ABILHAND

Purpose of the measure
The ABILHAND is an interview-based assessment tool that measures a patient’s perceived difficulty using his/her hands to perform manual activities in daily life. The ABILHAND assesses active function of the upper limbs. The tool measures an individual’s ability to perform bimanual tasks, regardless of strategies used to complete the task (Ashford et al., 2008; Penta et al., 1998).
Available versions
The ABILHAND was originally developed by Penta et al. (1998) as a 56-item, 4-level questionnaire of unimanual and bimanual ability for patients with rheumatoid arthritis. The original ABILHAND was intended to measure rehabilitation outcomes and to provide guidelines for goal setting in treatment planning (Gustafsson et al., 2004). Penta et al. (2001) found that patients with stroke were able to complete unimanual activities with the unaffected limb, regardless of hand dominance, whereas bimanual tasks were more difficult. Accordingly, a version was developed specifically for patients with stroke that only included bimanual items, as well as two alternate unimanual’ activities that require skillful use of the affected hand (cutting nails, filing nails). Penta et al. (2001) also reviewed the 4-level scoring criterion (impossible, very difficult, difficult, easy) and found that patients rarely used the very difficult’ score. This indicated that the two intermediate scoring criteria (very difficult, difficult) were not sufficiently differentially distinct. Accordingly, the stroke version of the ABILHAND was developed with a 3-level scoring criterion (impossible, any difficulty, easy).

Other impairment-specific versions were subsequently created with modified item sets and levels. Each version of the ABILHAND has its own Rasch-derived item difficulty calibrations that rely on computerized algorithms to obtain the patient’s overall measure from his/her responses (Simone et al., 2011).

Features of the measure
Items
The ABILHAND is an inventory of 23 bimanual activities (from most difficulty to least difficult):

  1. Hammering a nail
  2. Threading a needle
  3. Peeling potatoes with a knife
  4. Cutting own nails
  5. Wrapping up gifts
  6. Filing own nails
  7. Cutting meat
  8. Peeling onions
  9. Shelling hazel nuts
  10. Opening a screw-topped jar
  11. Fastening zipper of jacket
  12. Tearing open pack of chips
  13. Buttoning up a shirt
  14. Sharpening a pencil
  15. Spreading butter on a slice of bread
  16. Fastening a snap
  17. Buttoning up trousers
  18. Taking the cap off a bottle
  19. Opening mail
  20. Squeezing toothpaste on a toothbrush
  21. Pulling up the zipper of trousers
  22. Unwrapping a chocolate bar
  23. Washing hands

Scoring
The patient is asked to rate his/her perceived difficulty performing items without help, according to the following scoring criteria:

0 = impossible
1 = difficult
2 = easy

Tasks that the patient has not performed in the past 3 months are not scored and are encoded as missing responses.

The ABILHAND was developed using the Rasch measurement model, which provides a method to convert the ordinal raw score into a linear measure on a unidimensional scale. Item scores are entered into the WINSTEPS computer program, and raw ordinal data is converted to linear measures expressed in logits (log-odds probability units). The total score is scaled along a unidimensional continuum with 0 at the centre of the scale, whereby the higher the logit number, the greater the patient’s perceived ability (Gustafsson et al., 2004).

What to consider before beginning
Users should note that self-estimated measures (i.e. when scores are not based on clinician observation of performance) are subject to overestimation or underestimation of actual performance, depending on motivation and cognitive skills (Penta et al. 2001).

Clinicians should consider patient factors such as self-esteem, insight, vision, hearing, language and cognitive function prior to administering the ABILHAND (Gustafsson et al., 2004).

Mpofu & Oakland (2010) advise caution when using the ABILHAND to measure improvements in impairment of the affected upper limb after stroke rehabilitation. The ABILHAND does not take into consideration the arm used to perform a task or compensatory strategies employed to complete the task. Accordingly, improvement in scores may be based on use of compensatory strategies rather than on improvement in the affected arm.

Time
The ABILHAND takes 10 to 30 minutes to administer (Ashford et al., 2008; Connell et al., 2012).

Training requirements
No training requirements have been specified for the ABILHAND, although administration by a clinician is recommended (Ashford et al., 2008).

Equipment
The ABILHAND is a semi-structured questionnaire that does not require specific equipment, however the WINSTEPS computer program is required to process raw scores.

Client suitability
Can be used with:

  • Individuals with chronic stroke
  • Individuals with rheumatoid arthritis
  • Individuals with systemic sclerosis

Should not be used with:

  • Due to the subjective nature of the patient’s reports, this measure should not be used with individuals with severe cognitive deficits (Penta et al., 2001).
  • The ABILHAND may not be suitable for use with patients with aphasia or apraxia (Gustafsson et al., 2004).
In what languages is the measure available?
  • French
  • English
  • Dutch
  • Italian
  • Swedish