[5] Connell LA, Tyson SF. "Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review." Arch Phys Med Rehabil. 2012 Feb;93(2):221-8. doi: 10.1016/j.apmr.2011.09.015.

[6] Cromwell FS. "Occupational Therapist's Manual for Basic Skill Assessment; Primary Prevocational Evaluation". Altadena, CA: Fair Oaks Printing, 1976, pp 29-30c.

[7] Desrosiers J, Bravo G, Hébert R, Dutil E, Mercier L. "Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies." rch Phys Med Rehabil. 1994 Jul;75(7):751-5.

[8] Lin KC, Chuang LL, Wu CY, Hsieh YW, Chang WY. "Responsiveness and validity of three dexterous function measures in stroke rehabilitation." J Rehabil Res Dev. 2010;47(6):563-71.

[9] Paltamaa J, West H, Sarasoja T, Wikström J, Mälkiä E. "Reliability of physical functioning measures in ambulatory subjects with MS." Physiother Res Int. 2005;10(2):93-109.

[10] Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. "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." Clin Rehabil. 2005 Jun;19(4):404-11.

[11] Smith DA. "The Box and Block Test: Normative Datafor 7, 8, 9 Year-Old Children (master's thesis)". Los Angeles: Univ of Southern California, 1961.

[12] Svensson E, Häger-Ross C. "Hand function in Charcot Marie Tooth: test retest reliability of some measurements." Clin Rehabil. 2006 Oct;20(10):896-908.

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