Box and Block Test (BBT)


Box and Block Test (BBT) Evaluation Summary

  What does the tool measure? Unilateral gross manual dexterity.
  What types of clients can the tool be used for? The BBT can be used with, but is not limited to clients with stroke.
  Is this a screening or assessment tool? Assessment
Time to administer From 2 to 5 minutes.
  Versions There are no alternative versions.
Other Languages There are no official translations.
Measurement Properties
  Reliability – No studies have examined the internal consistency of the BBT.
– Two studies have examined the test-retest reliability of the BBT. Both reported excellent test-retest reliability using ICC’s.
– Two studies have examined the inter-rater reliability of the BBT and reported excellent inter-rater reliability using correlation coefficients and ICC.
– One study used Pearson correlation and the other, ICC and Spearman rho correlation.

Predictive Validity:
One study has examined predictive validity and reported that the BBT, compared to the Nine-Hole Peg Test (NHPT), the Frenchay Arm Test, Grip Strength and the Stroke Rehabilitation Assessment of Movement (STREAM) was the best predictor of upper limb function 5 weeks post-stroke.

One study has examined the concurrent validity of the BBT and reported adequate to excellent correlations with the Action Research Arm Test (ARAT) and the NHPT at pre and post-treatment.

Convergent validity:
Three studies have examined convergent validity of the BBT and reported excellent correlations between the BBT and the Minnesota Rate of Manipulation Test, the ARAT, the Hemispheric Stroke Scale and the motor function score of the Fugl-Meyer Assessment (FMA). Adequate correlations were reported between the BBT and the SMAF, the Ashworth scale and the Passive Joint Motion/Joint Pain subscore of the FMA. Poor correlations were reported between the BBT and the Sensation subscore of the FMA and the Modified Barthel Index.

  Floor/Ceiling Effects No studies have examined floor/ceiling effects of the BBT
  Sensitivity/ Specificity No studies have examined sensitivity/specificity of the BBT
  Does the tool detect change in patients? Two studies have examined the responsiveness of the BBT and reported that the BBT has moderate to large Standardized Response Mean, therefore, is able to detect change in clients with stroke.
  Acceptability The BBT should not be used clients with severe upper extremity impairment and severe cognitive impairments.
Feasibility The administration of the BBT is quick and simple, however requires standardized equipment.
How to obtain the tool? The BBT instructions can be obtained in the study by Mathiowetz et al. (1985)

Standardized equipment can be obtained at the website: