Full Length Article| Volume 36, ISSUE 1, P110-120, January 2023

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Psychometric evaluation of the Southampton hand assessment procedure (SHAP) in a sample of upper limb prosthesis users


      • The SHAP measures function in upper limb amputation but many items are too difficult
      • Validity of the SHAP overall score, the IOF, was supported
      • The validity of individual grip scores of the SHAP was not supported.
      • We examined properties of the SHAP and proposed a modified version, the P-IOF
      • The P-IOF is valid, takes less time to administer and is easy to score



      The 26-item Southampton Hand Assessment Protocol (SHAP) is a test of prosthetic hand function that generates an Index of Functionality (IOF), and prehensile pattern (PP) scores. Prior researchers identified potential issues in SHAP scoring, proposing alternative scoring methods (LIF and W-LIF).

      Study design

      Cross-sectional study.


      Evaluate the psychometric properties of the SHAP IOF, LIF, and W-LIF and PP scores and develop the Prosthesis Index of Functionality (P-IOF).


      We examined item completion, floor andceiling effects, concurrent, discriminant, construct and structural validity. The P-IOF used increased boundary limits and information from item completion and completion time. Calibration used a nonlinear mixed model. Scores were estimated using maximum a posteriori Bayesian estimation. Mixed integer linear programing (MILP) informed development of a shorter measure. Validity analyses were repeated using the P-IOF.


      126 persons, mean age 57 (sd 15.8), 69% with transradial amputation were included. Floors effects were observed in 18.3%-19.1% for the IOF, LIF, and W-LIF. Ten items were not completed by >15% of participants. Boundary limits were problematic for all but 1 item. Correlations with dexterity measures were strong (r =  0.54-0.73). Scores differed by amputation level (p > .0001). Factor analysis did not support use of PP scores. The P-IOF used expanded boundary limits to decrease floor effects. MILP identified 10 items that could be dropped. The 26-item P-IOF and 16-item P-IOF had reduced floor effects (<7.5%), strong evidence of concurrent and discriminant validity, and construct validity. P-IOF reduced administrative burden by 9.5 (sd 5.6) minutes.


      Floor effects limit a measure's ability to distinguish between persons with low function.


      Analyses supported the validity of the SHAP IOF, LIF, and W-LIF, but identified large floor effects, as well as issues with structural validity of the PP scores. The 16-item P-IOF minimizes floor effects and reduces administrative burden.


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      JHT Read for Credit

      Quiz: # 885

      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 SHAP generates scores for
        • a.
          comfort and compliance
        • b.
          PP and IOF
        • c.
          ICE and PQ
        • d.
          sensitivity and specificity
      • # 2.
        The authors sought to develop the
        • a.
          best practices for prosthetic rehabilitation
        • b.
          prosthetic version of the Quick DASH
        • c.
        • d.
      • # 3.
        The investigators were especially concerned with
        • a.
          ceiling and floor limits
        • b.
        • c.
        • d.
      • # 4.
        In creating their tool the authors
        • a.
          reduced their boundary limits by 50% of the normative values
        • b.
          increased their boundary limits to 12 x the normative values
        • c.
          used the currently established normative values
        • d.
          disregarded established normative values
      • # 5.
        The P-IOF maximizes the ceiling effect and virtually eliminates any administrative burden
        • 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.