Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties.

Abstract

Objective To provide an overview of applied upper limb outcome measures in MS, according to the ICF levels and review their psychometric properties in MS.

Data Source Pubmed and Web of Knowledge.

Study Selection Articles published until June 2013 were selected when written in English, published in the last 25 years, peer-reviewed, including more than 5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by two independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. 109 articles met the selection criteria and were included for data extraction.

Data Extraction All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by two independent reviewers. In addition, available psychometric properties (reliability, validity and responsiveness) in MS were summarized and discussed.

Data Synthesis A diversity of outcome measures assessing impairments on ‘body functions and structures’ level (n=33), upper limb capacity (n=11) and performance (n=8) on ‘activity’ level were extracted from 109 articles. Hand grip strength and the Nine Hole Peg Test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT.

Conclusion The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.