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Rehab Measures: Jebsen Hand Function Test

Link to instrument

Available from nsw.gov.au 

Title of Assessment

Jebsen Hand Function Test 

Acronym

JHFT

Instrument Reviewer(s)

Initially reviewed by Dorian Rose, PT, PhD and the StrokEdge task force of the Neurology Section of the APTA in 2011 and Cara Leone Weibsach, PT, DPT, Wendy Romney, PT, DPT, NCS,  and the SCI EDGE task force of the Neurology Section of the APTA in 4/2012

 

Summary Date

10/26/2012 

Purpose

To assess a broad range of uni-manual hand functions required for activities of daily living (ADLs) 

Description

  • 7 subtests, performed on both non-dominant and dominant hand:

1. Writing a 24-letter, 3rd grade reading difficulty sentence

2. Card turning

3. Picking up small common objects (e.g. pennies, paper clips, bottle caps) and placing them in a container

4. Stacking checkers

5. Stimulated feeding

6. Moving light objects (e.g. empty cans)

7. Moving heavy objecst (e.g. 1lb weighted cans)

 

  • Subtest score = time (seconds) to complete task
  • Total score = sum of times for each subtests
  • Max time allotted per subtest is 120 seconds
  • Lower score = greater function
  • Each item performed with each hand separately – non-dominant hand first
  • Measures unilateral hand function
  • Assesses speed, not quality of performance

 

Area of Assessment

Activities of Daily Living; Upper Extremity Function 

Body Part

Upper Extremity 

ICF Domain

Participation 

Domain

Motor 

Assessment Type

Performance Measure 

Length of Test

06 to 30 Minutes 

Time to Administer

15 minutes

Number of Items

Equipment Required

  • Stopwatch
  • Chair (18” seat height), desk/table (30” high)
  • Black ball point pen, four 8x11” sheets of unruled white paper stacked and fastened to a clipboard
  • Sentences typed in all capital letters and centered on a 5x8” index card on a bookstand
  • Five 3x5” index cards (ruled on one side only)
  • Empty 1 pound coffee can
  • Two 1” paper clips
  • 2 regular sized bottle caps (1” diameter)
  • 2 U.S. pennies
  • 5 kidney beans (~5/8” long)
  • 1 regular teaspoon
  • Wooden board (41 ½” long, 11 ¼” wide, ¾” thick), “C” clamp, plywood (20” long, 2” wide, ½” thick) glued to the board (see Jebsen 1969 for details)
  • Four standard size (1 ¼” diameter) red wooden checkers
  • Five No. 303 cans

Training Required

No training, read the manual

Type of training required

No Training; Reading an Article/Manual 

Cost

Not Free 

Actual Cost

A test kit is sold commercially through multiple vendors, which usually includes instructions, all items needed to perform seven subtests, a carrying bag, and pad of 50 blank record forms.  Cost is generally in the $300+ range.

Age Range

Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Acquired Brain Injury; Arthritis; Geriatrics; Spinal Cord Injury; Stroke; Traumatic Brain Injury 

Populations Tested

  • Cerebral Vascular Accident (CVA)/Stroke
  • Brain injury
  • S/P hand surgery
  • Rheumatoid Arthritis (RA)
  • 1st Carpometacarpal osteoarthritis (OA)
  • Distal radius fracture (fx)
  • Carpal Tunnel Syndrome (CTS)
  • Cervical Spinal Cord Injury

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Normal:

(Hackel et al, 1992; n  = 121 “normal” men and women living independently in the community; mean age = 74.6(7.7) years)

 

Mean Subtest Scores for women in seconds (± standard deviation) by age group

Subtest

60-69 years (n = 19)

70-79 years (n = 31)

80-89 years (n = 19)

Dominant

Non-dominant

Dominant

Non-dominant

Dominant

Non-dominant

Writing

12.41±2.82a

35.99±11.28a

13.43±2.64a

40.13±7.84a

18.19±4.83

60.39±26.16

Card turning

4.79±1.26a

5.62±1.84b

5.33±1.06b

6.05±1.07b

6.28±1.78

7.25±2.15

Small, common objects

6.62±2.10

6.73±1.31b

6.91±1.29

7.07±1.44b

7.44±1.56

8.09±1.70

Simulated feeding

6.94±1.21c,d

8.05±1.38a,c

8.07±1.76

10.23±2.99

7.92±1.49

10.09±3.14

Checkers

4.55±1.30b

5.21±1.47

4.64±1.01b

5.41±1.24

5.56±1.45

5.94±1.24

Large, light objects

3.85±0.72b,d

4.01±0.74a,d

4.35±0.81

4.64±0.87

4.39±0.79

4.88±1.03

Large, heavy objects

3.84±0.74a

4.04±0.76a,d

4.26±0.82

4.63±0.87

4.51±0.66

4.91±0.81

a significant difference from 80-89 years age group (p < 0.01)
b significant difference from 80-89 years age group (p < 0.05)
c significant difference from 70-79 years age group (p < 0.01)
d significant difference from 70-79 years age group (p < 0.05)

Mean Subtest Scores for Men in seconds (± standard deviation) per age group

Subtest

60-69 years (n = 17)

70-79 years (n = 20)

80-89 years (n = 15)

Dominant

Non-dominant

Dominant

Non-dominant

Dominant

Non-dominant

Writing

15.31±5.38a

36.56±9.87a

17.22±4.59b

43.29±10.27b

20.53±4.69

54.54±28.21

Card turning

4.74±1.20a

5.71±1.60 a

5.25±1.18a

6.35±1.60b

7.108±2.56

7.90±3.38

Small, common objects

6.72±1.39 a

7.48±2.20

7.10±1.03a

7.92±1.39

9.17±3.00

8.34±1.67

Simulated feeding

7.32±0.99 a

9.24±1.72b

7.64±0.86a

9.49±1.28b

9.39±2.02

11.28±2.49

Checkers

4.19±0.93 a

5.46±2.83b

4.55±0.91a

5.27±0.81a

6.69±2.09

6.72±1.56

Large, light objects

3.69±0.71a,c

3.94±0.69a

4.20±0.70a

4.53±0.82b

4.96±0.88

5.31±1.35

Large, heavy objects

3.62±0.73a

4.03±0.78a

4.00±0.76a

4.39±0.67a

4.90±0.90

5.23±1.01

a significant difference from 80-89 years age group (p < 0.01)
b significant difference from 80-89 years age group (p < 0.05)
c significant difference from 70-79 years age group (p < 0.05)

(Jebsen et al 1969; n = 360; age 20-94 years)
Mean Subtest Score for Women in seconds (± standard deviation) by age group

Subtest

20-59 years (n=120)

60-94 years (n=30)

Dominant

Non-dominant

Dominant

Non-dominant

Writing

11.7±2.1

30.2±8.6

15.7±4.7

38.9±14.9

Card turning

4.3±1.4

4.8±1.1

4.9±1.2

5.5±1.1

Small, common objects

5.5±0.8

6.0±1.0

6.6±1.3

6.6±0.8

Simulated feeding

6.7±1.1

8.0±1.6

6.8±1.1

8.7±2.0

Checkers

3.3±0.6

3.8±0.7

3.6±0.6

4.4±1.0

Large, light objects

3.1±0.5

3.3±0.6

3.5±0.6

3.4±0.6

Large, heavy objects

3.2±0.5

3.3±0.5

3.5±0.6

3.7±0.7


Mean Subtest Scores for Men in seconds (± standard deviation) by age groups

Subtest

20-59 years

60-94 years

Dominant

Non-dominant

Dominant

Non-dominant

Writing

12.2±3.5

32.3±11.8

19.5±7.5

48.2±19.1

Card turning

4.0±0.9

4.5±0.9

5.3±1.6

6.1±2.2

Small, common objects

5.9±1.0

6.2±0.9

6.8±1.2

7.9±1.9

Simulated feeding

6.4±0.9

7.9±1.3

6.9±0.9

8.6±1.5

Checkers

3.3±0.7

3.8±0.6

3.8±0.7

4.6±1.0

Large, light objects

3.0±0.4

3.2±0.6

3.6±0.7

3.9±0.7

Large, heavy objects

3.0±0.5

3.1±0.4

3.5±0.7

3.8±0.7

 

Test-retest Reliability

Stroke:

(Beebe and Lang, 2009; n = 33 subjects with hemiparesis due to stroke; mean age = 56.9(10.2) years)

 

  • Excellent test-retest reliability (r = 0.92)

 

Stable hand disorders due to tetraplegia:

(Jebsen, 1969; n = 26; n = 6, post poliomyelitis n = 1, cerebral palsy n = 4, stroke n = 5, rheumatoid arthritis n = 4, burn n = 1, congenital anomaly n = 2, trauma n = 1, polyneuropathy n = 1, severe degenerative joint disease n = 1)

 

  • Excellent Test-Retest Reliability for all subtests for dominant hand except writing (r = 0.91-0.99) and non-dominant hand except feeding and large, light objects (r = 0.78-0.92)
  • Adequate Test-Retest Reliability for dominant hand writing (r = 0.67) and non-dominant hand feeding (r = 0.60) and large light objects (r = 0.67)
  • Absent practice effect (p < 0.05)

 

Correlation Coefficients for Test-Retest Reliability

Test

Dominant Hand

Non-dominant Hand

Writing

0.67

0.84

Card turning

0.91

0.78

Small, common object

0.93

0.85

Simulated Feeding

0.92

0.60

Checkers

0.99

0.91

Large, light objects

0.89

0.67

Large, heavy objects

0.89

0.92

All significant at the p < 0.01 level

 

Interrater/Intrarater Reliability

Normal:

(Hackel et al,1992)

 

· Excellent Intra-rater reliability (r = 0.84 and 0.85, p < 0.05) for 2 raters

· Excellent Inter-rater reliability (ICC = 0.82 – 1.00)

 

Subtest

Dominant Hand

Non-dominant Hand

Writing

1.00

1.00

Card turning

0.82

0.98

Small, common objects

0.95

1.00

Feeding

0.99

1.00

Checkers

0.99

0.98

Large, light objects

0.99

0.99

Large, heavy objects

0.99

0.99

 

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Status Post Hand Surgery:

(Sears and Chung, 2010; n = 111 (RA n = 37, OA n = 10, CTS n = 18, and Fx n = 46); evaluated preoperatively and 9-12 months post op; Michigan Hand Function Test (MHQ) used as reference standard)

 

  • Poor correlation with MHQ total scores for RA, OA, CTS, Fx (r =0.19, 0.04, 0.59, 0.36, respectively)
  • Poor correlation with MHQ subtests(ADL, function, work, satisfaction) for RA, OA, Fx (r = 0.10-0.41) and CTS for work & satisfaction (r = 0.38, 0.56 respectively)
  • Adequate correlation moderate for CTS for ADL and function (r = 0.68, 0.69, respectively)

Construct Validity (Convergent/Discriminant)

Discriminant Validity:

(Sears and Chung, 2010)

 

  • Poor discriminative validity for predicting positive or negative outcomes in hand function as measured by the MHQ outcomes (positive = change in MHQ score > 20; negative = change in MHQ score ≤ 20) for RA, OA, CTS, and Fx (ROC area under curve = 0.52, 0.58, 0.66, 0.59, respectively)
  • Poor discriminative validity for discriminating individuals with high or low MHQ scores (high = MHQ >75; low = MHQ ≤ 75) for RA, OA, and CTS all conditions except distal radius fracture (ROC area under curve = 0.48, 0.0, 0.65, respectively with 95% CI)
  • Adequate discriminative validity for determining high versus low score on MHQ (ROC area under curve = 0.76), indicating a 76% probability of predicting high or low test score on the MHQ

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Effect Size:

(Davis Sears, 2010)

 

  • Small change for CTS (ES = 0.05)
  • Moderate change for Fx, RA, and OA (ES = 0.35, 0.47, 0.67, respectively)
  • Effect size was greater for detecting change in and hand function following hand surgery using the MHQ (0.74-1.30) for all groups than Jebsen

 

Stroke:

(Beebe and Lang, 2009)

 

  • Moderate responsiveness between 13 mo poststroke (0.69) and between 16 mo poststroke (0.73)

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

LS

LS

StrokEDGE

NR

UR

UR

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

UR

UR

UR

UR

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

Yes

Not reported

StrokEDGE

No

Yes

Yes

Not reported

Considerations

  • Bovend’ Eerdt et al 2004 reports validity and reliability of a modified Jebsen Test (3 of the subtest combined into 1 test).
  • Assesses hand function with understanding that proximal upper extremity function will influence ability to place and position the hand. Proximal weakness and forearm rotation limitations may influence hand function outcomes.
  • Jebsen is not recommended for use in hand neuroprosthesis outcomes for individuals with C5 tetraplegia.
  • May not detect changes of intrinsic hand muscles and allows for compensatory trunk and shoulder movement to complete tasks.
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Agnew, P. J. and Maas, F. (1982). "Hand function related to age and sex." Archives of Physical Medicine and Rehabilitation 63(6): 269-271. Find it on PubMed

Beebe, J. A. and Lang, C. E. (2009). "Relationships and responsiveness of six upper extremity function tests during the first 6 months of recovery after stroke." Journal of neurologic physical therapy: JNPT 33(2): 96. Find it on Pubmed

Bovend'Eerdt, T. J., Dawes, H., et al. (2004). "Evaluation of the Modified Jebsen Test of Hand Function and the University of Maryland Arm Questionnaire for Stroke." Clinical Rehabilitation 18(2): 195-202. Find it on PubMed

Colyer, R. A. and Kappelman, B. (1981). "Flexor pollicis longus tenodesis in tetraplegia at the sixth cervical level. A prospective evaluation of functional gain." Journal of Bone and Joint Surgery 63(3): 376-379. Find it on PubMed

Davis Sears, E. and Chung, K. C. (2010). "Validity and responsiveness of the Jebsen-Taylor Hand Function Test." J Hand Surg Am 35(1): 30-37. Find it on PubMed

Hackel, M. E., Wolfe, G. A., et al. (1992). "Changes in hand function in the aging adult as determined by the Jebsen Test of Hand Function." Physical Therapy 72(5): 373-377. Find it on PubMed

Kinnucan, E., Van Heest, A., et al. (2010). "Correlation of motor function and stereognosis impairment in upper limb cerebral palsy." J Hand Surg Am 35(8): 1317-1322. Find it on PubMed

Smith, B. T., Mulcahey, M. J., et al. (1992). "The application of a modified neuroprosthetic hand system in a child with a C7 spinal cord injury. Case report." Paraplegia 30(8): 598-606. Find it on PubMed

Taylor, N., Sand, P. L., et al. (1973). "Evaluation of hand function in children." Archives of Physical Medicine and Rehabilitation 54(3): 129-135. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 8/17/2012 10:34 AM  by Jason Raad 
Last modified at 9/3/2014 1:25 PM  by Jason Raad