Upper Limb Outcome Measures

Upper limb instruments cover three different things. Region-wide patient-reported measures such as the Disabilities of the Arm, Shoulder and Hand questionnaire, its short form QuickDASH and the Upper Extremity Functional Index ask about the whole limb. Joint-specific measures such as the Penn Shoulder Score, the American Shoulder and Elbow Surgeons Score, the Simple Shoulder Test, the Western Ontario indices, the Boston Carpal Tunnel Questionnaire, the Michigan Hand Outcomes Questionnaire and the Patient-Rated Wrist and Hand Evaluation ask about one region in detail. Performance tests such as the Nine Hole Peg Test, the Box and Block Test, the Action Research Arm Test and the Pinch Gauge Test measure what the hand can actually do under observation.

The Motor Activity Log sits apart from all of these. It asks how much the affected arm is used in daily life and how well, which is a different question from what the arm is capable of in a clinic.

The gap between capacity and use is larger in the upper limb than almost anywhere else, particularly after stroke. A person can score reasonably on a performance test and still not use the arm spontaneously, a pattern well enough recognised to have driven a whole class of rehabilitation approaches. A study that measures only capacity will miss it entirely.

Region-wide and joint-specific instruments also behave differently. Region-wide measures allow comparison across a mixed upper limb caseload but are less responsive to change confined to one joint. Joint-specific measures are more sensitive within their region and cannot be pooled across regions. Where a study includes several conditions, collecting a region-wide instrument alongside the joint-specific one is the usual compromise.

Check hand dominance and record it, then record which side was affected. An outcome in the dominant hand is not equivalent to the same outcome in the non-dominant hand, and several performance tests have separate norms for each.

Check whether the instrument has a work or sports module. Some, including the DASH, have optional modules that are scored separately and must not be folded into the main score.

Check equipment standardisation for the performance tests. The Box and Block Test and the Nine Hole Peg Test depend on a specific apparatus and setup, and results from improvised equipment are not comparable with published norms. Where a test is timed, the instruction wording affects the result, so use the published script rather than a paraphrase.

What is the difference between DASH and QuickDASH?

QuickDASH is an 11-item short form of the 30-item DASH. It is a separate instrument with its own scoring and is not simply a subset score of the full version. Do not switch between them within a study.

Which instrument measures real-world arm use rather than ability?

The Motor Activity Log asks about amount and quality of use in daily life, which is distinct from what a performance test shows a person can do in a clinic. In stroke populations the two frequently diverge, and measuring only capacity overstates recovery.

Do I need special equipment for upper limb performance tests?

Yes for several of them. The Box and Block Test and the Nine Hole Peg Test both require standardised apparatus, and scores from non-standard equipment cannot be compared with published norms or between sites.

Should I record hand dominance?

Always. Dominance affects both baseline performance and expected recovery, and several tests have separate norms by hand. Record which side is dominant and which side is affected for every participant.