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Upper Extremity Functional Index

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Upper Extremity Functional Index

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The Upper Extremity Functional Index (UEFI) is a punch of 20 questions to evaluate the functional impairment of the upper extremity that is caused by disability and pain. It was first developed by Stratford PW in 2001.

The Patients are asked to rate the difficulty of performing 20 functional tasks on a Likert type scale ranging from 0 (extremely difficult or unable to perform activity) to 4 (no difficulty). A total score out of 80 is calculated by summing each score.

The answers provide a score between 0 and 80, with lower scores representing more disability.

See Also: Forearm Muscles Anatomy

The 20 tasks of Upper Extremity Functional Index are:

Today, do you or would you have any difficulty at all with:

  1. Any of your usual work, housework, or school activities.
  2. Your usual hobbies, re creational or sporting activities.
  3. Lifting a bag of groceries to waist level.
  4. Lifting a bag of groceries above your head.
  5. Grooming your hair.
  6. Pushing up on your hands (eg from bathtub or chair).
  7. Preparing food (eg peeling, cutting).
  8. Driving.
  9. Vacuuming, sweeping or raking.
  10. Dressing.
  11. Doing up buttons.
  12. Using tools or appliances.
  13. Opening doors.
  14. Cleaning.
  15. Tying or lacing shoes.
  16. Sleeping.
  17. Laundering clothes (eg washing, ironing, folding).
  18. Opening a jar.
  19. Throwing a ball.
  20. Carrying a small suitcase with your affected limb.
See Also: DASH Score

The score for each question is chosen as following:

  • 0: Extreme Difficulty or Unable to Perform Activity.
  • 1: Quite a Bit of Difficulty.
  • 2: Moderate Difficulty.
  • 3: A Little Bit of Difficulty.
  • 4: No Difficulty.
Upper Extremity Functional Index
Upper Extremity Functional Index UEFI

UEFI Modifications

In 2007, the UEFI was changed for 2 items. Because most patients do not normally lift their groceries in the manner described in item 4 (“Lifting a bag of groceries above your head”), it was changed to “Placing an object onto, or removing it from, an overhead shelf.”

Item 5 was changed from “Grooming your hair” to “Washing your hair or scalp” because patients could have age-related hair loss or hair loss associated with aggressive medical therapies such as chemotherapy.

Rasch analysis of UEFI

Rasch analysis of UEFI (or UEFI-15) has only 15 items, as the 5 items are deleted in the following order of most to least misfit:

  1. sleeping,
  2. usual hobbies/recreational or sporting activities,
  3. throwing a ball,
  4. dressing,
  5. tying or lacing shoes.

The UEFI-15 items are (Items are arranged most to least difficult, top to bottom):

  1. Doing up buttons
  2. Preparing food (eg, peeling, cutting)
  3. Opening doors
  4. Laundering clothes (eg, washing, ironing, folding)
  5. Driving
  6. Using tools or appliances
  7. Cleaning
  8. Washing your hair or scalp
  9. Opening a jar
  10. Vacuuming, sweeping, or raking
  11. Pushing up on your hands (eg, from bathtub or chair)
  12. Any of your usual work, housework, or school activities
  13. Lifting a bag of groceries to waist level
  14. Carrying a small suitcase with your affected limb
  15. Placing an object onto, or removing it from, an overhead shelf.

Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal disorders of the upper extremity.

Rasch analysis of UEFI
Rasch analysis (UEFI-15)

References

  • Stratford PW, Binkley JM, Stratford DM. Development and initial validation of the upper extremity functional index. Physiotherapy Canada. 2001;53: 259-263.
  • Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H, Burns C, Chan L, Frey E, Gillies G, Gravelle T, Ho R, Holmes R, Lavallée RL, MacKinnon M, Merchant AJ, Sherman T, Spears K, Yardley D. Reliability and validity of two versions of the upper extremity functional index. Physiother Can. 2014 Summer;66(3):243-53. doi: 10.3138/ptc.2013-45. PMID: 25125777; PMCID: PMC4130402
  • Hamilton CB, Chesworth BM. A Rasch-validated version of the upper extremity functional index for interval-level measurement of upper extremity function. Phys Ther. 2013 Nov;93(11):1507-19. doi: 10.2522/ptj.20130041. Epub 2013 Jun 27. PMID: 23813086; PMCID: PMC3827714.
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