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574 September/October 2008, Volume 62, Number 5 Relationship Between Performance-Based and Self-Reported Assessment of Hand Function KEY WORDS • evaluation • limitation of activities • rehabilitation • task performance Celina R. Rallon, MA, OTR/L, CHT, ICLM, SIPT-C, is Occupational Therapy Specialist, Department of Rehabilitation Medicine, Staten Island University Hospital, Staten Island, NY. Christine C. Chen, ScD, OTR/L, FAOTA, is Associate Professor, Programs in Occupational Therapy, College of Physicians and Surgeons, Columbia University, 710 West 168th St., 8th Floor, New York, NY 10032; ccc2114@ columbia.edu OBJECTIVE. To examine the relationships between self-reported and performance-based hand function. METHOD. Thirty participants with hand function limitations completed the Manual Ability Measure (MAM–36) and the Upper Extremity Performance Test for the Elderly (TEMPA). Participants were categorized into two groups: (1) Dominant Hand Affected and (2) Nondominant Hand Affected. Correlations between the two assessments were examined. The speed of task execution and TEMPA scores were compared between the two groups. RESULTS. A significant correlation was found between the MAM–36 and TEMPA Total Functional Rating (r = 0.79, p < .05). Significant differences were found in the speed of execution of unilateral tasks and the Unilateral Functional Ratings between the two groups. CONCLUSION. The MAM–36 is a promising assessment tool for measuring a client’s perceived hand function. However, a performance-based assessment can supplement information about the quality and speed of hand-task performance. Rallon, C. R., & Chen, C. C. (2008). Relationship between performance-based and self-reported assessment of hand func- tion. American Journal of Occupational Therapy, 62, 574–579. Celina R. Rallon, Christine C. Chen I n evaluating and treating clients with hand function problems, occupational therapistsarefacedwithdecidingwhichassessmenttooltouse.Amongthecur- rentlyavailabletools,onetypeisstandardized,performancebased,andadministered by the therapist, whereas another is self-report. Performance-based assessments providethetherapistwithobjectiveandfirsthand(orobserved)informationabout theclient’shandfunctionbutaremoretimeconsuming.Questionnairesarefilled outbyclientstoshowtheirownratingoftheirhanduse;theyareusuallyquicker toadministerbutprovidetheoccupationaltherapistwithonlysubjectiveinforma- tionabouttheclient’sperception.Severalstudiesdemonstratetheimportanceof usingeitherstandardizedassessmentsorquestionnaires.However,onlyminimal studyhasbeendonetoshowthecorrelationbetweenfindingsfromastandardized test and a client’s self-report of hand function. The purpose of this exploratory researchwastoexaminetheextenttowhichaclient’sself-reportrelatestooragrees withtheoccupationaltherapist’sevaluationofhanduse. Literature Review Standardized Assessments Theuseofstandardizedtestshasbeenwellrecognizedinevaluatingclientswith upper-extremityorhandimpairmentsbecausestandardizedtestsprovideaccurate andobjectiveinformationthatcanbeusedfortreatmentplanninganddetermining treatmenteffectiveness(Rudman&Hannah,1998).Inmanyclinicalsettings,for Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930099/ on 09/02/2018 Terms of Use: http://AOTA.org/terms

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574� September/October 2008, Volume 62, Number 5

Relationship Between Performance-Based and Self-Reported Assessment of Hand Function

KEY WORDS• evaluation• limitation of activities• rehabilitation• task performance

Celina R. Rallon, MA, OTR/L, CHT, ICLM, SIPT-C, is Occupational Therapy Specialist, Department of Rehabilitation Medicine, Staten Island University Hospital, Staten Island, NY.

Christine C. Chen, ScD, OTR/L, FAOTA, is Associate Professor, Programs in Occupational Therapy, College of Physicians and Surgeons, Columbia University, 710 West 168th St., 8th Floor, New York, NY 10032; [email protected]

OBJECTIVE. To examine the relationships between self-reported and performance-based hand function.

METHOD. Thirty participants with hand function limitations completed the Manual Ability Measure (MAM–36) and the Upper Extremity Performance Test for the Elderly (TEMPA). Participants were categorized into two groups: (1) Dominant Hand Affected and (2) Nondominant Hand Affected. Correlations between the two assessments were examined. The speed of task execution and TEMPA scores were compared between the two groups.

RESULTS. A significant correlation was found between the MAM–36 and TEMPA Total Functional Rating (r = 0.79, p < .05). Significant differences were found in the speed of execution of unilateral tasks and the Unilateral Functional Ratings between the two groups.

CONCLUSION. The MAM–36 is a promising assessment tool for measuring a client’s perceived hand function. However, a performance-based assessment can supplement information about the quality and speed of hand-task performance.

Rallon, C. R., & Chen, C. C. (2008). Relationship between performance-based and self-reported assessment of hand func-tion. American Journal of Occupational Therapy, 62, 574–579.

Celina R. Rallon, Christine C. Chen

In� evaluating� and� treating� clients�with�hand� function�problems,� occupational�therapists�are�faced�with�deciding�which�assessment�tool�to�use.�Among�the�cur-

rently�available�tools,�one�type�is�standardized,�performance�based,�and�administered�by� the� therapist,�whereas� another� is� self-report.�Performance-based� assessments�provide�the�therapist�with�objective�and�firsthand�(or�observed)�information�about�the�client’s�hand�function�but�are�more�time�consuming.�Questionnaires�are�filled�out�by�clients�to�show�their�own�rating�of�their�hand�use;�they�are�usually�quicker�to�administer�but�provide�the�occupational�therapist�with�only�subjective�informa-tion�about�the�client’s�perception.�Several�studies�demonstrate�the�importance�of�using�either�standardized�assessments�or�questionnaires.�However,�only�minimal�study�has�been�done�to�show�the�correlation�between�findings�from�a�standardized�test�and�a�client’s� self-report�of�hand�function.�The�purpose�of� this�exploratory�research�was�to�examine�the�extent�to�which�a�client’s�self-report�relates�to�or�agrees�with�the�occupational�therapist’s�evaluation�of�hand�use.

Literature Review

Standardized Assessments

The�use�of�standardized�tests�has�been�well�recognized�in�evaluating�clients�with�upper-extremity�or�hand�impairments�because�standardized�tests�provide�accurate�and�objective�information�that�can�be�used�for�treatment�planning�and�determining�treatment�effectiveness�(Rudman�&�Hannah,�1998).�In�many�clinical�settings,�for�

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The American Journal of Occupational Therapy� 575

example,�dexterity�tests�are�used�to�evaluate�upper-extremity�function� (Desrosiers,� Hebert,� Bravo,� &� Dutil,� 1995).�Common�standardized�assessments�include�the�Nine�Hole�Peg�Test�(Mathiowetz,�Weber,�Kashman,�&�Volland,�1985),�the�Box�and�Block�Test�(Mathiowetz,�Volland,�Kashman,�&�Weber,�1985),�and�the�Purdue�Pegboard�(Tiffin,�1968).�All�of� these�assessments�use� speed�of�manipulation�as� the�surrogate�of�hand�function�(O’Neill,�1995).�The�Nine�Hole�Peg�Test�has�a�high�interrater�reliability�(intraclass�correlation�[ICC]�=�.98�to�.99;�Oxford�Grice�et�al.,�2003).�The�Box�and�Block�Test�has�a�high�test–retest�reliability�(ICC�=�.89�to�.97;�Desrosiers,�Bravo,�Hebert,�Dutil,�&�Mercier,�1994).�The�Purdue�Pegboard�also�has�a�high�test–retest�reliability�(ICC�=� .85� to� .90;�Gallus�&�Mathiowetz,�2003).�These�assess-ments,�however,�do�not�consider�the�following:�(1)�the�func-tion�of�the�entire�upper�extremity,�(2)�how�the�measurement�of�components�of�hand�function�(i.e.,�speed)�translates�into�use�of�the�extremity�in�daily�life,�and�(3)�the�effect�of�artificial�setting�in�which�the�testing�occurs.

Questionnaires

Questionnaires�are�a�part�of�the�evaluation�of�upper-extrem-ity�and�hand�conditions�and�allow�us�to�better�understand�what�clients�experience�(Schuind�et�al.,�2003).�Questionnaires�are� also� easier� to� administer� than�physical� testing:�They�require�no�special�equipment,�are�less�time�consuming,�and�can�be� self-administered� and� therefore� eliminate�observer�bias�(Amadio,�2001).�Amadio�(2001),�however,�pointed�out�that�questionnaires�are�not�the�best�tool�to�measure�anatomic�or�physiologic�impairments.�Even�with�an�increase�in�the�use�of�client�self-report�outcome�measures�by�clinicians,�some�practitioners�hesitate� to�use� them�as�part�of� their�practice�(Michener�&�Leggin,�2001).�According�to�Michener�and�Leggin� (2001),� there� is� a�belief� among�practitioners� that�information�gathered�through�self-report�is�subjective,�less�reliable,�and�less�accurate�than�information�obtained�through�standardized�assessments.�They�concluded,�however,�that�if�a�questionnaire�is�well�designed�and�validated,�the�informa-tion�collected�from�clients�through�this�method�is�also�reli-able�(Michener�&�Leggin,�2001).

Correlation Between Objective and Subjective Assessments

Numerous� studies� demonstrate� the� importance�of� either�standardized�assessments�(Desrosiers�et�al.,�1995;�Pap,�Angst,�Herren,� Schwyzer,� &� Simmen,� 2003;� Richards,� Stoker-Yates,�Pohl,�Wallace,�&�Duncan,�2001;�Rudman�&�Hannah,�1998;�Schuind�et�al.,�2003)�or�client�self-report�assessments�(Amadio,�2001;�Barbier,�Penta,�&�Thonnard,�2003;�Chen,�Granger,�Peimer,�Moy,�&�Wald,�2005;�Michener�&�Leggin,�2001;�Pap�et�al.,�2003;�Schuind�et�al.,�2003).�However,�only�

one�study�correlated�the�findings�between�the�two�types�of�assessments:�O’Connor�and�colleagues�(1999)�attempted�to�correlate�the�findings�from�two�objective�measures�(Sollerman�Hand� Function� Test� [Sollerman� &� Ejeskär,� 1995]� and�Sequential�Occupational�Dexterity�Assessment�[van�Lankveld�et�al.,�1996])�with�two�subjective�measures�(Visual�Analog�Scales� for�Pain� and� the�Upper�Limb�Health�Assessment�Questionnaire�[ULHAQ],�both�of�which�can�be�found�as�components�of�the�Health�Assessment�Questionnaire�[see�Bruce�&�Fries,�2005])�for�clients�with�rheumatoid�arthritis.�This� study� showed� a� strong� relation�between� the� scores;�however,�reliability�and�validity�of�the�ULHAQ�has�not�been�studied,�and�this�study�involved�clients�with�only�one�specific�condition�(rheumatoid�arthritis).�Therefore,�the�purpose�of�the�current�study�is�to�examine�the�relation�between�a�self-reported�hand�function�measure�and�a�performance-based�standardized�test.

Method

Description of Participants

The�participants�consisted�of�30�adults�who�had�hand�func-tional�limitations�caused�by�current�or�past�injuries�or�dis-eases� such� as� fractures,� carpal� tunnel� syndrome,�previous�hand�surgeries,�arthritis,�and�stroke.�The�participants�were�occupational�therapy�clients�who�responded�to�an�advertise-ment� posted� at� the� outpatient� Occupational� Therapy�Department�of�Staten�Island�University�Hospital�in�Staten�Island,�New�York.

Inclusion Criteria

To�be�included�in�the�study,�participants�had�to�be�more�than�18�years�old�and�pass�a�screening�assessment�that�deter-mined�whether�the�participant�had�adequate�cognitive�ability�to�follow�instructions.

Instruments

We�used�the�Manual�Ability�Measure�(MAM–36;�Chen�&�Giustino,� 2007;� Chen,� Kasven,� Karpatkin,� &� Sylvester,�2007)�and�the�Upper�Extremity�Performance�Test�for�the�Elderly�(TEMPA;�Desrosiers,�Hebert,�Dutil,�&�Bravo,�1993)�to�assess�hand�function�among�the�participants.

MAM–36. The�MAM–36,�a�recently�developed,�psycho-metrically�sound�outcome�measurement�tool�that�is�a�task-oriented� and� client-centered�questionnaire,�measures�per-ceived�manual�ability�(Chen�&�Giustino,�2007;�Chen�et�al.,�2007).�It�consists�of�a�list�of�36�discrete�hand�tasks.�A�4-point�rating�system�is�used�for�the�client�to�indicate�how�easy�or�hard�the�task�is�for�him�or�her�to�perform:�4�(easy),�3�(a little hard),�2�(very hard),�and�1�(cannot do).�Chen�and�colleagues�

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576� September/October 2008, Volume 62, Number 5

have�demonstrated�evidence�of�the�reliability�and�validity�of�the�MAM–36:�Rasch�person�reliability�ranged�from�0.83�to�0.94,�and�the�item�reliability�ranged�from�0.85�to�0.98�(Chen�et�al.,�2007;�Chen�&�Giustino,�2007).�They�also�provided�preliminary�evidence�of�criterion-related�validity�(Chen�et�al.,�2005).�A�copy�of�the�MAM–36�can�be�found�at�Chen�et�al.�(2007).

Compared�with�the�Disabilities�of�the�Arm,�Shoulder�and�Hand�assessment�(Beaton�et�al.,�2001),�which�measures�clients� performing� complex� tasks� including� recreational�activities�and�heavy�household�chores,�tasks�in�the�MAM–36�are� simpler�and�more� specific� to� the�construct�of�manual�ability�(Chen�et�al.,�2005).�Unlike�ABILHAND�(Barbier�et�al.,� 2003),� a�questionnaire�developed� to�measure�manual�ability� that�was� administered� to� a� sample�of� clients�with�rheumatoid�arthritis�and�chronic�stroke�only,�the�MAM–36�was� administered� to� a� sample�of� clients�with� a� variety�of�impairments,�such�as�rheumatoid�and�osteoarthritis,�multiple�sclerosis,� cerebral� vascular� accident� (CVA),� carpal� tunnel�syndrome,�tenosynovitis,�and�traumatic� injuries� including�fractures�and�open�wounds�(Chen�et�al.,�2005,�2007;�Chen�&� Giustino,� 2007).� The� MAM–36,� therefore,� has� been�shown� to�be� a�promising�outcome�measurement� tool� to�measure�manual�ability.

TEMPA. The�Upper�Extremity�Performance�Test�for�the�Elderly�(TEMPA;�Desrosiers,�Hebert,�Dutil,�&�Bravo,�1993)�is� a� standardized� assessment� developed� to� assess� upper-extremity�function;�it�includes�both�quantitative�and�qualita-tive� information� (Desrosiers� et� al.,� 1995).� It� has� been�regarded�as�an�assessment�with�adequate�psychometric�prop-erties�and�clinical�utility�(Rudman�&�Hannah,�1998).�The�TEMPA�requires�a�person�to�perform�nine�tasks�related�to�activities�of�daily�living:�five�bilateral�tasks�(open�a�jar�and�remove�a�spoonful�of�coffee,�unlock�a�lock�and�open�a�pill�container,�write�on� an� envelope� and� stick� a� stamp�on� it,�shuffle�and�deal�playing�cards,� and� tie� a� scarf� around� the�neck)�and�four�unilateral�tasks�(pick�up�and�move�a�jar,�pick�up�a�pitcher�and�pour�water�into�a�glass,�handle�coins,�and�pick�up�and�move�small�objects).�Three�parameters�are�mea-sured�for�each�task:�(1)�speed,�(2)�functional�rating,�and�(3)�task�analyses.�The�functional�rating�(FR)�indicates�the�extent�of�independent�completion�of�the�task,�and�there�are�four�scores:� unilateral� functional� ratings� (R–FR�or�L–FR)� for�unilateral�hand�tasks,�bilateral�functional�rating�(B–FR)�for�bilateral�hand�tasks,�and�the�total�or�combined�functional�rating.�If�the�task�is�successfully�completed�without�assistance�or�modification,�a�score�of�0�is�given;�if�the�task�is�completed�with�some�difficulty,�a�score�of�–1�is�given;�if�the�task�could�only�be�partially�completed�or�performed�in�its�entirety�with�major�difficulty,�a�–2�is�given;�if�more�than�25%�of�the�task�cannot�be�performed,�a�–3�is�given.

The�TEMPA�has�been�shown�to�have�excellent� test–retest� reliability� for� its� speed�of� execution� and� functional�rating� components� (Richards� et� al.,� 2001).�According� to�Richards�et�al.�(2001),�ICC�was�.89�for�the�unilateral�tasks�of�the�TEMPA�and�>.97�for�the�functional�rating�compo-nent�of�the�test.�Concurrent�validity�of�the�TEMPA�has�been�established�(Desrosiers,�Hebert,�Dutil,�Bravo,�&�Mercier,�1994).� High� correlations� (.90� to� .95)� exist� between� the�TEMPA’s� four� functional� ratings� and� task� analysis� total�scores�and�the�Action�Research�Arm�Test�(Lyle,�1981).

Procedure

The�Institutional�Review�Boards�of�New�York�University�and�Staten�Island�University�Hospital�approved�this�research.�The�researcher�screened�each�possible�participant�to�deter-mine�whether�he�or�she�was�eligible�as�a�candidate�using�the�screening� assessment.�The�MAM–36� and�TEMPA�were�administered�to�each�participant,�and�after�each�participant�completed�the�two�hand�function�assessments,�he�or�she�was�asked�to�rate�himself�or�herself�on�the�ease�or�difficulty�of�the�TEMPA�activities�as�well.

Data Analysis

Descriptive�statistics�were�calculated�to�determine�the�char-acteristics�of�the�participants.�Ordinal�ratings�of�the�MAM–36�were�first� transformed� into� interval�measures� through�Rasch�Rating�Scale�Analysis� (Wright�&�Masters,� 1982).�Next,�Spearman�correlations�were�conducted� to�examine�the�relationships�between�the�MAM–36�and�the�functional�ratings�of�the�TEMPA.�The�participants�were�categorized�into�two�groups:�(1)�Dominant�Hand�Affected�(participants�whose�dominant�hand�was�also�the�affected�or�symptomatic�hand)�and�(2)�Nondominant�Hand�Affected�(participants�whose�nondominant�hand�was�the�affected�or�symptomatic�hand).�Four�participants�who�had�both�hands�affected�were�assigned�to�a�group�depending�on�which�hand�was�more�symptomatic.�T�tests�were�conducted�to�compare�functional�ratings,�task�performance�speed,�and�MAM–36�measures�of�the�two�groups.

ResultsTwenty�women�and�10�men�(n�=�30)�participated� in�the�study.�The�participants’�ages�ranged�from�34�to�76�(M�=�56.07,�SD�=�11.87).�Most�of�the�participants�had�a�diagnosis�that�fell�under�the�orthopedic�category�involving�the�hand�(26.7%),�such�as�wrist�sprain,�capsulotomy�of�the�metacarpal�joints,�wrist�fracture,�and�tendon�transfer�or�repair;�another�13.3%�had�involvement�of�parts�of�the�arm�other�than�the�hand,�such�as�shoulder�adhesive�capsulitis,�lateral�epicondy-litis,�rotator�cuff�tear,�and�shoulder�bursitis.�An�additional�

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The American Journal of Occupational Therapy� 577

23.3%�had�a�diagnosis�that�fell�under�the�“other”�category,�which�included�brachial�plexopathy,�Charcot�Marie�Tooth�Disease,�diabetic�neuropathy,�reflex�sympathetic�dystrophy,�and�hand�infection.�Twenty�percent�had�a�diagnosis�of�CVA.�Last,�16.7%�had�a�diagnosis�of�spinal�cord�injury,�rheuma-toid�arthritis,�or�osteoarthritis.�Twenty-four�of�the�partici-pants�(80%)�were�right-hand�dominant,�whereas�the�other�six�were�left-hand�dominant.�Eighteen�participants�(60%)�had�their�left�hand�affected,�eight�(26.7%)�had�their�right�hand�affected,�and� the� remaining� four� (13.3%)�had�both�hands�affected.

Significant�correlations�were�noted�between�the�MAM–36�measures� and� the� functional� ratings� on� the� TEMPA�(Table�1).�The�Dominant�Hand�Affected�group�consisted�of�12�participants,�and�the�Nondominant�Hand�Affected�group�had�18�participants.�Eight�participants�(67%)�in�the�Dominant�Hand�Affected�group�were�right-hand�dominant,�whereas�16�participants�(89%)�were�right-hand�dominant�in�the�Nondominant�Hand�Affected�group.�The�t-test�analyses�revealed�a�significant�difference�between�the�two�groups�for�the�TEMPA�functional�ratings�for�the�right-�and�left-handed�unilateral� tasks� (Table�2).�The�Dominant�Hand�Affected�group�had�a�lower�group�mean�(–3.25)�for�the�functional�rating�for�the�right�than�the�Nondominant�Hand�Affected�group�(–1.28).�Conversely,�the�Dominant�Hand�Affected�group�had�a�higher�group�mean�for�the�functional�rating�for�the�left�than�the�Nondominant�Hand�Affected�group.�No�significant�difference�was�noted�for�the�bilateral�and�com-bined�functional�ratings�of�the�TEMPA,�the�MAM–36�mea-sures,�and�task�performance�speed�for�all�five�bilateral�tasks�of� the� TEMPA� between� the� two� groups.� Although� the�MAM–36�measures�did�not� show�a� significant�difference�between�the�two�groups,�it�should�be�noted�that�the�group�mean�was�0.92�logits�for�the�Dominant�Hand�Affected�group�and�1.09�logits�for�the�Nondominant�Hand�Affected�group,�indicating�that�the�manual�ability�was�greater�in�those�who�had�their�nondominant�hand�impaired.�A�significant�differ-ence�was�noted�in�the�task-performance�speed�for�the�follow-ing�unilateral�tasks�of�the�TEMPA:�(1)�picking�up�a�jar�with�the�right�or�the�left,�(2)�pouring�with�a�pitcher�with�the�right,�

(3)�handling�coins�with�the�left,�and�(4)�picking�up�small�objects�with�the�left.

ConclusionThe�findings�of�this�study�showed�a�moderate�correlation�between�a�client’s�self-report�(MAM–36)�and�standardized�assessment�(TEMPA)�of�hand�function.�Moreover,�the�speed�of�execution�and�the�proficiency�of�performance�were�sig-nificantly�compromised�when�clients�performed�unilateral�hand�tasks�with�their�affected�hand.�Last,�the�fact�that�no�between-group�difference�was�found�in�the�MAM–36�or�the�TEMPA�bilateral�or�combined�functional�ratings�suggests�that�the�MAM–36�measured�the�bilateral�or�overall�manual�ability�of�the�clients.

The�MAM–36�is�a�promising�assessment�tool�that�occu-pational�therapists�can�use�as�a�valid�measure�to�quickly�and�adequately�evaluate�a�client’s�hand�function.�This�tool�may�be�helpful�to�many�clinicians�to�better�manage�the�time�spent�with�their�clients.�Self-report�questionnaires�need�to�be�short�enough�for�easy�completion�and�review�and�must�contain�items� that� will� evaluate� a� client’s� functional� limitations�(Michener�&�Leggin,�2001).�When�additional�information�

Table 1. Correlations Between MAM–36 and Functional Ratings of the Upper Extremity Performance Test for the Elderly

MAM FR–R FR–L FR–bilateral

FR–R 0.38*FR–L 0.38* –0.35FR–bilateral 0.68** 0.47** 0.23FR–combined 0.79** 0.54** 0.47** 0.87**

Note. MAM = Manual Ability Measure; FR–R = functional rating of the right hand; FR–L = functional rating of the left hand.

*p < .05. **p < .01.

Table 2. T-test Analyses Comparing the TEMPA Functional Ratings and MAM–36 Measures of the Dominant Hand Affected and Nondominant Hand Affected Groups

M SD T test

Unilateral functional rating for tasks performed with the right hand Dominant hand affected –3.25 2.45 Nondominant hand affected –1.28 2.24 (Range = 12–0) 0.03*Unilateral functional rating for tasks performed with the left hand Dominant hand affected –1.67 3.05 Nondominant hand affected –3.83 2.40 (Range = 12–0) 0.03*Bilateral functional rating Dominant hand affected –5.17 2.12 Nondominant hand affected –4.56 1.75 (Range = 15–0) 0.40Total/combined functional rating Dominant hand affected –10.08 4.75 Nondominant hand affected –9.67 4.89 (Range = 39–0) 0.82Total MAM raw score Dominant hand affected 102.33 18.86 Nondominant hand affected 105.44 21.84 0.69MAM measure (logits) Dominant hand affected 0.92 1.28 Nondominant hand affected 1.09 1.49 0.75

Note. TEMPA = Upper Extremity Performance Test for the Elderly; MAM–36 = Manual Ability Measure–36.

*p < .05.

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578� September/October 2008, Volume 62, Number 5

is�needed�about�a�client’s�quality�of�performance�on�a�given�task�(i.e.,�how�fast�or�coordinated�a�task�is�done),�however,�a�performance-based�assessment�such�as�the�TEMPA�may�be�needed.�These�findings� are� similar� to� the�findings� of�O’Connor�et�al.�(1999),�which�showed�the�need�for�using�a�more�sensitive�assessment�tool�to�determine�the�severity�of�hand�function�limitation�than�a�self-report�measure�alone.

The� current� sample� included�participants�with�hand�impairments�and�functional�limitations.�Many�of�them�have�had�the�condition�for�some�time�and�have�learned�to�adapt.�A�limitation�of�the�current�study�is�that�the�severity�of�the�participants’� hand� impairment�was�not� categorized.�The�participants�were� also�not� categorized� according� to� their�diagnosis.�Additional�data�from�a�larger�sample�size�is�needed�to�clarify�whether�a�stronger�correlation�exists�between�the�two�hand�function�assessments�and�whether�clearer�differ-ences�may�be�found�between�people�with�injuries�to�their�dominant�hand�and�those�whose�symptomatic�hand�is�their�nondominant�hand.

The� information� gained� from� the� MAM–36� and�TEMPA�is�valuable.�Both�measures�offer�information�on�a�client’s�ability�to�function�and�complete�tasks.�At�the�same�time,�the�two�assessments�offer�important�as�well�as�different�additional�information�about�the�client.�The�MAM–36�pro-vides�insight�into�the�client’s�perception�of�his�or�her�ability�to�function,�whereas�the�TEMPA�provides�information�on�the�speed�and�proficiency�of�performance.�The�MAM–36�requires�the�client�to�rate�the�difficulty�of�the�tasks�regardless�of�which�hand� is�used� to�perform� the� tasks,�whereas� the�TEMPA�can�compare�the�performance�of�the�affected�hand�to�that�of�the�nonaffected�hand,�especially�with�unilateral�tasks.�Therefore,�the�use�of�a�performance-based�assessment�complements�that�of�a�self-report,�and�both�may�be�necessary�for�a�thorough�occupational�therapy�evaluation�and�treat-ment�planning.� s

AcknowledgmentsThis�research�was�undertaken�in�partial�fulfillment�of�Celina�R.�Rallon’s�requirements�for�an�advanced�masters�of�occu-pational� therapy�degree� from�New�York�University.�The�research�was�partially�supported�by�a�National�Institutes�of�Health�career�development�grant�awarded�to�Christine�C.�Chen,�ScD�(5K23HD042702).�We�extend�our�thanks�to�the�people�who�participated�in�the�research.

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