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The Prosthetic Upper Extremity Functional Index: development and reliability testing of a new functional status
F V Wright1, S Hubbard, J Jutai
1Bloorview MacMillan Centre, Toronto, Ontario, Canada. vwright@bloorviewmacmillian.on.ca
Insights
The Prosthetic Upper Extremity Functional Index (PUFI) demonstrates good test-retest reliability for assessing pediatric prosthetic use. This tool effectively measures how children use prosthetic limbs in daily activities.
Area of Science:
- Rehabilitation Engineering
- Pediatric Prosthetics
- Functional Assessment
Background:
- Assessing functional outcomes in children with upper extremity prostheses is crucial for treatment effectiveness.
- Existing measures may not fully capture the nuances of prosthetic utilization in daily life.
- The Prosthetic Upper Extremity Functional Index (PUFI) was developed to address these evaluation gaps.
Purpose of the Study:
- To evaluate the test-retest and interrater reliability of the Prosthetic Upper Extremity Functional Index (PUFI).
- To determine the PUFI's effectiveness in measuring prosthetic limb use, ease of task performance, and perceived usefulness in children.
- To provide a reliable tool for clinicians and researchers assessing pediatric prosthetic users.
Main Methods:
- The study involved 24 children with upper extremity prostheses.
- Test-retest and interrater reliability were assessed using Intraclass Coefficients (ICCs) across four PUFI subscales.
- Data were collected from both child and parent respondents.
Main Results:
- Good test-retest reliability (ICCs > 0.65) was found for older child respondents.
- Fair to good reliability (ICCs 0.40-0.84) was observed for parent respondents.
- Interrater reliability between child and parent ratings showed variability (ICCs 0.30-0.77).
- Prosthetic use was reported at 53% for older children and over 75% for younger children.
Conclusions:
- The PUFI demonstrates good overall test-retest reliability as a measure of functional upper extremity activity in children using prostheses.
- The findings support the PUFI's utility in clinical and research settings for pediatric prosthetic users.
- Further investigation into child-parent rating discrepancies may enhance understanding of functional environments.
Abstract:
The Prosthetic Upper Extremity Functional Index (PUFI) was developed by the authors' clinical research group to evaluate the extent to which a child actually uses a prosthetic limb for daily activities, the comparative ease of task performance with and without the prosthesis, and its perceived usefulness. The PUFI's test-retest and interrater reliability were evaluated with 24 children. Intraclass coefficients (ICCs) were calculated for each of four subscales of the PUFI--specifically, method of performance, ease of prosthetic use, usefulness of the prosthesis, and ease of performance without the prosthesis. The ICCs were greater than 0.65, indicating good test-retest reliability for the older-child respondents (n = 10) and fair to good reliability (ICCs, 0.40 to 0.84) for the parent respondents overall (n= 21). Interrater (child-parent) reliability was lower, with ICCs from 0.30 to 0.77. This finding was not unexpected, since a child and parent may rate in the context of different functional environments. The prosthesis was used 53% of the time by older children and more than 75% of the time by younger children. The results provide evidence that the PUFI has good test-retest reliability overall as a measure of a child's ability to perform upper extremity activities with a prosthesis.