Upper Extremity Functional Index (UEFI) Calculator

How does the upper extremity functional index (UEFI) calculator work?

This is a health tool that evaluates the limitation in fulfilling daily activities caused by upper limb problems. This is a quick to administer (usually 5 minutes) questionnaire that starts with the following instruction:

“We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer for each activity.

Today, do you or would you have any difficulty at all with:”

Then, the upper extremity functional index (UEFI) calculator lists 20 day to day activities:

1. Any of your usual work, housework, or school activities;

2. Your usual hobbies, recreational or sporting activities;

3. Lifting a bag of groceries to waist level;

4. Lifting a bag of groceries above your head;

5. Grooming your hair;

6. Pushing up on your hands (eg, from bathtub or chair);

7. Preparing food (eg, peeling, cutting);

8. Driving;

9. Vacuuming, sweeping or raking;

10. Dressing;

11. Doing up buttons;

12. Using tools or appliances;

13. Opening doors;

14. Cleaning;

15. Tying or lacing shoes;

16. Sleeping;

17. Laundering clothes (eg, washing, ironing, folding);

18. Opening a jar;

19. Throwing a ball;

20. Carrying a small suitcase with your affected limb.

The UEFI is usually applied in the assessment of people with upper extremity orthopaedic conditions in order to determine their functional status in a series of normal activities, from self care or leisure to housework tasks.

When referring to upper extremity musculoskeletal impairments, this concerns the shoulder, elbow, wrist and hand areas.

Amongst the recognized strengths of the model there is the fact that it is easy to administer, with straight forward items that do not require further explanation, therefore can be self administered and as well the fact that it allows a quick and simple identification of the main areas of concern that should be addressed in physical and pain management therapies.

Some of the criticism received by the UEFI concerns the fact that it is not entirely specific in delineating which part of the specific action is found to be difficult and because of what. At the same time, the lack of a score interpretation with specific cut offs seems to encourage assessor subjectivity and less reliability.

UEFI score interpretation

The patient is required to score each one of the actions above based on the difficulty met while trying to perform it. The 5 point scale used is:

■ Extreme difficulty or unable to perform activity (0 points);

■ Quite a bit of difficulty (1 point);

■ Moderate difficulty (2 points);

■ A little bit of difficulty (3 points);

■ No difficulty (4 points).

Therefore the answers that suggest a higher severity of the upper limb impairment weight 0, 1 or 2 points. While the answer choices that suggest less difficulty weight 3 or 4 points.

The overall score ranges between 0, most severe limitation to 80, least limitation.

There are no specific cut off points for the impairment severity degree within the 0 to 80 score range of the Upper Extremity Functional Index. The indication in the original study is that lower scores indicate that the subject is reporting increased difficulty with the activities as a result of their upper limb condition.

When the test is repeated, there is a nine scale point threshold as a minimum amount to be recognized as a significant change.

The test-retest reliability coefficient was found to be 0.95 with an internal consistency of 0.94. There have also been conducted several validation studies.

References

1) Stratford P, Binkley J, Stratford D. (2001) Development and initial validation of the upper extremity functional index. Physiotherapy Canada; 53(4):259-67.

2) Gabel CP, Michener LA, Burkett B, Neller A. (2006) The Upper Limb Functional Index: development and determination of reliability, validity, and responsiveness. J Hand Ther; 19(3):328-48; quiz 349.

3) Chesworth BM, Hamilton CB. et al. (2014) Reliability and validity of two versions of the upper extremity functional index. Physiother Can; 66(3):243-53.