Description: The Upper Extremity Functional Index (UEFI) is a 20-item, region-specific, patient-reported outcome measure developed by Paul Stratford and colleagues in 2001.1 The UEFI is used to measure upper extremity function in individuals with hand and upper extremity disorders. Patients rate their function on a 0 to 4 Likert scale, where 0 indicates extreme difficulty and 4 indicates no difficulty performing the task. This translates into a maximum possible score of 80, which indicates excellent function.2 The UEFI takes about 5 minutes to complete, and is easy to administer and score with minimal training. The total score is computed by adding up individual item scores.
Validity and reliability: The UEFI has been validated in a variety of populations like post-surgical patients with shoulder, elbow, wrist and hand conditions.1, 2, 3 The UEFI has demonstrated construct validity through moderate correlations with the Patient-Specific Functional Scale (0.59, 95% CI 0.48 to 0.67),2 and stronger correlations with UEFS (0.82) in a sample that consisted of upper extremity musculoskeletal conditions.1 The UEFI is able to distinguish improved patients from stable patients (AUC 0.88, 95% CI 0.81 to 0.94) with a sensitivity of 0.73 and a specificity of 0.92, and had a minimally important difference of 8.50 in a sample of shoulder, elbow, wrist and forearm musculoskeletal conditions.2 In the shoulder disorder population, UEFI has demonstrated moderate correlations with the Western Ontario Rotator Cuff Index (Spearman’s Rho = 0.78) and Rotator cuff Quality of life questionnaire (Spearman’s Rho = 0.67).3 The known group validity of the UEFI has been established through its ability to differentiate subgroups based on work status (p < 0.05).4 The UEFI has demonstrated acceptable sensitivity to change in a shoulder disorder population (SRM = 1.54).3 A Rasch analysis revealed misfit and multidimensionality in the original version of the UEFI, and a 15-item Rasch validated version has been proposed to provide a better fit to the Rasch model.5 The UEFI has been cross-culturally adapted into multiple languages (Turkish,6 French Canadian,7 Spanish8) and has shown consistent measurement properties to the original English version.
Studies have determined test re-test reliability and found it to be excellent (ICC 0.94, 95% CI 0.92 to 0.95) in a sample with shoulder, elbow, wrist and hand musculoskeletal conditions;4 ICC 0.95 in a sample of upper extremity musculoskeletal conditions,1 and ICC 0.85 (95% CI: 0.73, 0.92) in a sample with shoulder, elbow, wrist and forearm musculoskeletal conditions.2 It has also exhibited excellent internal consistency (Cronbach’s alpha 0.94).1The minimum clinically important difference value for the UEFI was 8/80 (shoulder, elbow, wrist and hand musculoskeletal conditions).4
The UEFI measures function related to upper extremity injuries and disorders.9 Although used and studied less than the DASH, it has demonstrated strong clinical measurement properties in multiple clinical populations. Clinicians should be aware that 20-item and 15-item versions exist. Further studies are required to clarify the optimal items and performance in additional clinical or cultural contexts.
- Stratford, P.W. et al. Physiother Can. 2001; 53: 259–267
- Hefford, C. et al. J Orthop Sports Phys Ther. 2012; 42: 56–65
- Razmjou, H. et al. BMC Musculoskelet Disord. 2006; 7: 26
- Chesworth, B.M. et al. Physiother Can. 2014; 66: 243–253
- Hamilton, C.B. et al. Phys Ther. 2013; 93: 1507–1519
- Aytar, A. et al. J Back Musculoskelet Rehabil. 2015; 28: 489–495
- Hamasaki, T. et al. J Hand Ther. 2014; 27: 247–252
- Cuesta-Vargas, A.I. et al. Health Qual Life Outcomes. 2013; 11: 126
- Hong, I. et al. Int J Rehabil Res. 2017; 40: 1–10