Research Article| Volume 35, ISSUE 2, P200-214, April 2022

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Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs

Published:April 18, 2021DOI:


      • Majority of the outcome measures used speed as a criterion for performance.
      • Newer outcome measures increasingly focus on representing daily activities and qualitative aspect of performance.
      • No outcome measure included in this review covered all the theoretical aspects and scope of dexterity and hand function.
      • As the terms: hand function and dexterity are not clearly defined, clinicians and researchers need to ensure that the outcome measure they select reflects the attribute they want to measure.



      Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity.


      This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions.

      Study Design

      Scoping review, with qualitative content analysis.


      MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function.


      Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks.


      Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.


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      JHT Read for Credit

      Quiz: # 845

      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.
        The design of the study is
        • a.
          retrospective cohort
        • b.
          a review of published literature on the topic
        • c.
          case series
        • d.
      • # 2.
        Experts agree that
        • a.
          the Moberg Pickup Test is the best test of manual dexterity
        • b.
          the Purdue Peg Board is the definitive test of manual dexterity
        • c.
          the 9 Hole Peg Test is the definitive test of manual dexterity
        • d.
          currently there is no consensus as to an operational definition to measure manual dexterity
      • # 3.
        The most common performance criterion was
        • a.
          patient evaluation of the task
        • b.
          difficulty of the task
        • c.
          speed of completion of the task
        • d.
          accuracy of the completed task
      • # 4.
        Smart phones and other modern-day technologies were
        • a.
          included in 45% of the PBOMDs
        • b.
          routinely absent from the PBOMDs
        • c.
          included in 75% of the PBMODs
        • d.
          felt by the authors to be inappropriate for inclusion of PBOMDs
      • # 5.
        The authors suggest that in assessing hand dexterity and function, clinicians should consider the scores of whatever PBOMDs are administered, but not take those scores as the sole determinant
        • 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.