Skip to main content
  

Rehab Measures: Capabilities of Upper Extremity Instrument

Link to instrument

Available on Spinalcordcenter.org 

Title of Assessment

Capabilities of Upper Extremity Instrument 

Acronym

CUE

Instrument Reviewer(s)

Initially reviewed by Cara Leone Weibsach PT, DPT; Wendy Romney, PT, DPT, NCS; and the SCI EDGE task force of the Neurology Section of the APTA in 3/2012

Summary Date

12/13/2013 

Purpose

To measure upper extremity functional limitations in individuals with tetraplegia.

Description

  • 32 item questionnaire
    • 15 unilateral (left and right), 2 bilateral
      • 3 Reaching items
      • 4 Pulling/pushing items
      • 2 Wrist items
      • 6 Hand and Finger items
      • 2 Bilateral items
  • Scored on 7-point scale representing self-perceived difficulty 1 = "Totally limited, can't do at all", 7 = "Not at all limited"
  • Minimum score = 32, Maximum score = 224 (higher score = greater function)
  • Left and right scores can be assessed separately
  • Self-reported measure performed by interview

Area of Assessment

Functional Mobility 

Body Part

Upper Extremity 

ICF Domain

Body Function 

Domain

Motor 

Assessment Type

Patient Reported Outcomes 

Length of Test

06 to 30 Minutes 

Time to Administer

approximately 30 minutes

Number of Items

32 

Equipment Required

None

Training Required

No training required

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

Adult: 18-64 years 

Administration Mode

 

Diagnosis

Spinal Cord Injury 

Populations Tested

  • Spinal Cord Injury (SCI)

Standard Error of Measurement (SEM)

Cervical SCI:

(Marino, Shea, Stineman, 1998, n = 154; mean age = 36.7; motor complete (AIS A or B) or incomplete (AIS C or D); 68% were motor complete)

 

  • SEM = 12.2 (95% CI indicating true score is within 23.9 points of score obtained)

Minimal Detectable Change (MDC)

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

  • MDC = 33.82

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

CUE Scores in Participants with Cervical SCI

Item

Mean (SD)

Right

Left

Arm Function

Reach 1

4.5 (2.0)

5.4 (2.1)

Reach 2

4.6 (2.4)

4.5 (2.5)

Reach 3

3.2 (2.5)

3.2 (2.5)

Pull/push 1

5.9 (1.9)

5.7 (2.1)

Pull/push 2

5.1 (2.2)

5.0 (2.2)

Pull/push 3

5.8 (2.1)

5.5 (2.3)

Pull/push 4

4.9 (2.3)

4.6 (2.3)

Wrist 1

5.0 (2.5)

4.8 (2.5)

Wrist 2

5.2 (2.3)

5.2 (2.3)

Hand Function

Hand 1

3.0 (2.3)

3.0 (2.3)

Hand 2

3.8 (2.5)

3.7 (2.4)

Hand 3

3.9 (2.5)

3.8 (2.5)

Hand 4

2.8 (2.3)

2.7 (2.3)

Hand 5

2.4 (2.0)

2.2 (2.0)

Hand 6

3.6 (2.6)

3.5 (2.6)

Bilateral

Reach down

Bilateral 1

4.7 (2.4)

Bilateral 2

3.8 (2.6)

 

Test-retest Reliability

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

  • Excellent Test-Retest Reliability for total test (ICC = 0.94)
  • Good agreement of individual items: Weighted kappa coefficient > 0.60 for all but 3 items (reaching forward w/right k = 0.58; manipulating objects w/right k = 0.55; lifting a 5lb object overhead k = 0.57)

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

  • Excellent internal consistency of full scale (Chronbach’s α = 0.96)
  • Poor to adequate internal consistency of Item-total correlation was between 0.49 for “reaching down with right arm” and 0.78 for “pushing heavy items away with left arm”

Criterion Validity (Predictive/Concurrent)

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

  • Excellent correlation (for total sample and motor complete) to Upper Extremity Motor Score (UEMS) & Functional Independence Measure (FIM)
  • Excellent correlation for motor incomplete with both UEMS & FIM

 

Correlations Between Motor Completeness, CUE, UEMS, and FIM Scores in Participants with SCI

Total Sample

(n = 154)

Motor Complete

(n = 105)

Motor Incomplete

(n = 49)

UEMS

FIM

UEMS

FIM

UEMS

FIM

Pearson Correlations

CUE

0.782

0.738

0.798

0.753

0.683

0.672

UEMS

0.741

0.772

0.593

Spearman's Correlations

CUE

0.798

0.798

0.815

0.822

0.650

0.719

UEMS

0.803

0.825

0.580

(none is significantly different from another at the p < 0.05 level)

  • CUE is a better predictor of the FIM than the UEMS
  • CUE explains 73% of the variance in the FIM
  • UEMS explains 67% of the variance in the FIM
  • CUE and UEMS together still explain only 73% of the variance in FIM; therefore CUE was able to explain more of the variance in the FIM than the UEMS

 

Chronic Tetraplegia:

(Kalsi-Ryan et al, 2012)

 

  • Excellent correlation of sensation subtest of GRASSP with CUE (r = 0.77)
  • Excellent correlation of strength subtest of GRASSP and CUE (r = 0.76)
  • Excellent correlation of prehension performance subtests of GRASSP with CUE (r = 0.83)

Construct Validity (Convergent/Discriminant)

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

Discriminant Validity

 

  • CUE scores increased with motor level
  • Post hoc Tukey tests indicated mean CUE scores were significant (p ≤ 0.001) between motor levels > 1 level apart (except for C7 and T1 on right side) – therefore CUE is able to discriminate among individuals 2 motor levels apart (This was measured by side of body - comparing right or left motor level with 15 unilateral items score for right or left side)

 

CUE Scores by Motor Level for Participants with SCI

n

Mean (SD)

p*

Right Motor Level

< 0.001

C2-4

7

28.9 (20.2)

a

C5

39

43.3 (21.4)

a

C6

53

64.1 (17.2)

C7

31

78.3 (12.9)

b

C8

13

92.2 (8.5)

b

T1

11

93.9 (12.1)

b

Left Motor Level

< 0.001

C2-4

6

19.0 (9.8)

C5

41

43.4 (20.9)

C6

58

63.9 (20.0)

c

C7

27

75.1 (15.4)

c,e

C8

14

91.0 (9.8)

d,e

T1

8

100.2 (4.2)

d

*Letters in column p indicated that mean values were not statistically significant (p < 0.05) between levels marked with the same letter.

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Cervical SCI:

(Marino, Shea, Stineman, 1998)

 

  • Borderline floor effect on 1 item (Hand 5 on Left) - manipulating small objects

Responsiveness

Not Established

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 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

R

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

R

R

 

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

Yes

Yes

Not reported

Considerations

  • High internal consistency (0.96) suggests there may be redundancy in items however this can only be determined after items are assessed for sensitivity to change (Marino, Shea, Stineman, 1998)
  • It was determined that a chest strap can be used for the item “lifting a 5lb object overhead” (Marino, Shea, Stineman 1998).
  • Measure assesses upper limb function including proximal arm and hand function, not strictly hand function.
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Kalsi-Ryan, S., Beaton, D., et al. (2012). "The Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity." J Neurotrauma 29(5): 905-914. Find it on PubMed

Marino, R. J., Shea, J. A., et al. (1998). "The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia." Archives of Physical Medicine and Rehabilitation 79(12): 1512-1521. Find it on PubMed

Year published

1998 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 9/26/2012 11:01 AM  by Jason Raad 
Last modified at 2/11/2015 2:43 PM  by Jason Raad