Jebsen Hand Function Test (JHFT)

Overview
A literature search was conducted to identify all relevant publications on the psychometric properties of the Jebsen Hand Function Test (JHFT). While studies have been conducted with other patient groups, this review specifically addresses the psychometric properties relevant to patients with stroke. At the time of publication five studies were identified: three relating to the JHFT, and one each for the JHFT (Portuguese version) and the Modified Jebsen Hand Function Test (MJT).
Floor/Ceiling Effects
No studies have examined the floor or ceiling effects of the JHFT.
Reliability

Internal consistency:
Ferreiro, dos Santos, & Conforto (2010) examined the internal consistency of the JHFT (Portuguese version) with a sample of 40 patients with stroke using Cronbach’s alpha, and reported excellent internal consistency(α=0.924). Internal consistency of individual items, reported using Pearson’s correlation coefficient and Cronbach’s alpha , was adequate to excellent (writing: r=0.812, α=0.844; card turning r=0.857, α=0.632; small common objects r=0.657, α=0.651; simulated feeding r=0.813, α=0.646; checkers r=0.712, α=0.633; large light objects r=0.849, α=-0.681; large heavy objects r=0.898, α=0.687).

Test-retest:
Jebsen et al. (1969) examined test-retest reliability of the JHFT in a sample of 26 patients with a range of upper limb conditions including hemiparesis from cerebral vascular disease (n=5), using Pearson’s correlation coefficient. Test-retest reliability of individual tasks was adequate to excellent (writing: r=0.67, 0.84; cards: r=0.91, 0.78; small objects: r=0.93, 0.85; simulated feeding: r=0.92, 0.60; checkers: r=0.99, 0.91; large light objects: r=0.89, 0.67; large heavy objects: r=0.89, 0.92, dominant and non-dominant hands respectively).

Bovend’Eerdt et al. (2004) examined the test-retest reliability of the Modified Jebsen Hand Function Test (MJT) in a sample of 26 individuals with neurological disorders including stroke (n=12), Multiple Sclerosis (n=7), head injury (n=4), and tumours (n=3). The mean time between retesting was 9.6 days. The study reported excellent test-retest reliability of the MJT (r = 0.95), using Pearson’s correlation coefficient.

Intra-rater:
Ferreiro, dos Santos, & Conforto (2010) examined intra-rater reliability of the JHFT (Portuguese version) with a sample of 40 patients with stroke and reported excellent intra-rater reliability (ICC=0.997), using intraclass correlation coefficient (ICC).

Inter-rater:
Ferreiro, dos Santos, & Conforto (2010) examined the inter-rater reliability of the JHFT (Portuguese version) with a sample of 40 patients with stroke using intraclass correlation coefficient (ICC), and reported excellent inter-rater reliability (ICC=1.0). Inter-rater reliability for individual items was also excellent (writing, ICC=0.999; card turning, ICC=0.977; small common objects, ICC=0.998; simulated feeding, ICC=0.991; checkers, ICC=0.995; large light objects, ICC=0.988; large heavy objects, ICC=0.991).

Validity

Content:
No studies have examined the content validity of the JHFT

Criterion:
Concurrent:
Beebe & Lang (2009) examined the concurrent validity of the JHFT with grip and pinch strength (measured by dynamometer), the Action Research Arm Test (ARAT) , Nine Hole Peg Test (NHPT), and the Stroke Impact Scale – Hand domain (SIS-Hand) in a sample of 33 patients with stroke, using Spearman’s correlation. Measures were administered at 1 month, 3 months and 6 months post-stroke. The JHFT demonstrated excellent correlations with grip strength (r=0.79-0.81), pinch strength (0.60-0.79), ARAT (r=0.87-0.95), NHPT (0.84-0.97) and SIS-Hand (0.61-0.83) at all time points.
Note: The study did not use the first task of the JHFT (writing a sentence) due to its dependence on hand dominance and education level.

Beebe & Lang (2007) examined concurrent validity of the JHFT with grip and pinch strength (measured by dynamometer), Action Research Arm Test (ARAT), 9-Hole Peg Test (NHPT), and Stroke Impact Scale – Hand Function Subscale (SIS-Hand) in a sample of 32 participants with stroke, using Pearson’s product moment correlation. The JHFT demonstrated excellent correlations with ARAT (r=-0.89), grip strength (r=-0.76), pinch strength (r=-0.68), 9-HPT (r=-0.89), and SIS-Hand Function (r=-0.82).
Note: The study did not use the first task of the JHFT (writing a sentence) due to its dependence on hand dominance and education level.

Bovend’Eerdt et al. (2004) examined the concurrent validity of the Modified Jebsen Hand Function Test (MJT) with the University of Maryland Arm Questionnaire for Stroke (UMAQS), Nine Hole Peg Test (NHPT), and grip strength (measured by dynamometer) in a sample of 26 individuals with neurological disorders including stroke (n=12), Multiple Sclerosis (n=7), head injury (n=4), and tumours (n=3). Measures were administered on two occasions (T1, T2) on average 9.6 days apart. The MJT showed excellent correlation with the NHPT (r=0.86 and 0.88 on T1 and T2 respectively) and adequate correlation with grip strength (r=0.44, significant on T2 only), using Pearson’s correlation coefficient. Correlations between the MJT and UMAQS were not significant at either time point.

Predictive:
No studies have examined the predictive validity of the JHFT.

Construct:
No studies have examined the construct validity of the JHFT.

Known Groups:

Ferreiro et al. (2010) reported no significant difference in scores on the JHFT (Portuguese version) according to education level or hand dominance in a sample of 40 patients with stroke.

Responsiveness

Beebe & Lang (2009) measured the responsiveness of the JHFT with a sample of 33 patients with stroke, using the single population effect size method. Measures were taken at 1, 3 and 6 months post-stroke, during which time participants received conventional stroke rehabilitation. The JHFT demonstrated moderate responsiveness from 1 to 3 months post-stroke (ES=0.69) and from 3 to 6 months post-stroke (ES=0.73).

Sensitivity & Specificity:
 No studies have examined the sensitivity and specificity of the JHFT.

References
  • Beebe, J.A. & Lang, C.E. (2007). Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis. Neurorehabilitation and Neural Repair, 21(3), 279 – 291.
  • Beebe, J.A. & Lang, C.E. (2009). Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke. Journal of Neurologic Physical Therapy, 33(2), 96-103.
  • Bovend’Erdt, T.J.H., Dawes, H., Johansen-Berg, H., & Wade, D.T. (2004). Evaluation of the Modified Jebsen Test of Hand Function and the University of Maryland Arm Questionnaire for Stroke. Clinical Rehabilitation, 18, 195-202
  • Celnik, P., Hummel, F., Harris-Love, M., Wolk, R., & Cohen, L. (2007). Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke. Archives of Physical Medicine and Rehabilitation, 88, 1369-76.
  • Cook, C., McCluskey, A., & Bowman, J. (2006). Jebsen Test of Hand Function. Penrith South, NSW: University of Western Sydney. Retrieved from http://www.maa.nsw.gov.au/default.aspx?MenuID=376
  • Duncan, P., Richards, L., Wallace, D., Stoker-Yates, J., Pohl, P., Luchies, C., Ogle, A., & Studenski, S. (1998). A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke, 1998(29), 2055-2060.
  • Ferreiro, K.N., dos Santos, R.L., & Conforto, A.B. (2010). Pyschometric properties of the Portuguese version of the Jebsen-Taylor test for adults with mild hemiparesis. Revista Brasileira de Fisioterapia (Brazilian Journal of Physiotherapy), 14(5), 377-81.
  • Jebsen, R.H., Taylor, N., Trieschmann, R.B., Trotter, M.J., & Howard, L.A. (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50(6), 311 – 319.
  • Hummel, F., Celnik, P., Giraux, P., Floel, A., Wu, W., Gerloff, C., & Cohen, L. (2005). Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain, 2005(128), 490-9.
  • Poole, J. (2003). Measures of Adult Hand Function: Arthritis Hand Function Test (AHFT), Grip Ability Test (GAT), Jebsen Test of Hand Function, and The Rheumatoid Hand Functional Disability Scale (The Duruöz Hand Index [DHI]). Arthritis and Rhematism (Arthritis Care and Research), 49(5S), S59-66.
  • Spinal Cord Injury Rehabilitation Evidence. (2010). Jebsen Hand Function Test. Retrieved from http://www.scireproject.com/outcome-measures/jebsen-hand-function-test
  • Wu, C., Seo, H., & Cohen, L. (2006). Influence of electric somatosensory stimulation on paretic-hand function in chronic stroke. Archives of Physical Medicine and Rehabilitation, 87, 351-7.