The development of an outcome scale to measure the unilateral hand function of people with tetraplegia

[Truncated abstract] Spinal cord injury at the 6th and 7th cervical level results in tetraplegia with variable levels of hand function. There are few clinical assessments of hand function for these individuals. The primary objective of the work undertaken in this thesis was to develop a reliable and valid assessment scale of hand function for use with individuals with C6 and C7 tetraplegia. To achieve this, the research aims were firstly to develop a list of activities that represented typical tetraplegic hand function, secondly to design a testing system for multicentre reliability testing and finally to document the reliability of each of the functional tasks used in the new scale. The first aim involved qualitative work in the development of the new outcome measure, the "AuSpinal Hand Assessment". Existing scales of hand function were reviewed and the expert opinions of seven senior therapists from six Australian Spinal Units were sought in the design phase of the scale development. Following many iterations, a final consensus was reached on seven tasks that were considered to be representative of tetraplegic hand function. These included: picking up and using a key, coin, credit card, telephone, nut/bolt, 'Smartie' and soft drink can. Each task was analysed and broken down into sub-tasks. The scoring system was designed to involve categorical judgments (e.g. could they do X in under 60 seconds? Yes / No). The Yes/No responses were assigned numerical values, weighted within each task to enhance responsiveness. The different tasks were therefore weighted arbitrarily, as the number of sub-tasks varied for each task. A unique CD assessment system was developed using LabView software where the specific criterion-marking scheme was presented with random video images of different quality of performances for each specific task. ... The therapists were consistently able to score different performances by individuals with tetraplegia with little between-therapist error. The seven tasks of the assessment demonstrated a high degree of internal consistency (Cronbach Alpha 0.93) suggesting that these items were assessing the same domain of hand function. The findings of the series of studies support the development of the AuSpinal Hand Assessment and in particular the development of an interactive quality assurance CD system to quantify inter-therapist reliability. The AuSpinal Hand Assessment demonstrates high internal consistency. Therapists are reliably able to score performance across all the tasks from the video system and also whilst observing individuals with spinal cord injury in a real-time setting. These results suggest that there is good potential for this scale to be clinically reliable and provides a foundation for further refinement of the AuSpinal Hand Assessment. Future research should firstly aim to improve the clinical efficiency of the assessment by identifying redundant tasks from the seven elements in the current form. Secondly, it is important to examine the clinical sensitivity of the tool within the clinical setting to establish the minimal clinically important difference for people with tetraplegia.