ARTHRITIS HAND FUNCTION TEST (AHFT)
The Arthritis Hand Function Test (AHFT) is an 11-item performance based test designed to measure hand strength and dexterity.
The items include grip and pinch strength, pegboard dexterity, lacing a shoe and tying a bow, fastening/unfastening 4 buttons, fastening/unfastening 2 safety pins, cutting putty with a knife and fork, manipulating coins into a slot, lifting a tray of tin cans, and pouring a glass of water.
Catherine Backman and Hazel Mackie. Arthritis Hand Function Test Manual (1997) can be ordered for $25.00 US Funds from School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, V6T2B5 Canada.
Number of items in scale
There are 4 subscales: Strength, Applied Strength, Dexterity, and Applied Dexterity.
Adults with rheumatoid arthritis (RA), osteoarthritis (OA), and systemic sclerosis (SSc).
WHO ICF Components
Items are administered in order on the scoring worksheet in the manual. Right and left hands are tested separately for the strength and dexterity items. The applied dexterity and applied strength items are performed using both hands.
Test is not difficult to administer or score. Manual provides specific instructions.
Time to administer/complete
Sphygmomanometer, pinch meter, 9-hole pegboard, shoe, button board, 2 safety pins, theraplast, plate, knife and fork, coins, box, wooden tray, 12 cans of soup, pitcher, glass, 1,000 ml container, measuring cup, dycem, stopwatch. All items can be stored in a 24-inch suitcase for portability.
Test manual purchased from authors. Pinchmeter and theraplast must be ordered from an adapted equipment catalogue for around $250. Equipment such as the pegboard, coin box, putty guide, and tray must be fabricated. Other equipment is easily available from a discount store. A cheap suitcase is helpful to transport items. In total, the entire cost (including support staff time to assemble) according to one of the authors is approximately $500.
Varies by subscale.
Grip strength range 0–300 mm Hg, pinch strength range 0–30 kg, applied strength range for cans 0–12 cans, applied strength range for pouring water is 0–2,000 ml, dexterity range is 0 – undetermined number of seconds.
Interpretation of scores
Scores can be transferred to a Hand Function Profile sheet matched for age and sex. This profile provides a summary and compares the scores to the norms.
Method of scoring
Grip strength is measured in mm Hg while pinch strength is measured in kg. Dexterity and applied dexterity items are timed in seconds. Applied strength is number of cans lifted and volume of water lifted in the pitcher in ml.
Time to score
Training to score
Training to interpret
No training is needed to interpret scores.
Norms for both men and women are reported in the manual
In RA, intraclass correlation coefficient (ICC) ranged from 0.89 to 1.0 between 2 independent observers rating 20 subjects (1). In OA, ICC ranged from 0.99 to 1.0 between 2 independent observers rating 26 subjects (4). In SSc, ICC ranged from 0.99 to 1.0 between 2 independent observers rating 20 subjects (5)
In RA, 20 subjects were tested twice within 2 weeks (ICC 0.53–0.96) (1–3). In OA, 26 subjects were tested twice within 2 weeks (ICC 0.74–0.96) (4). In SSc, 20 subjects were tested twice within 2 weeks (ICC 0.80–0.97) (5).
Content or face validity
Items were developed based on a systemic review of other hand function tests. Items reviewed by 5 occupational therapists who judged the final items to be clear and important unilateral and bilateral tasks
Healthy controls: 395 healthy adult volunteers were administered the Nine-hole pegboard test and items from the Applied Dexterity section of the AHFT. Correlations ranged from 0.32 to 0.60. In RA 20 subjects were evaluated with the AHFT and the Jebsen Hand Function Test (JHFT). Correlations between the AHFT and scores on the JHFT were 0.61–0.64 for the right hand scores and 0.02–0.08 for left hand scores (1). ICC was 0.71 between scores on the AHFT and the dexterity subscale of the Arthritis Impact Measurement Scale (AIMS) (1).
In OA 26 subjects were evaluated with the AHFT and self-reports of physical activities of daily living (PADL) and instrumental activities of daily living (IADL). Correlations between the AHFT and PADL scores ranged from 0.40 to 0.69 and between the AHFT and IADL scores ranged from 0.46 to 0.75 (4). In SSc 20 subjects with SSc were evaluated with the AHFT and the Health Assessment Questionnaire (HAQ) and the physical component of the AIMS2. Correlations ranged from 0.32 to 0.73 with the HAQ and from 0.19 to 0.69 with the AIMS2 (5).
Sensitivity/responsiveness to change
Comments and Critique
The majority of hand function tests assess only one aspect of function such as strength or dexterity, only unilateral tasks and do not include functional tasks. The AHFT is a performance-based test that measures both unilateral and bilateral functional tasks. Thus, numerous items are needed. However, most are easily available and fit into a 24-inch suitcase. The test had adequate psychometric properties for RA, OA, and SSc. Predictive validity and responsiveness to change have not been documented. There is no summative total score, which is a disadvantage when using in research since numerous correlations or comparisons must be made for each of 11 items and not just one score.
1.(Original) Backman C, Mackie H, Harris J. Arthritis hand function test: Development of a standardized assessment tool. Occup Ther J Res 1991;11:246–256.
2.Backman C, Cork S, Gibson D, Parsons J. Assessment of hand function: the relationship between pegboard dexterity and applied dexterity. Can J Occup Ther 1992;59:208–13.
3.Backman C, Mackie H. Arthritis hand function test: Inter-rater reliability among self-trained raters. Arthritis Care Res 1995;8:10–5.
4.Backman C, Mackie H. Reliability and validity of the Arthritis Hand Function test in adults with osteoarthritis. Occup Ther J Res 1997;17:55–67.
5.Poole JL, Gallegos M, O'Linc S. Reliability and validity of the Arthritis Hand Functional Test in adults with systemic sclerosis (scleroderma). Arthritis Care Res 2000;13:69–73.