Upper Extremity Functional Index
Original Editor - Simisola Ajeyalemi
The Upper Extremity Functional Index (UEFI) is a patient report outcome measure used to assess functionality in the upper extremities in individuals with upper limb dysfunction of musculoskeletal origin. The original UEFI consists of 20 questions on a 5- point rating scale assessing level of difficulty in performing activities of daily living using the upper extremities including household and work activities, hobbies, lifting a bag of groceries, washing your scalp, pushing up on your hands, driving etc.
There are currently two versions of the upper extremity functional index; UEFI 20-item and UEFI 15-item. The 15-item was developed to fit the Rasch analysis and it has been recommended because it's unidimensional. The effect of arm dominance on the positive minimal clinically important difference (pMCID) has not been determined for both versions of UEFI.
The UEFI has been adapted into other languages including Turkish, French Canadian and Spanish.
The UEFI is intended for use in individuals with upper extremity (including the shoulder, elbow, wrist and hand) dysfunction of musculoskeletal origin. A study by Binkley et al supported the use of UEFI in patients after breast cancer surgery.
Method of Use
The Upper extremity functional index is easy to administer. Patients respond to each item by circling a number that best describes their level of difficulty. Item scores range from 0 to 4, 0 indicates extreme difficulty while 4 indicates no difficulty with a task and the total score is a total of the item scores. Possible range on the UEFI 20-item from 0 – 80 with 0 indicating lowest functional status and 80 indicating highest functional status. The minimum amount of change that is considered to be clinically significant is 9 points
However, the UEFI-15 item is scored 0-59 and converted to give an interval level total score 0-100 with 0 indicating worst state and 100 best state.
In a study by Chesworth et al, reliability for the UEFI-20 and UEFI-15 was the same (ICC=0.94 for both measures). MDC values were 9.4/80 for the UEFI-20 and 8.8/100 for the UEFI-15. Positive minimal clinically important difference values were 8/80 for the UEFI-20 and 6.7/100 for the UEFI-15; pMCID was higher for people whose non-dominant arm was affected.
In a study by Stratford et al, comparing Upper Extremity Functional Index (UEFI 20- item) and the Upper Extremity Functional Scale (UEFS), the discriminant cross-sectional validity of the UEFI was found to be 6.65 with p = .003 while the convergent cross-sectional validity coefficient between the UEFI and the UEFS was 0.82. In the same study, the longitudinal validity coefficient between the UEFI and the UEFS was 0.74. This study concluded that the longitudinal validity of the Upper Extremity Functional Index was superior to the Upper Extremity Functional Scale.
- Stratford PW, Binkley JM, Stratford DM. Development and initial validation of the upper extremity functional index. Physiotherapy Can. 2001;53:259–67
- Jill M. Binkley, Paul Stratford, Stephanie Kirkpatrick,Clara R. Farley, Joel Okoli, Sheryl Gabram Estimating the Reliability and Validity of the Upper Extremity Functional Index in Women After Breast Cancer Surgery. 2018 Clinical Breast Cancer, Vol. 18, No. 6, e1261-7.
- Liebenson, C. (2007). Rehabilitation of the spine: A practitioner’s manual. Baltimore, MD: Lippincott Williams & Wilkins.
- Chesworth BM, Hamilton CB, Walton DM, et al. Reliability and validity of two versions of the upper extremity functional index. Physiother Can. 2014;66(3):243–253