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Subject of the scale: Impairment: prehension

Keitel Functional Test (KFT)


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The KFT is a functional performance test for patients suffering from rheumatoid arthritis (RA). It is based on the completion of 24 items assessing joint range of motion and muscular activity. 3 groups: hands and wrists (9 items), shoulders (2 items) and lower limbs (13 items). [7].

15 items are assessed bilaterally (the other 9 notably assess walking or change of position) and an overall score is awarded to them. [5]

The scores for each of the items are different, varying from 0 to 2 up to 0 to 6.

The minimum score is 4 (normal), and the maximum score 100 (severe).

The total time to complete the test is 15 to 20 minutes. It does not require specific materials or specially trained staff.

The HFI (Hand Functional Index) only comprises the 9 items of the KFT concerning the hands and wrists. It is quicker to complete, less than one minute. The test is conducted bilaterally.

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Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity


Predictive validity


Construct validity

Convergent validity


Divergent validity


Discriminant validity
(sensitivity and distinctiveness)



Intra-rater reliability


Inter-rater reliability




Internal consistency (alpha)




General comment on reliability:

Good inter- and intra-rater reproducibility [2, 7]. Good concomitant validity [3]. Good correlations with the HAQ [7], the AIMS [4], the RAI and the DQ (Disability Questionnaire) [3]. No correlation between the DHI and the KFT [6] Poor sensitivity to change [7]. This scale is not recommended for supervision in clinical practice, or as evaluation criterion in studies or as predictor of functional change [7]. With regard to the HFI: this is a strong predictor of variance of the KFI in patients suffering from RA [3, 5]. It presents high correlations with the Modified Kapandji Index (MKI) [9] and with the DHI [8, 9] in diabetics or patients under haemodialysis, but moderate in patients suffering from RA [10].

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More information:

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr Thibaud HONORE :


Inaugural references:

[1] Keitel, W., H. Hoffmann, et al. (1971). "[Evaluation of the percentage of functional decrease of the joints using a motor function test in rheumatology]." Dtsch Gesundheitsw 26(40): 1901-1903.

Psychometric references:

[2] Eberl, D. R., V. Fasching, et al. (1976). "Repeatability and objectivity of various measurements in rheumatoid arthritis. A comparative study." Arthritis Rheum 19(6): 1278-1286.

[3] Kalla, A. A., T. J. Kotze, et al. (1988). "Clinical assessment of disease activity in rheumatoid arthritis: evaluation of a functional test." Ann Rheum Dis 47(9): 773-779.

[4] Hakala, M., P. Nieminen, et al. (1994). "Joint impairment is strongly correlated with disability measured by self-report questionnaires. Functional status assessment of individuals with rheumatoid arthritis in a population based series." J Rheumatol 21(1): 64-69.

[5] Kalla, A. A., P. R. Smith, et al. (1995). "Responsiveness of Keitel functional index compared with laboratory measures of disease activity in rheumatoid arthritis." Br J Rheumatol 34(2): 141-149.

[6] Poole, J. L., K. J. Cordova, et al. (2006). "Reliability and validity of a self-report of hand function in persons with rheumatoid arthritis." J Hand Ther 19(1): 12-16.

[7] Holm, B., S. Jacobsen, et al. (2008). "Keitel Functional Test for patients with rheumatoid arthritis: translation, reliability, validity, and responsiveness." Phys Ther 88(5): 664-678.

[8] Turan, Y., M. T. Duruoz, et al. (2009). "Validation of Duruoz Hand Index for diabetic hand dysfunction." J Investig Med 57(8): 887-891.

[9] Lefevre-Colau, M. M., S. Poiraudeau, et al. (2003). "Reliability, validity, and responsiveness of the modified Kapandji index for assessment of functional mobility of the rheumatoid hand." Arch Phys Med Rehabil 84(7): 1032-1038.

[10] Duruoz, M. T., S. Poiraudeau, et al. (1996). "Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap." J Rheumatol 23(7): 1167-1172.

[11] Duruoz, M. T., L. Cerrahoglu, et al. (2003). "Hand function assessment in patients receiving haemodialysis." Swiss Med Wkly 133(31-32): 433-438.

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