Korean Upper Extremity Performance Test for the Elderly: Validity and Reliability

BACKGROUND AND PURPOSE: The Upper Extremity Performance Test for the Elderly (TEMPA) measures daily activities both quantitatively (length of execution) and qualitatively (functional rating, task analysis; Desrosiers et al., 1993). In Korean clinical settings, assessment tools like the TEMPA that can accurately assess overall upper extremity function are needed but lacking (Lee & Jung, 2015). The purpose of this study was to establish validity and reliability of the TEMPA after modifying the items affected by cultural differences.

METHOD: Data were collected by continuous sampling in Wonju, Korea, among community-dwelling adults and older adults. A total of 212 participants, 171 without and 41 with upper extremity impairment, were recruited for the study. Inclusion criteria for the impaired group were one or more neurological or musculoskeletal deficits affecting upper extremity function, onset ≥3 mo previously, no cognitive impairment, and no difficulty following instructions during assessments. Types of impairment included hemiplegia, diplegia, hand or finger amputation, arthritis, carpal tunnel syndrome, and tremor.

Content validity was established by a committee consisting of four professors of occupational therapy. The content validity index (CVI) calculation method was used. Discriminant validity was established by comparing the assessment results of the impaired and healthy groups. The comparison was conducted using the dominant hand and nondominant hand separately. In the impaired group, the impaired side was considered the nondominant hand and the healthy side the dominant hand. Test–retest reliability was conducted with 25 participants in the healthy group. After 2–3 wk, all measures were retested. To establish interrater reliability, video analysis was used. The two raters were occupational therapists, and their results were compared.

To analyze the results, CVI scores were calculated, with a cutoff score of 1.0. For discriminant validity, results for speed of execution were analyzed using independent t tests, and chi-square tests were used to analyze functional rating and task analysis. For reliability, intraclass correlation coefficients (ICC) were used to analyze speed of execution and functional rating. For task analysis, the kappa index was used.

RESULTS: Two items, (1) unlock a lock and open a pill container and (2) write on an envelope and stick on a stamp, were modified after the content validity test because of cultural differences in experiences and language. Discriminant validity testing confirmed that the participants with normal upper extremity function performed at higher level than those with impairments (p < .001). Test–retest reliability of length of execution (ICC) ranged from .71 to .94, functional rating (kappa) was 1.0, and task analysis (ICC) was 1.0. Interrater reliability for length of execution was 1.0, functional rating ranged from .79 to 1.0, and task analysis ranged from .94 to 1.0.

CONCLUSION: The results indicate that the TEMPA can clearly distinguish people with upper extremity impairment from those without impairment. The TEMPA exhibited moderate to high test–retest reliability and substantial to high interrater reliability. Through this study, use of the TEMPA will be introduced in Korea. With the Korean TEMPA, Korean occupational therapists will be able to carry out accurate and holistic upper extremity assessment.

References

Desrosiers, J., Hébert, R., Dutil, E., & Bravo, G. (1993). Development and reliability of an upper extremity function test for the elderly: The TEMPA. Canadian Journal of Occupational Therapy, 60, 9–16. https://doi.org/10.1177/000841749306000104

Lee, C. D., & Jung, M. (2015). A study of hand function assessment tools in Korean adults: A review. Journal of Work Ability Association, 1(1), 39–50.