Scientific/Clinical ArticleModification of the Upper Limb Functional Index to a Three-point Response Improves Clinimetric Properties
Section snippets
Purpose of the Study
- 1.
To determine whether psychometric and practical characteristics are improved when the original ULFI is modified from dichotomous to a three-point response option (ULFI3-pt).
- 2.
To investigate the factor structure of the ULFI3-pt.
Modification of the Original ULFI to a Three-point Response
To modify the wording of the original ULFI and produce the ULFI3-pt, two focus groups were formed. The first had five patients with different upper limb conditions; the second had five clinicians that included two physical therapists, two certified hand therapists, and one occupational therapist. Each group independently developed methods to provide the ULFI3-pt with the desired three-point response option where the third point was central between “Yes” and “No.”10, 11, 12 The consensus
Psychometric Characteristics
These are presented for each PRO in both stages in Table 2 with the construct validity in Table 3. The values for the QuickDASH are invalid for summation to a single repeated score because of the bidimensional factor structure (the presence of two underlying constructs or themes).28, 51 They are provided for comparison to the other PROs and previous QuickDASH studies.
Discussion
The ULFI3-pt demonstrated validity and reliability as a three-point response scale questionnaire. The improved reliability over the original ULFI reduced the measurement error, which in turn made the questionnaire more sensitive to change. The additional “Half Mark” response option was accepted by most of the participants in most of their responses. The similar demographic factors, psychometric values, and criterion validity between the calibration and validation stages indicated consistency
Conclusions
The ULFI3-pt improved the original ULFI psychometric properties without the loss of clinical utility and demonstrated a unidimensional factor structure. Practical characteristics were retained and a high overall performance score for both the “Measurement of outcome measures” and “Bot” clinimetric summary performance scales. These characteristics were both preferable and superior to the QuickDASH, which had questionable validity because of its bidimensional structure. The findings indicated
Acknowledgments
This research was supported by the University of the Sunshine Coast. We thank all participating patients, general practitioners, and therapists for their time and effort. The study was approved by the Human Research Ethics Committee of the University of the Sunshine Coast. We wish to thank Lukas Staub for statistical editing and Selena Horner of Red Cedar Physical Therapy for her invaluable contribution of patient's data.
Quiz: Article # 147
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
- #1.
The ULFI
- a.
is being introduced as a new outcome measure in this issue of the JHT
- b.
has been previously described in an earlier issue of the JHT
- c.
was developed at the Fulbright Institute of the University of Louisiana
- d.
is a research tool, not intended to be used clinically
- a.
- #2.
The 3-point response option proved to be
- a.
more time consuming to administer
- b.
less time
- a.
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Cross-cultural adaptation, reliability, and validity of the Persian version of the Lower Limb Functional Index
2022, Musculoskeletal Science and PracticeTranslation, cross-cultural adaptation and validation of the Upper Limb Functional Index (ULFI) into Brazilian Portuguese in patients with chronic upper limb musculoskeletal disorders
2021, Musculoskeletal Science and PracticeCitation Excerpt :The original design of the ULFI as a single-page instrument was maintained. The modification to a three-point response with the inclusion of three separate boxes (“no”, “partly” and “yes”) in the response section was also retained as recommended in previous studies (Gabel et al., 2010; Gabel, 2016). Table 1 shows the sociodemographic and clinical characteristics of patients.
Assessment of Functional Outcomes
2020, Cooper's Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity
Presented at the 7th Triennial Congress of the International Federation of Societies for Hand Therapy, Sydney, 11th–15th March 2007.