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Upper Extremity Functional Index

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Original Editor - Simisola Ajeyalemi

Top Contributors - Simisola Ajeyalemi, Kristen Holeman, Kim Jackson, Yvonne Yap, Amanda Ager, Janine van Dyk and Alexandra Stead

Introduction

The Upper Extremity Functional Index (UEFI) is a patient reported outcome measure used to assess the functional impairment in individuals with musculoskeletal upper limb dysfunction. 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.[1]


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, Spanish, Chinese, Greek and Arabic.[1]

Intended Population

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[2] supported the use of UEFI in patients after breast cancer surgery. With a more recent study also showed the UEFI can be used in patients with Chronic Obstructive Pulmonary Disease.[3]

Method of Use

The UEFI is easy to administer as it is a self-reported questionnaire. 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.[2]

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.

The 20 tasks in the UEFI include:

  1. Any of your usual work, housework, or school activities
  2. Your usual hobbies, recreational or sporting activities
  3. Lifting a bag of groceries to waist level
  4. Lifting a bag of groceries above your head
  5. Grooming your hair
  6. Pushing up on your hands (eg, from bathtub or chair)
  7. Preparing food (eg, peeling, cutting)
  8. Driving
  9. Vacuuming, sweeping or raking
  10. Dressing
  11. Doing up buttons
  12. Using tools or appliances
  13. Opening doors
  14. Cleaning
  15. Tying or lacing shoes
  16. Sleeping
  17. Laundering clothes (eg, washing, ironing, folding)
  18. Opening a jar
  19. Throwing a ball
  20. Carrying a small suitcase with your affected limb

Evidence

Reliability

In a study by Chesworth et al[4], 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.

Validity

In a study by Stratford et al[5], 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.

Resources

View Upper Extremity Functional Index

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 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.
  3. ↑ 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.
  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.
  5. ↑ 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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