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The Unilateral Below Elbow Test: a function test for children with unilateral congenital below elbow deficiency
Anita M Bagley1, Fred Molitor, Lisa V Wagner
1Shriners Hospital for Children Northern California, Sacramento, California 95817, USA. abagley@shrinenet.org
Insights
The Unilateral Below Elbow Test (UBET) reliably assesses bimanual task completion in children with limb differences. This functional evaluation tool is recommended for children using or not using their prostheses.
Area of Science:
- Pediatric Rehabilitation
- Occupational Therapy
- Prosthetics and Orthotics
Background:
- Bimanual functional assessment is crucial for children with unilateral upper limb differences.
- Existing tools may not adequately capture functional performance with and without prostheses.
- The Unilateral Below Elbow Test (UBET) was developed to address this gap.
Purpose of the Study:
- To evaluate the reliability of the Unilateral Below Elbow Test (UBET) for assessing bimanual function in children.
- To determine the reliability of two scoring scales: Completion of Task and Method of Use.
- To assess reliability across different age groups and prosthetic conditions.
Main Methods:
- The UBET includes nine tasks across four age-specific categories (2-21 years).
- Performance was rated using Completion of Task (interval scale) and Method of Use (nominal scale).
- Interrater and intrarater reliability were assessed using interclass correlation coefficients (ICC) and Cohen's kappa coefficients.
Main Results:
- High reliability (ICC > 0.80) was found for Completion of Task, particularly for older children and prosthesis-on conditions.
- Method of Use scoring showed higher reliability with prostheses on.
- Reliability varied across age groups, with younger children showing slightly lower scores for Completion of Task.
Conclusions:
- The UBET is a reliable tool for evaluating bimanual task completion in children with unilateral congenital below elbow deficiency.
- The 'Completion of Task' scale is recommended for functional evaluation with or without prostheses.
- The 'Method of Use' scale is valuable for guiding therapy and prosthetic training.
Abstract:
The Unilateral Below Elbow Test (UBET) was developed to evaluate function in bimanual activities for both the prosthesis wearer and non-wearer. Nine tasks were chosen for each of four age-specific categories defined by development stages of hand function (2-4y, 5-7y, 8-10y, and 11-21y). Two scales, Completion of Task and Method of Use, were designed to rate performance. To measure reliability, four occupational therapists scored samples of videotaped UBET performances. For Completion of Task, an interval scale, agreement in scoring was measured with interclass correlation coefficients (ICC; n=9; five females, four males). For Method of Use, a nominal scale, chance-adjusted association was calculated with Cohen's kappa coefficients (interobserver n=198; 111 females, 87 males; intraobserver n=93; 56 females, 37 males). For Completion of Task, the average ICC was 0.87 for the prosthesis-on condition, and 0.85 for the prosthesis-off condition. ICCs exceeded 0.80 for eight out of nine tasks for the two older age groups, but for only five out of nine tasks in the younger age groups. Higher inter- and intraobserver kappa coefficients for Method of Use resulted when scoring children with their prostheses on versus off. The oldest age group had lower kappa values than the other three groups. The UBET is recommended for the functional evaluation of Completion of Task in children with unilateral congenital below elbow deficiency with and without their prostheses. Method of Use scoring can evaluate individuals for directed therapy interventions or prosthetic training.
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