Finding a clinical assessment scale - Physical Medicine and Rehabilitation

< Back

Subject of the scale: Spinal cord injury

Capabilities of Upper Extremity Questionnaire (CUE)


Download / Print :    PDF



The CUE-Q questionnaire (not to be confused with the CUE-T based on task observation [4]) was published in 1998. It was created specifically to evaluate the motor capacities of the upper limbs of tetraplegic adults, independently of any environmental interaction [1]. It covers 5 sections: 1) reaching or lifting an object, s) pulling or pushing an object, 3) tasks using the wrist, 4) using the hands and the fingers, 5) two-handed tasks.

The first 15 items are dedicated to sections 1 to 4 and are scored for each of the two upper limbs, which corresponds to an assessment of 30 items. The last 2 items are dedicated to section 5 and are each scored once only.

Through each of the 32 items, on the basis of a direct or telephone interview, the scale records the difficulties in carrying out certain acts with both hands or with only one hand, and they are quantified with an ordinal score:
. Either a seven-point scale in the initial version 1.1 [1] (7: not at all limited, 6: a little limited, 5: somewhat limited, 4: moderately limited, 3: very limited, 2: extremely limited, 1: totally limited, cannot do anything).
This results in a total score A for the upper right limb, in a total score B for the upper left limb, and in a total score C for two-handed tasks.
The total score A+B+C is a minimum of 32 and a maximum of 224. The higher the score, the greater the level of motor capabilities of the upper limbs.
. Or a five-point scale in the revised version 2.1 [2] (4: No difficulty, 3: Mild difficulty, 2: Moderate difficulty, 1: Severe difficulty, 0: Unable/Complete difficulty).
The total score A+B+C is a minimum of 0 and a maximum of 128. The higher the score, the greater the level of motor capabilities of the upper limbs.

The two versions (initial 1.1 and revised 2.1) only differ by the rating scale.

The time spent completing the questionnaire is estimated at around 30 to 45 minutes.

No prior learning of the method of completing it is necessary.

While it is described that no dedicated material is necessary, in reality the material must be preconfigured.

The version provided has been translated into French, but has not been validated in this language.

This questionnaire may be used for the initial evaluation of the patient, and also to monitor the patient's progress over time.

> Access to the scale is free

Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity


Predictive validity


Construct validity

Convergent validity

[1] [3]

Divergent validity


Discriminant validity
(sensitivity and distinctiveness)



Intra-rater reliability


Inter-rater reliability




Internal consistency (alpha)



[1] [2]

General comment on reliability:

The metrological qualities of the CUE-Q questionnaire were originally studied over a population of 154 tetraplegic people, adult (average age 36.7), ASIA A, B, C or D, whose length of injury was always over 1 year and on average 8.1 years, and deemed representative for neurological levels < C4 [1]. This scale showed:
1) an excellent overall test-retest reproducibility (intraclass correlation coefficient = 0.94) [1] that is more nuanced depending on whether the patient was assessed upon admission
2) a good item by item reproducibility (weighted kappa coefficient >0.60, save for the 3 items with a ICC between 0.55 and 0.58) [1]
3) a margin of error (standard error of measurement SEM) of 12.2 with a confidence interval at 95% of 23.9 [1]
4) an excellent internal consistency (Cronbach's alpha = 0.96) [1]
5) an internal item by item consistency (item score/overall score correlation varying between 0.49 and 0.78 [1]
6) a construct validity of a very high level
- excellent correlation (all ASIA profiles combined and ASIA A and B profiles) with the FIM (Functional Independence Measure): Spearman respectively of 0.798 and 0.822 [1]
- excellent correlation (all ASIA profiles combined and ASIA A and B profiles) with the ASIA motor score: Spearman respectively of 0.798 and 0.815 [1]
- excellent correlation with the GRASSP (sensibility sub-score / strength sub-score / prehension sub-score): Spearman respectively of 0.77, 0.76 and 0.83 [3]
- good correlation (ASIA C and D profiles) with the FIM: Spearman of 0.719 [1]
- good correlation (ASIA C and D profiles) with the ASIA motor score: Spearman of 0.650 [1]
7) a predictive validity of the FIM score better than for the motor score [1]
8) an accurate discriminating validity making it possible to observe an increase in the CUE-Q score with the neurological level and to discriminate groups of patient differing by at least two neurological levels [1]
9) an analysis of variance [1]
- The CUE explains 54% of the variance of the FIM (all profiles combined).
- The CUE explains 57% of the variance of the FIM (ASIA A and B profiles)
- The CUE explains 45% of the variance of the FIM (ASIA C and D profiles)
10) a factor analysis which made it possible to isolate four dimensions: two-handed function, one-handed right function, one-handed left function, access to objects sited low [1].
No ceiling effect was observed [1]. A slight floor effect was only observed for one item (manipulation of a small object with the left hand) [1]. Lastly, the sensitivity to change conveyed by an effect size estimated at 0.73 was valued with the revised version whose items, as a reminder, were scored with a 5-point ordinal scale [2]. The effect size rose from 0.73 to 0.92 [2], without however changing the level of correlations found in the original version with the FIM and the ASIA motor score. With a 5-point scoring scale, completion was generally facilitated.

Reference update:

To notify us of a missing reference, please use:

Related scales:

Related scales available soon

More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Charles FATTAL :

. . . . . . . . . . . . . . . . .     Copyright © 2012 Cytisco - Web Agency. All rights reserved     . . . . . . . . . . . . . . . . .