Scientific/Clinical Article| Volume 30, ISSUE 4, P500-506, October 2017

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Validity and reliability of the Functional Dexterity Test in children

Published:November 15, 2016DOI:


      Study Design

      Clinical measurement study.


      The Functional Dexterity Test (FDT) has not been validated in children.

      Purpose of the Study

      To determine reliability and validity of the FDT in a pediatric population.


      Intraclass Correlation Coefficients (ICCs) were used to calculate interrater and test-retest reliability in typically developing children. Pearson correlation coefficients were used to compare FDT speed with the Jebsen-Taylor Hand Function Test (JHFT) and with 2 activities of daily living tasks to establish validity in children with congenital hand differences.


      The FDT demonstrated excellent interrater (ICC, 0.99) and test-retest (ICC, 0.90) reliability. Pearson correlation coefficients exceeded 0.67 for JHFT subsets of fine dexterity and were all less than 0.66 for JHFT subsets of gross grasp. Correlations with the activities of daily living tasks were good to excellent. FDT speeds in TD children exceeded those of children with congenital hand differences (P < .001), demonstrating discriminant validity.


      Children with congenital hand differences are often treated early in life, making it important to reliably assess hand function of these young children to distinguish developmental change from changes due to interventions. The FDT can reliably measure functional progress over time, help clinicians monitor the efficacy of treatment, and provide families realistic feedback on their child’s progress.


      The FDT is a valid and reliable instrument for the measurement of fine motor dexterity in children.


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        • Szabo R.M.
        Outcomes assessment in hand surgery: when are they meaningful?.
        J Hand Surg Am. 2001; 26: 993-1002
        • Yancosek K.E.
        • Howell D.
        A narrative review of dexterity assessments.
        J Hand Ther. 2009; 22: 258-269
        • Fess E.E.
        The need for reliability and validity in hand assessment instruments.
        J Hand Surg. 1986; 11A: 621-623
        • Pehoski C.
        Object manipulation in infants and children.
        in: Hendreson and Pehoski ed. Hand Function in the Child, Foundations for Remediation. 2nd ed. Mosby, St. Luis2006: 151
        • Stamm T.A.
        • Cieza A.
        • Machoid K.P.
        • Smolen J.S.
        • Stucki G.
        Content comparison of occupation-based instruments in adult rheumatology and musculoskeletal rehabilitation based on the International Classification of Functioning, Disability, and Health.
        Arthritis Rheum. 2004; 51: 917-924
      1. Available at:

        • Aaron D.H.
        • Jansen C.W.
        Development of the Functional Dexterity Test (FDT): construction, validity, reliability, and normative data.
        J Hand Ther. 2003; 16: 12-21
        • Sartorio F.
        • Bravini E.
        • Vercelli S.
        • et al.
        The Functional Dexterity Test: test-retest reliability analysis and up-to date reference norms.
        J Hand Ther. 2013; 26 (quiz 68): 62-67
        • Netscher D.T.
        • Aliu O.
        • Sandvall B.K.
        • et al.
        Functional outcomes of children with index pollicizations for thumb deficiency.
        J Hand Surg Am. 2013; 38: 250-257
        • Staines K.G.
        • Majzoub R.
        • Thornby J.
        • Netscher D.T.
        Functional outcome for children with thumb aplasia undergoing pollicization.
        Plast Reconstr Surg. 2005; 116: 1314-1323
        • Aliu O.
        • Netscher D.T.
        • Staines K.G.
        • Thornby J.
        • Armenta A.
        A 5-year interval evaluation of function after pollicization for congenital thumb aplasia using multiple outcome measures.
        Plast Reconstr Surg. 2008; 122: 198-205
        • Weintraub N.
        • Gilmour-Grill N.
        • Weiss P.L.
        Relationship between handwriting and keyboarding performance among fast and slow adult keyboarders.
        Am J Occup Ther. 2010; 64: 123-132
        • Melchior H.
        • Vatine J.J.
        • Weiss P.L.
        Is there a relationship between light touch-pressure sensation and functional hand ability?.
        Disabil Rehabil. 2007; 29: 567-575
        • Melchior H.
        • Velema J.
        A comparison of the Screening Activity Limitation and Safety Awareness (SALSA) Scale to objective hand function assessments.
        Disabil Rehabil. 2011; 33: 2044-2052
        • Videler A.J.
        • Beelen A.
        • van Schaik I.N.
        • de Visser M.
        • Nollet F.
        Manual dexterity in hereditary motor and sensory neuropathy type 1a: severity of limitations and feasibility and reliability of two assessment instruments.
        J Rehabil Med. 2008; 40: 132-136
        • Lee-Valkov P.M.
        • Aaron D.H.
        • Eladoumikdachi F.
        • Thornby J.
        • Netscher D.T.
        Measuring normal hand dexterity values in normal 3-, 4-, and 5-year-old children and their relationship with grip and pinch strength.
        J Hand Ther. 2003; 16: 22-28
        • Schoneveld K.
        • Wittink H.
        • Takken T.
        Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation.
        J Hand Ther. 2009; 22: 221-235
        • Gogola G.R.
        • Velleman P.F.
        • Xu S.
        • Morse A.M.
        • Lacy B.
        • Aaron D.
        Hand dexterity in children: administration and normative values of the Functional Dexterity Test.
        J Hand Surg Am. 2013; 38: 2426-2431
        • Wainer H.
        Speed vs reaction time as a measure of cognitive performance.
        Mem Cognit. 1977; 5: 278-280
        • Jebsen R.H.
        • Taylor N.
        • Trieschmann R.B.
        • Trotter M.J.
        • Howard L.A.
        An objective and standardized test of hand function.
        Arch Phys Med Rehabil. 1969; 50: 311-319
        • Sears E.D.
        • Chung K.C.
        Validity and responsiveness of the Jebsen-Taylor Hand Function Test.
        J Hand Surg. 2010; 35: 30-37
        • Gordon A.M.
        • Duff S.V.
        Relation between clinical measures and fine manipulative control in children with hemiplegic cerebral palsy.
        Dev Med Child Neurol. 1999; 41: 586-591
        • Gordon A.M.
        • Schneider J.A.
        • Chinnan A.
        • Charles J.R.
        Efficacy of a hand–arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial.
        Dev Med Child Neurol. 2007; 49: 830-838
        • Cohen-Holzer M.
        • Katz-Leurer M.
        • Reinstein R.
        • Rotem H.
        • Meyer S.
        The effect of combining daily restraint with bimanual intensive therapy in children with hemiparetic cerebral palsy: a self-control study.
        NeuroRehabilitation. 2011; 29: 29-36
        • Dekker J.
        • Dallmeijer A.J.
        • Lankhorst G.J.
        Clinimetrics in rehabilitation medicine: current issues in developing and applying measurement instruments.
        J Rehabil Med. 2005; 37: 193-201
        • Molenaar H.M.
        • Selles R.W.
        • Schreuders T.A.
        • Hovius S.E.
        • Stam H.J.
        Reliability of hand strength measurements using the Rotterdam Intrinsic Hand Myometer in children.
        J Hand Surg Am. 2008; 33: 1796-1801
        • Davids J.R.
        • Peace L.C.
        • Wagner L.V.
        • Gidewall M.A.
        • Blackhurst D.W.
        • Roberson W.M.
        Validation of the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) for children with hemiplegic cerebral palsy.
        J Bone Joint Surg Am. 2006; 88: 326-333
        • Velleman P.F.
        • Hoaglin D.C.
        Exploratory data analysis.
        in: APA Handbook of Research Methods in Psychology. Data Analysis and Research Publication. Vol 3. American Psychological Association, Washington, DC2012: 5170
        • Lehman L.A.
        • Velozo C.A.
        Ability to detect change in patient function: responsiveness designs and methods of calculation.
        J Hand Ther. 2010; 23: 361-370

      JHT Read for Credit

      Quiz: #511

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        Reliability was established through this statistical method
        • a.
        • b.
        • c.
          Standard Deviations
        • d.
          Student T Tests
      • #2.
        Validity was determined by comparing FDT speeds with those of the
        • a.
        • b.
        • c.
          Hunter-Mackin Dexterity Test
        • d.
      • #3.
        In the context of dexterity testing, capacity refers to the patient's
        • a.
          sum total of manual performance over a given time
        • b.
          skill level in the manipulation of small objects
        • c.
          willingness and ability to perform the given task
        • d.
          accuracy of performing dexterous activities
      • #4.
        For validation volunteer subjects
        • a.
          had undergone reconstructive surgery of a hand injury
        • b.
          had a congenital hand condition
        • c.
          were old enough to give legal consent to participate in the study
        • d.
          were receiving hand therapy at the Houston VA hospital
      • #5.
        Prior to this report the FDT had not been validated for use with children
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.