ABILHAND

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the ABILHAND. While additional studies have been conducted on other ABILHAND versions, this review specifically addresses the psychometric properties of the 23-item stroke version of the ABILHAND, unless otherwise specified. Two studies were identified.

Floor/Ceiling Effects

No studies have reported on the floor or ceiling effects of the ABILHAND. However, given the hierarchical relationship of items, lower-level tasks of the ABILHAND may be susceptible to floor effects (Ashford et al., 2008).

Reliability

Internal consistency:
Penta et al. (2001) examined the internal consistency of the original 56-item ABILHAND in a sample of 103 patients with chronic stroke using Rasch analysis and reported high reliability (Rasch separation reliability=0.90; person separation reliability=0.90). The authors examined the stability of the scale through differential item functioning (DIF) tests among 12 subgroups: sex (male/female); country (Belgium/Italy); age (< 60/≥ 60), affected side (dominant/nondominant); delay since stroke (< 2 years/≥ 2 years), level of depression, dexterity and manual ability of the unaffected limb, grip strength, dexterity and sensitivity of the affected limb, and motricity of the affected limb. The difficulty hierarchy of the ABILHAND was uniformly perceived by patients with chronic stroke.

Simone et al. (2011) examined the internal consistency of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from stroke (n=83), multiple sclerosis (n=17), peripheral or cerebellar ataxia (n=13), spinal cord lesion (n=10) or Parkinson’s disease (n=3), and 24 health subjects. The ABILHAND demonstrated high reliability (item reliability index=0.94; Cronbach’s alpha=0.99). All items of the ABILHAND fit the Rasch model satisfactorily. There were at least 4 strata of statistically different measures, indicating that variance across scores did not reflect randomness. The authors also examined stability of item difficulty through differential item functioning (DIF) by comparing 4 different groupings of the sample pool: impairment (hemiparesis vs. other); age (≤ 69 vs. > 69); sex (male vs. female); and ability (above median vs. below median). There was a very moderate DIF across the grouping criteria, whereby item hierarchy was substantially retained for all subgroups: impairment (1 outlier: buttoning a shirt); sex (6 outliers: fastening a snap, shelling hazel nuts, hammering a nail, wrapping up gifts, peeling potatoes, spreading butter); age (4 outliers: threading a needle, wrapping up gifts, spreading butter, fastening a snap); and ability (2 outliers: sharpening a pencil, cutting meat).

Inter-rater:
No studies have reported on the inter-rater reliability of the ABILHAND. Note, however that inter-rater reliability is less necessary because administration of the ABILHAND does not rely on clinician-observation of patient performance.

Intra-rater:
No studies have reported on the intra-rater reliability of the ABILHAND.

Test-retest:
No studies have reported on the test-retest reliability of the ABILHAND.

Validity

Content

Penta et al. (2001) examined the measure of perceived difficulty of the ABILHAND in a sample of 103 patients with chronic stroke. Item distribution ranged from 1.72 to -2.18 logits. All items fit the Rasch model and the 23 items define a common continuum of manual ability. All point measure correlation coefficients (RPM) were positive, indicating that all items are coherent with the overall questionnaire and contribute to the measurement of manual ability. Although fit statistics indicated that most activities adequately measure recovery of manual ability in chronic stroke, 1 item obtained an outlier outfit value (buttoning up a shirt, mean square=1.64), and four items obtained outlier infit values (cutting meat, mnsq=0.69; shelling hazel nuts, mnsq=1.33; tearing open a packet of chips, mnsq=1.22; sharpening a pencil, mnsq=0.65).

Penta et al. (2001) examined the content validity of the ABILHAND by comparing the ranking of item difficulty with expert opinion of four occupational therapists regarding the involvement of the affected hand in each activity. The following classifications were used: (1) the item does not require the affected limb, if it is broken down into several unimanual sequences; (2) the task requires the affected upper limb to stabilize an object but does not involve any fingers; and (3) the task requires precision grip, grip strength, dexterity or any digital activity from the affected side. Findings indicate that more difficult items also tend to require a greater degree of use of the affected limb, whereas easier items do not require the use of the affected limb.

Simone et al. (2011) examined the validity of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from stroke (n=83), multiple sclerosis (n=17), peripheral or cerebellar ataxia (n=13), spinal cord lesion (n=10) or Parkinson’s disease (n=3), and 24 health subjects. Modeled scores explained 84% of observed variance. The main factor across the residuals explained only 11.4% of the residual variance (1.8% of the total variance).

Criterion

Predictive:
No studies have reported on the predictive validity of the ABILHAND.

Concurrent:
Simone et al. (2011) compared the concurrent validity of the ABILHAND, Jamar handgrip, Box and Block Test (BBT), Purdue pegboard test and Nine Hole Peg Test (NHPT) in a sample of 126 patients with chronic upper limb impairment resulting from stroke, multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease, and 24 healthy subjects, using Pearson’s r. Adequate correlations were found between the ABILHAND and the Jamar handgrip (r=0.377, p=0.001), BBT (r=0.481, p=0.000) and the Purdue pegboard test (r=0.493, p=0.000), and an adequate negative correlation was found between the ABILHAND and the NHPT (r=-0.370, r=0.007).

Construct

Known Group Validity:
Penta et al. (2001) examined the relationship of the ABILHAND measures to other demographic and clinical variables in a sample of 103 patients with chronic stroke, using univariate ANOVA and correlation coefficients (Mann-Whitney U test, Kruskal-Wallis H tests, Spearman p, Pearson r). Tests revealed no significant differences in ABILHAND measures according to demographic indexes of country (Belgium/Italy), sex or age. Clinical variables such as time since stroke, affected side (dominant/nondominant), lesion site and tactile sensitivity of either limb (measured using the Semmes-Weinstein tactile sensation test) were not significantly related to ABILHAND measures. There was a poor correlation between ABILHAND measures and grip strength (Jamar handgrip, R=0.242, P<0.014) and manual dexterity (Box and Block Test, R=0.248, P=0.012) of the unaffected limb, and a poor negative correlation with depression (Geriatric Depression Scale, p=-0.213, P=0.030). ABILHAND measures demonstrated an adequate correlation with grip strength (R=0.562, P<0.001) and manual dexterity (R=0.598, P<0.001) of the affected limb, and an excellent correlation with upper limb motricity (Brunnstrom upper limb motricity test, p=0.730, P<0.001). Results showed a direct relationship between ABILHAND measures of manual ability and impairment on the affected side, where more complex combinations of manual dexterity without/without grip strength and/or upper limb motricity impairment correlated with higher manual disability.

Simone et al. (2011) examined the known-group validity of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from stroke, multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease, and 24 healthy subjects, using Kruskal-Wallis test. Highly significant differences (P<0.001) were found between patients with tetraparesis, hemiparesis, other neurological impairments (multiple sclerosis, Parkinson’s disease, ataxia) and control participants.

Convergent/Discriminant Validity:
No studies have reported on the convergent/discriminant validity of the ABILHAND.

Responsiveness

Simone et al. (2011) reported a satisfactory match between the distribution of item difficulty levels and patients’ ability levels. The average ability of healthy controls vs. patients with chronic upper limb impairment resulting from stroke, multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease was 89 (standard error=8) vs. 63 (standard error=17).

Sensitivity & Specificity:
Simone et al. (2011) examined the sensitivity and specificity of the ABILHAND in a sample of 126 patients with chronic upper limb impairment resulting from stroke, multiple sclerosis, sensory or cerebellar ataxia, spinal cord lesion or Parkinson’s disease, and 24 healthy subjects. An “impairment-normality” cut-off was computed through logistic regression and a lower cut-off score of 80/100 is proposed for healthy controls (area under ROC curve=0.9097, p<0.05). This allowed correct classification of patients vs. healthy controls with a 92% sensitivity rate and 80% specificity rate, whereby 82% of the sample was correctly classified.

References
  • Ashford, S., Slade, M., Malaprade, F., & Turner-Stokes, L. (2008). Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review. Journal of Rehabilitation Medicine, 40, 787-95.
  • Connell, L.A. & Tyson, S.F. (2012). Clinical reality of measuring upper-limb ability in neurological conditions: a systematic review. Archives of Physical Medicine and Rehabilitation, 93, 221-8.
  • Gustafsson, S., Sunnerhagen, K.S, & Dahlin-Ivanoff, D. (2004). Occupational therapists’ and patients’ perceptions of ABILHAND, a new assessment tool for measuring manual ability. Scandinavian Journal of Occupational Therapy, 11, 107-17.
  • Mpofu, E. & Oakland, T. (2010). Rehabilitation and Health Assessment: Applying ICF Guidelines. New York: Springer Publishing Company.
  • Penta, M., Tesio, L., Arnould, C., Zancan, A., & Thonnard, J-L. (2001). The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment. Stroke, 32, 1627-34.
  • Simone, A., Rota, V., Tesio, L., & Perucca, L. (2011). Generic ABILHAND questionnaire can measure manual ability across a variety of motor impairments. International Journal of Rehabilitation and Research, 34, 131-40.