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Upper Extremity Functional Index

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Original Editor - Simisola Ajeyalemi

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Introduction

The Upper Extremity Functional Index (UEFI) is a region-specific patient-reported outcome measure (PROM) used to assess activity limitations related to upper extremity function. 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.[1][2]


The UEFI is available as the original 20-item UEFI (UEFI-20) and a Rasch-reduced 15-item version (UEFI-15). The UEFI-15 was developed after Rasch analysis of the UEFI-20 did not support unidimensional measurement structure.[3] The resulting UEFI-15 demonstrated fit to the Rasch model and provides an interval-level measure of upper extremity function.[3]

Intended Population

The UEFI was originally developed for individuals with musculoskeletal upper-extremity dysfunction.[2] Subsequent studies have also demonstrated its reliability and validity in other populations, including individuals following breast cancer surgery, patients with stable chronic obstructive pulmonary disease, burn injuries, and stroke.[2] [4] [5][6]

Available Versions

Cross-cultural adaptations of the UEFI have been developed and evaluated in several languages and populations, including Turkish, Arabic, Greek, Italian, Chinese (Cantonese) and Brazilian Portuguese.[1][7][8][9]

Method of Use

The UEFI-15 is self-reported questionnaire used to assess difficulty performing activities involving the upper extremity. It was developed from the original 20-item UEFI to improve measurement properties of the original instrument.[3] Patients respond to each item by circling a number that best describes their level of difficulty. Two versions are available: the original 20-item UEFI and the Rasch-validated 15-item UEFI.

UEFI-15

The UEFI-15 contains 15 activities related to work, household tasks, recreation, self-care, lifting and ADLs. Items are generally rated on a 5-point scale from 0 (extreme difficulty or unable to perform the activity) to 4 (no difficulty). One item "doing up buttons", uses a modified scoring structure of 0, 1, 1, 2, and 3 following Rasch analysis.[2]

The UEFI-15 raw score ranges from 0 to 59. The raw score is then converted using the published Rasch conversion table to give an interval-level total score ranging from 0 to 100, with higher scores indicating better upper-extremity function.[3]

UEFI-15 Items
  1. Any of your usual work, housework, or school activities
  2. Lifting a bag of groceries to waist level
  3. Placing an object onto, or removing it from an overhead shelf
  4. Washing your hair or scalp
  5. Pushing up on your hands (e.g., from bathtub or chair)
  6. Preparing food (e.g., peeling, cutting)
  7. Driving
  8. Vacuuming, sweeping or raking
  9. Doing up buttons (Modified: 0-3 scoring)
  10. Using tools or appliances
  11. Opening doors
  12. Cleaning
  13. Laundering clothes (e.g., washing, ironing, folding)
  14. Opening a jar
  15. Carrying a small suitcase with your affected limb

UEFI-20

The UEFI-20 is the original version of the measure and consists of 20 items scored from 0 to 4, producing a total score from 0 to 80. Higher scores indicate better upper-extremity function.[4]

Evidence

Reliability

The UEFI-15 has demonstrated excellent test-retest reliability. Chesworth et al. reported an intraclass correlation coefficient (ICC) of 0.94 for both the UEFI-15 and UEFI-20, indicating a high level of consistency between repeated measurements in individuals whose upper-extremity condition was considered stable.[10]

A 2023 systematic review of the psychometric properties of the UEFI also found generally strong evidence for test-retest reliability across studies evaluating the UEFI and its modified versions.[2]

Measurement Error

Chesworth et al. reported a minimal detectable change at the 90% confidence level (MDC90) of 8.8 points on the 0-100 UEFI-15 scale.[10] The MDC represents the amount of change required to exceed expected measurement error and can assist clinicians in determining whether a change in score likely reflects a true change in the upper-extremity function.

Validity

The UEFI-15 has demonstrated evidence of construct validity through expected relationships with other measures of upper-extremity function and patient-reported change.[2] Available evidence supports its use in assessing upper-extremity limitations, although measurement properties should be considered in relation to the specific version and population being assessed.

The original UEFI has also demonstrated convergent and longitudinal validity when compared to the Upper Extremity Functional Scale (UEFS).[11]

Responsiveness and Clinical Interpretation

The UEFI-15 has demonstrated responsiveness to changes in the upper-extremity function over time. Chesworth et al. reported a positive minimal clinically important difference (pMCID) of 6.7 points on the 0-100 scale.[10] However, the reported pMCID was smaller than the MDC90 of 8.8 points, indicating that a change considered important by the patient may still fall within range of measurement error.[10]

The authors found that pMCID estimates varied depending on whether the dominant or non-dominant upper extremity was affected.[10] Therefore, MCID values should not be interpreted as universal thresholds, and changes in the UEFI-15 scores should be considered alongside measurement error, the clinical context, and the individual's perceived change in function.

Cross-Cultural Adaptations

The UEFI has been translated and culturally adapted for use in several languages and populations. However, many cross-cultural validation studies have evaluated the original UEFI-20 rather than the Rasch-derived UEFI-15.[2] Measurement properties established for one language or version should not automatically be assumed to apply to another.

Summary

The Upper Extremity Functional Index (UEFI) is a patient-reported outcome measure that is used to assess activity limitations related to upper-extremity function. The UEFI-15 was developed from the original 20-item version and provides a practical measure of upper-extremity function. Overall, the UEFI has demonstrated good to excellent reliability, validity, and responsiveness across a range of upper-extremity conditions and populations. It can be used to assess functional status or monitor change over time, with consideration given to measurement error, clinically important change, and the population being assessed when interpretating scores.

Resources

UEFI-15

UEFI-20

UEFI-20 Calculator

References

  1. ↑ 1.0 1.1 Eleftherios Paraskevopoulos, Plakoutsis G, Papandreou M. A Pilot Test of the Measures of the Greek Version of Upper Extremity Functional Index in Patients with Lateral Elbow Tendinopathy. Medical Sciences [Internet]. 2023 Jun 28 [cited 2025 Feb 20];11(3):45–5.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Chiam SS, Che Daud AZ, Ahmad Roslan NF. Psychometric properties of the Upper Extremity Functional Index (UEFI): a systematic review. J Sustain Sci Manag. 2023;18(8):178-90.
  3. ↑ 3.0 3.1 3.2 3.3 Hamilton CB, Chesworth BM. A Rasch-validated version of the Upper Extremity Functional Index for interval-level measurement of upper extremity function. Phys Ther. 2013;93(11):1507-1519.
  4. ↑ 4.0 4.1 Binkley JM, Stratford P, Kirkpatrick S, Farley CR, Okoli J, Gabram S. Estimating the Reliability and Validity of the Upper Extremity Functional Index in Women After Breast Cancer Surgery. Clinical Breast Cancer. 2018 Dec;18(6):e1261–7.
  5. ↑ Alnahdi AH, Albarrati A. The Upper Extremity Functional Index: Reliability and Validity in Patients with Chronic Obstructive Pulmonary Disease. International Journal of Environmental Research and Public Health. 2021 Oct 10;18(20):10608.
  6. ↑ Itakussu EY, Morita AA, Kakitsuka EE, Kuwahara RM, Anami EHT, Pitta F, et al. The Brazilian-Portuguese version of the Upper Extremity Functional Index (UEFI): translation, cross-cultural adaptation and measurement properties for Brazilian adults after a burn injury. Burns. 2024;50(1):219-225.
  7. ↑ Alijathlani MF, Alshammari MO, Alsuwaygh MA, Al-Mutairi MS, Alijassir FF, Bindawas SM, Alnahdi AH. Cross-cultural adaptation and validation of the Arabic version of the upper extremity functional index. Disabil Rehabil. 2022;44(19):5656-5662.
  8. ↑ Karanasios S, Kampourakis G, Ntoulaveris I, Kouvaras K, Lignos I, Diamantopoulos N, Gioftsos G. Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Upper Extremity Functional Index. Cureus. 2023;15(1):e33381. doi:10.7759/cureus.33381.
  9. ↑ Pan H, Ng SSM, Liu TW, Tsoh J, Wong TWL. Psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index in people with chronic stroke. Front Neurol. 2023;14:989403.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H, et al. Reliability and Validity of Two Versions of the Upper Extremity Functional Index. Physiotherapy Canada. 2014 Jul;66(3):243–53.
  11. ↑ Stratford PW, Binkley JM, Stratford DM. Development and initial validation of the upper extremity functional index. Physiotherapy Can. 2001;53:259–67
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