JHT READ FOR CREDIT #039 The Upper Limb Functional Index: Development and Determination of Reliability, Validity, and Responsiveness C. Philip Gabel, MSc, PT Lori A. Michener, PhD, PT, ATC Virginia Commonwealth University Medical College of Virginia Richmond, Virginia Brendan Burkett, PhD Anne Neller, PhD University of the Sunshine Coast Queensland, Australia ABSTRACT: Purpose. Current upper limb regional self-report outcome measures are criticized for poor clinical utility, including length, ease, and time to complete and score, missing responses, and poor psychometric properties. To address these concerns a new measure, the Upper Limb Functional Index (ULFI), was devel- oped with reliability, validity, and responsiveness being deter- mined in a prospective study. Methods. Patients from nine Australian outpatient settings com- pleted the ULFI and two established scales, the Disabilities of the Arm, Shoulder, and Hand (DASH) (n ¼ 214) and the Upper Ex- tremity Functional Scale (UEFS) (n ¼ 64) concurrently to enable construct and criterion validity to be assessed. Two subgroups were used to assess test–retest reliability at 48-hour intervals (n ¼ 46) and responsiveness through distribution-based methods (n ¼ 29). Internal consistency, change scores, and missing re- sponses were calculated. Practical characteristics of the scale were assessed. Results. The ULFI correlated with the DASH (r ¼ 0.85; 95% CI) and UEFS (r ¼ 0.78; 95% confidence interval [CI]), demonstrated test– retest reliability (intraclass correlation coefficient ¼ 0.96; 95% CI) and internal consistency (Cronbach alpha ¼ 0.89). The change scores of the ULFI with standard error of the measurement was 4.5% or 1.13 ULFI-points and minimal detectable change at the 90% CI was 10.4% or 2.6 ULFI-points. Responsiveness indices were standardized response mean at 1.87 and effect size at 1.28. The ULFI demonstrated an impairment range of 0–100%, with no missing responses and a combined patient completion and thera- pist scoring time of less than 3 minutes. Conclusions. The ULFI demonstrated sound psychometric prop- erties, practical characteristics, and clinical utility thereby making it a viable clinical outcome tool for the determination of upper limb status and impairment. The ULFI is suggested as the pre- ferred upper limb regional tool due to its superior practical charac- teristics and clinical utility, and comparable psychometric properties without a tendency toward item redundancy. J HAND THER. 2006;19:328–49. The use of standardized Self-report Outcome Measures (SROMs) for the determination of func- tional impairment and the monitoring of change over time has gained increasing favor over the last decade. They are defined as ‘‘. a questionnaire completed by the patient to indicate the status of functional loss in a specific area or condition ..’’ 1–6 Musculoskeletal SROMs include condition-specific tools for the various joints and diseases and more recently, region-specific tools have emerged as the preferred option due to their greater application across a variety of clinical and research situations. 7–11 Region-specific tools con- sider the body in single kinetic chains of the spine and upper and lower extremities 8,9 and provide a means of clarifying clinical status and any subse- quent changes that may result from treatment or intervention. They are more practical and easier to implement and administer than objective clinical measures, 7,12,13 responsive to significant improve- ments over time, 10,11 and require fewer patient num- bers to detect an effect. 14 Evidence indicates that only SCIENTIFIC/CLINICAL ARTICLES Correspondence and reprint requests to C. Philip Gabel, MSc, PT, PO Box 760, Coolum, Queensland 4573, Australia; e-mail: <cp.gabel@bigpond.com>. 0894-1130/$ – see front matter Ó 2006 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. doi:10.1197/j.jht.2006.04.001 328 JOURNAL OF HAND THERAPY