Upper Extremity Functional Index (UEFI)

UEFI explained

The upper extremity functional index evaluates the impairment the subject perceives they encounter when performing 20 types of activities of daily living. The UEFI is addressed to patients diagnosed with orthopaedic conditions that affect the upper limb (shoulder, elbow, wrist or hand).

The following instruction needs to be provided before the questionnaire is administered:

“We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer for each activity.

Today, do you or would you have any difficulty at all with:”

The 20 activities included in the UEFI are listed in the following table:

There are other similar disability and pain evaluation questionnaires that evaluate the quality of life, such as the Shoulder Pain And Disability Index (SPADI) or the Expanded Disability Status Scale (EDSS).

Result interpretation

Each of the 20 actions in the UEFI is evaluated on a 5-point scale that refers to the perceived difficulty in performing the mentioned action:

■ Extreme difficulty or unable to perform activity (0 points);

■ Quite a bit of difficulty (1 point);

■ Moderate difficulty (2 points);

■ A little bit of difficulty (3 points);

■ No difficulty (4 points).

The overall UEFI result ranges between 0 and 80, where 0 indicates most severe limitation and 80 suggests least limitation.

The UEFI model does not provide any specific cut off points that could classify the upper limb disability degree, however, a minimal detectable change of 9 points is provided.

This means that for improvement or deterioration to be considered, between two subsequent evaluations, the scores must differ by at least 9 points.

Strengths and weaknesses of the model

The UEFI is based on a 2001 study by Stratford et al. and allows a simple identification of the level of functional impairment patients with upper limb ortopedic conditions suffer from. The index is easy to administer and to score.

The test-retest reliability coefficient was found to be 0.95 with an internal consistency of 0.94. The UEFI has also been validated in numerous studies.

On the other hand, the UEFI has been criticised for failing to provide insight into the underlying cause of difficulties encountered in specific actions and the fact that it does not offer an exhaustive severity classification.

Some of the activities in the index were also deemed to be too broad. The index is said to encourage both patient and assessor subjectivity, the first because the index is self-report and depends on patient perception of said difficulties and the second because of the lack of severity cut-offs.

Original source

Stratford P, Binkley J, Stratford D. Development and initial validation of the upper extremity functional index. Physiotherapy Canada. 2001; 53(4):259-67.

Validation

Chesworth BM et al. Reliability and Validity of Two Versions of the Upper Extremity Functional Index. Physiother Can. 2014; 66(3): 243–253.

Other references

1. Liebenson C. (2007) Rehabilitation of the spine: A practitioner’s manual. Baltimore, MD: Lippincott Williams & Wilkins.

2. Gabel CP, Michener LA, Burkett B, Neller A. The Upper Limb Functional Index: development and determination of reliability, validity, and responsiveness. J Hand Ther. 2006; 19(3):328-48; quiz 349.