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Arthritis Hand Function Test

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Purpose

Arthritis Hand Function Test (AHFT) is an 11-item test to measure pure and applied strength and dexterity while performing activities associated with self-care, work and leisure in persons with arthritis.

Acronym AHFT

Area of Assessment

Activities of Daily Living
Functional Mobility
Dexterity

Cost

Not Free

Actual Cost

$25.00

Cost Description

Manual: $25.00. Cost of equipment: Pinch gauge $188.00. Peg hole test $23.00. Adaptive sphygmomanometer undetermined. General equipment and supplies for functional task averages $200.00. Total cost for all items combined approximately $500.00.

Populations

Rheumatic Disease
Osteoarthritis
Non-Specific Patient Population
Arthritis

Key Descriptions

  • 11-item performance-based test with 4 subscales performed bilaterally.
  • Grip and pinch strength section (3 items) with mean score of three trials each:
    1. gross grip strength in mm Hg,
    2. tip pinch with the thumb and index in kg,
    3. three-point pinch strength with thumb, index and middle finger in kg
  • Dexterity (1 item) – 9-hole peg test timed for place and removal in a 9-hole pegboard; performed 1 time with each hand.
  • Applied dexterity (5 items) measured in time to complete:
    1. Fasten and unfasten four buttons;
    2. Lace a shoe and tie a bow;
    3. Pin and unpin two safety pins in a cloth;
    4. Pick up and manipulate four coins into a slot;
    5. Cut a piece of putty with a knife and fork into four pieces.
  • Applied strength (2 items) measured in number of cans or volume of water lifted:
    1. Lifting a tray filled with six tin cans of soup. Cans are added or subtracted depending on the patients’ lifting ability
    2. Lifting one liter of water. Water is added or subtracted depending on the patients’ lifting ability
  • Minimal and maximum scores:
    1. Grip strength with a range of 0-300 mm HG;
    2. Pinch strength range is 0-30 kg;
    3. Applied strength range with cans is 0-12 cans;
    4. Applied strength range for pouring water is 0-2000 ml;
    5. Dexterity and applied dexterity range for peg placement time is 0 to an undetermined amount of time.
  • Scoring procedures and forms are in the test manual and must be purchased. Grip strength is determined with an adapted sphygmomanometer and pinch gauge. Dexterity with the 9-hole peg test is timed. Applied strength is determined by the weight and number of lifting repetitions.

Number of Items

11

Equipment Required

  • Adapted sphygmomanometer
  • Pinch gauge
  • 9-hole peg test
  • Custom made tray with handles
  • 12 soup cans
  • Coin box with 4 coins
  • Theraputty with putty guide
  • Knife and fork
  • Material with 4 buttons and four buttonholes
  • 2 safety pins and a cloth
  • Shoe and shoe lace
  • Water pitcher and glass cup
  • Stopwatch

Time to Administer

20-30 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Older Adults

+

years

Instrument Reviewers

Pamela Metzer, OTR, CHT

Body Part

Upper Extremity

ICF Domain

Activity
Body Function
Body Structure

Measurement Domain

Activities of Daily Living

Considerations

  • The AHFT produces scores for a variety of strength and dexterity tasks but has no total score summation.  This makes the use of this assessment in research studies more difficult.  Some studies are creating 4 subgroups for scoring for strength and dexterity
  • It shows a good functional assessment for bilateral tasks that other hand function assessments do not include.

Contact Catherine Backman and Hazel Mackie at the School of Rehabilitation Sciences, University of British Columbia for manual

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Rheumatic Disease

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Normative Data

Systemic Sclerosis (Scleroderma): (Poole, Gallegos & O’Linc, 2000)

  • Nondisabled – Norms for the AHFT are included within the manual with scoring tables having comparative norms for the strength and 9-hole-peg test.

Test/Retest Reliability

Systemic Sclerosis (Scleroderma): (Poole, Gallegos & O’Linc, 2000)

  • Excellent test-retest reliability for strength measurements (ICC 0.85 – 0.95 except right hand 2-point pinch at 0.57)
  • Adequate test-retest reliability for dexterity and applied lifting
  • Excellent test-retest reliability for applied dexterity (ICC = 0.72 – 0.95)

Interrater/Intrarater Reliability

Systemic Sclerosis (Scleroderma): (Poole, Gallegos & O’Linc, 2000)

Excellent inter-rater reliability for all items (ICC = 0.99 – 1.00)

Criterion Validity (Predictive/Concurrent)

Systemic Sclerosis (Scleroderma): (Poole, Gallegos & O’Linc, 2000)

  • Adequate correlation with Health Assessment Questionnaire (HAQ) with AHFT grip and pinch strength sections Pearson r values ranging 0.32 to 0.40
  • Adequate to excellent correlation with HAQ for dexterity and applied dexterity sections with Pearson r values ranging 0.46 to 0.73
  • Excellent correlation with HAQ for applied strength with lifting with Pearson r values ranging 0.62 to 0.66
  • Poor to adequate correlation with Arthritis Impact Measurement Scales 2 (AIMS2) for grip and pinch strength sections with Pearson r values ranging 0.19 to 0.31
  • Poor to adequate correlation with AIMS2 for dexterity and applied dexterity sections with Pearson r values ranging 0.20 to 0.49
  • Excellent correlation with AIMS2 for applied strength with lifting with Pearson r values ranging 0.66 to 0.69

Construct Validity

Systemic Sclerosis (Scleroderma): (Brower & Poole, 2004; n = 40; age range 26 – 74 years; mean age 35 years; diagnosed with systemic sclerosis.)

  • Adequate to Excellent correlation with strength, applied dexterity and applied strength sections of the AHFT (Spearman rho 0.39 – 0.58) to Duruӧz Hand Index.
  • Poor correlation with dexterity section of AHFT and Duruӧz Hand Index

Systemic Sclerosis (Scleroderma): (Poole, Gallegos & O’Linc, 2000)

  • Poor correlations for strength and applied strength of the AHFTwith Health Assessment Questionnaire (Pearson’s r -0.40 to -0.30)
  • Adequate to Excellent correlation for dexterity and applied dexterity of the AHFT with Health Assessment Questionnaire (Pearson’s r 0.46 – 0.73)
  • Poor correlations for strength and applied strength of the AHFT with the physical component of the AIMS2 (Pearson’s r -0.69 to – 0.19)
  • Adequate correlation for dexterity and applied dexterity of the AHFT with the physical component of the AIMS2 (Pearson’s r 0.21 – 0.46)

Osteoarthritis

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Test/Retest Reliability

Osteoarthritis: (Backman & Mackie, 1997)

  • Excellent test-retest (ICC = range 0.83 to 0.96).

Interrater/Intrarater Reliability

Osteoarthritis: (Backman & Mackie, 1997)

  • Excellent Inter-rater reliability (ICC ranging 0.99 to 1.0 for all subtests)

Rheumatoid Arthritis/Osteoarthritis: (Backman & Mackie, 1995; n = 30; mean age 57.5 years (range 28 – 79 years); average time since diagnosis 14.8 years; arthritis affects >2 joints)

  • Excellent inter-rater reliability coefficient (Pearson’s r range 0.45 to 0.99) between 6 self-trained raters assessing 30 subjects.

 

Criterion Validity (Predictive/Concurrent)

(Backman & Mackie, 1997) concurrent validity with OARS
Multidimensional Functional Assessment Questionnaire physical activities of daily living (PADL) and instrumental activities of daily living (IADL)

  • Adequate to excellent correlation coefficients with PADL ranging 0.40 to 0.69
  • Adequate to excellent correlation coefficients with IADL ranging 0.475 to 0.75

Predictive validity (Backman & Mackie, 1997)

  • Adequate to excellent predictive validity correlation of the AHFT with the physical activities of daily living (PADL) self-report section of Oars Multidimensional Assessment of Function for performing functional tasks with correlation scores ranging from 0.40 – 0.69.  A correlation suggests a relationship between hand function and predicting tasks in the functional domain.
  • Adequate to excellent predictive validity correlation of the AHFT with the instrumental activities of daily living (IADL) self-report Oars Multidimensional Assessment of Function section for instrumental tasks with correlation scores ranging 0.467 – 0.75. A correlation suggests a relationship between

Construct Validity

(Backman & Mackie, 1997)

  • Excellent to Adequate correlation of AHFT with physical activities of daily living (PADL) self-report section of the Oars Multidimensional Assessment of with correlation scores ranging from 0.40 – 0.69
  • Excellent to Adequate correlation of AHFT with instrumental activities of daily living (IADL) self-report section of the Oars Multidimensional Assessment of Function with correlation scores ranging from 0.467 – 0.75.

(Poole, Lucero, & Mynatt, 2010) n = 40, convenience sample, > 45 years old, diagnosis of osteoarthritis with presence of Heberden’s and/or Bouchard’s nodes

  • Excellent correlation with Cochin Hand Function Disability scale (HFDS) (r values s = 0.52 to 0.64) for performance-based items
  • Adequate to excellent correlation HFDS for grip strength with r values ranging 0.57 to 0.67
  • Poor correlation with HFDS for applied strength (r value 0.12)
  • Adequate to excellent correlation with Michigan Hand Questionnaire (MHQ) for strength items (rs  value  0.51 – 0.65)
  • Poor to adequate correlation with MHQ for pegboard and applied dexterity (r values 0.38 to 0.51)
  • Poor correlation with MHQ for applied strength (r value .28)
  • Adequate correlation with Dreiser’s Functional Index (DFI) for strength items (r values 0.47 to 0.57)
  • Adequate correlation with DFI for dexterity and applied dexterity (r s values 0.44 - 0.46)
  • Poor correlation with Dreiser’s Functional Index for applied strength (r value 0.19).

Face Validity

Rheumatoid Arthritis/Osteoarthritis: (Backman & Mackie, 1995)

The AHFT subcategories are scored numerically with norms established using standardized procedures on 400 nondisabled subjects.  Internal consistency established for the dexterity sections with norms determined on 360 nondisabled adult subjects

Floor/Ceiling Effects

(Backman & Mackie, 1997)

  • Lifting task floor 0 can and 0 volume of water
  • Lifting tasks ceiling 12 cans and 2 L water

Arthritis

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Cut-Off Scores

Rheumatoid arthritis: (Baker & Rogers, 2010; n = 45; age average mid-50s; rheumatoid arthritis > 17 years; diagnosed with rheumatoid arthritis; used a computer.)

  • Assessment items were transformed into 4 categories with impairment scores of severe, moderate, mild and effective, determined for this study.  No cut off scores were available.

Normative Data

Rheumatoid arthritis: (Baker & Rogers, 2010)

  • Total AHFT scores were transformed into four categories for this study.  with impairment scores of severe, moderate, mild, and effective. The scores ranged from 14-56; with higher scores indicating less hand function impairment.

Test/Retest Reliability

Rheumatoid Arthritis: (Backman, Mackie, & Harris, 1991; n=20; mean age 60.5; average number years post diagnosis 17.9 (SD =13.5 years) )

  • Excellent test-retest reliability subscales for strength, applied dexterity and applied strength (ICC range for all subtests = .69 to .95).  No Standard Deviation (SD)
  • Adequate test-retest with 9-hole-peg test for dexterity (ICC right hand = .85, ICC for left hand = .53).  No SD

Interrater/Intrarater Reliability

Rheumatoid Arthritis: (Backman, Mackie, & Harris, 1991)

  • Excellent Intra-rater reliability (ICC range for all subtests = .89 to 1.0)

Rheumatoid Arthritis/Osteoarthritis: (Backman & Mackie, 1995; n = 30; mean age 57.5 years (range 28 – 79 years); average time since diagnosis 14.8 years; arthritis affects >2 joints)

  • Excellent inter-rater reliability coefficient (Pearson’s r range 0.45 to 0.99) between 6 self-trained raters assessing 30 subjects.

Criterion Validity (Predictive/Concurrent)

(Poole, Cordova, & Bower, 2006; n = 40) concurrent validity with Duruӧz Hand Index (DHI).

  • Adequate correlation with DHI with r values = 0.36 - 0.54

(Backman, Mackie, & Harris, 1991)

  • Excellent correlation between the applied dexterity aggregate score and dexterity scale of the AIMS (ICC = 0.71)
  • Poor correlation between all other subgroups of the AHFT and AIMS (ICC ranging 0.01 to 0.24)

Predictive Validity: (Baker & Rogers, 2010)

  • Poor to adequate predictive validity correlation with higher scores for the Arthritis Hand Function Test indicate greater function and correlate with faster typing speeds.  Persons semi-partial correlations (keyboard 1 – r2 = 0.29 and keyboard 6 – r2 =0.35)

Construct Validity

Convergent validity (Backman, Mackie, & Harris, 1991)

  • Excellent correlation for applied dexterity and applied strength of the AHFT and Jebsen Hand Function test for right hand scores (Pearson’s r 0.61 – 0.643 right hand)
  • Poor correlation for applied dexterity and applied strength of the AHFT and Jebsen Hand Function Test with left hand scores (Pearson’s r 0.02 - 0.08 left hand)

Content Validity

(Backman, Mackie, & Harris, 1991)

Adequate - Establishes assessment subgroups using standardized assessments for dexterity (9-Hole-Peg test), and strength for gross grip and pinch.  Authors establish a functional activity group for applied dexterity using bilateral tasks.

Face Validity

(Backman, Mackie, & Harris, 1991)

Excellent – At face value the assessment uses standardized assessments for dexterity (9-Hole-Peg test), and strength measurements to add validity to the test.  The authors establish a functional activity group for applied dexterity using bilateral tasks that are routinely performed in a day and established time norms for completion of the tasks by nondisabled participants.

Rheumatoid Arthritis/Osteoarthritis: (Backman & Mackie, 1995)

The AHFT subcategories are scored numerically with norms established using standardized procedures on 400 nondisabled subjects.  Internal consistency established for the dexterity sections with norms determined on 360 nondisabled adult subjects

Non-Specific Patient Population

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Normative Data

Healthy: (Grice, Vogel, Le, Mitchell, Muniz, & Vollmer, 2003; n = 703; age 21 – 70+, from a variety of community and institution settings, could read)

Time and standard deviation by age and gender for 9-hole peg test.

Male

Age          N             M-right           M-left           SD right              SD left

                               (seconds)       (seconds)                                                                  

21-25      41             16.41             17.53             1.65                     1.73

26-30      32             16.88             17.84             1.89                     2.22

31-35      31             17.54             18.47             2.70                     2.94

36-40      32             17.71             18.62             2.12                     2.30

41-45      30             18.54             18.49             2.88                     2.42

46-50      30             18.35             19.57             2.47                     2.69

51-55      25             18.93             19.84             2.37                     3.10

56-60      25             20.90             21.64             4.55                     3.39

61-65      24             20.87             21.60             3.50                     2.98

66-70      14             21.23             22.29             3.29                     3.71

71+          25             25.79             25.95             5.60                    4.54

All male   314          18.99            19.79              3.91                    3.66

Female

Age                N          Ave right           Ave left          SD right         SD left     

21-25           43          16.04                17.21                1.82             1.55

26-30           33          15.90                16.97                1.91             1.77

31-35           32          16.69                17.47                1.70             2.13

36-40           35          16.74                18.16                1.95             2.08

41-45           37          16.54                17.64                2.14             2.06

46-50           45          17.36                17.96                2.01             2.30

51-55           42           17.38               18.92                1.88             2.29

56-60           31           17.86               19.48                2.39             3.26

61-65           29           18.99               20.33                2.18             2.76

66-70           31           19.90               21.44                3.15             3.97

71+              31            22.49               24.11                6.02             5.66

All female  389          17.67              18.91                 3.17             3.44        

Criterion Validity (Predictive/Concurrent)

Healthy Adults: (Backman, Cork, Gibson, & Parsons, 1992; N = 395 adults, age range 20-79). Relationship between 9-hole-peg test and applied dexterity section of the AHFT.

  • Poor to Adequate concurrent validity with correlation coefficients ranging from 0.32 – 0.60. Significant correlation coefficients for pegboard dexterity and applied dexterity at p< 0.01

Bibliography

Backman, C., Cork, S., Gibson, D., & Parsons, J. (1992). Assessment of hand function: The relationship between pegboard dexterity and applied dexterity. Canadian Journal of Occupational Therapy, 59(4), 208-213.   Find in Google Scholar

Backman, C., & Mackie, H. (1995). Arthritis hand function test: inter-rater reliability among self-trained raters. Arthritis Care and Research, 8(1), 10-15.  Find in Wiley Online Library

Backman, C., & Mackie, H. (1997). Reliability and validity of the Arthritis Hand Function Test in adults with osteoarthritis. The Occupational Therapy Journal of Research, 17(1), 55-66. Find on Google Scholar at Sage Journals    

Backman, C., Mackie, H., & Harris, J. (1991). Arthritis Hand Function Test: Development of a standardized assessment tool. The Occupational Therapy Journal of Research, 11(4), 245-256. Find on Google Scholar at Sage Journals

Baker, N. A., & Rogers, J. C. (2010). Association between computer use speed and age, impairments in function, and touch typing training in people with rheumatoid arthritis. Arthritis Care and Research, 62(2), 242-250.  Find on PubMed 

Brower, L. M., & Poole, J. L. (2004). Reliability and validity of the Duruoz Hand Index in persons with systemic sclerosis (Scleroderma). Arthritis & Rheumatism, 51(5), 805-809.  Find in Wiley Online Library

Grice, K. O., Vogel, K. A., Le, V., Michell, A., Muniz, S., & Vollmer, M. A. (2003). Adult norms for a commercially available nine-hole peg test for finger dexterity. The American Journal of Occupational Therapy, 57(5), 570-573. Find on PubMed

Poole, J. L. (2011). Measures of hand function: Arthritis Hand Function Test (AHFT), Australian Canadian Osteoarthritis Hand Index (AUSCAN), Cochin Hand Function Scale, Functional Index for Hand Osteoarthritis (FIHOA), Grip Ability Test (GAT), Jebsen Hand Function Test (JHFT) and Michigan Hand Outcomes Questionnaire (MHQ). Arthritis Care & Research, 63(S11), S189-99.   Find in Google Scholar on Wiley Online Library

Poole, J. L., Cordova, K. J., & Bower, L.M. (2006) Reliability and validity of a self-report of hand function in persons with rheumatoid arthritis. Journal of Hand Therapy, 19(1), 12-17.  Find in PubMed

Poole, J. L., Gallegos, M., & O’Linc, S. (2000). Reliability and validity of the Arthritis Hand Function Test in adults with systemic sclerosis (scleroderma). Arthritis Care & Research, 13(2), 69-73.  Find on PubMed

Poole, J. L., Lucero, S. L., & Mynatt, R. (2010). Self-reports and performance-based tests of hand function in persons with osteoarthritis. Physical & Occupational Therapy in Geriatrics, 28(3), 249-258.   Find on Google Scholar at Taylor & Francis Online

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