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VOLUME 5, ISSUE 2 

 2022 

 

LITERATURE REVIEW 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics 

Journal. 2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

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https://doi.org/10.33137/cpoj.v5i2.39023


 

1 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

 

 

LITERATURE REVIEW 

 

OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY IN AMPUTEE AND INTACT 

POPULATIONS: A LITERATURE REVIEW 

Carlyle K1,2*, Day S1 
 
1 Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom. 
2 EPSRC Centre for Doctoral Training in Prosthetics and Orthotics, University of Salford, United Kingdom. 

  
 

 

 

 

  

 

 

 

 

 

 

 

 
 

 

INTRODUCTION   

The hand is a complex structure responsible for powerful 

prehension and precise control. The range and adaptability 

achieved by the hand is due to the complex anatomical 

structure and precise control of movement and feedback by 

the central nervous system.1 Hands are capable of 

determining information by allowing identification of objects 

by their size, shape, surface, weight, texture, and thermal 

properties.2 Moreover, hands are crucial as terminal end-

effectors in enabling people to carry out activities of daily 

living (ADL) and participate in society.3 They are vital for  

 

 

carrying out basic ADL such as feeding, dressing, and 

hygiene. Additionally, hands can be used as communication 

tools as demonstrated through the use of sign language and 

touch reading, and creative tools in music and dance.  

If the hand is incapacitated due to trauma, tumour, infection, 

peripheral vascular disease, or congenital anomaly, then 

amputation may be the result. Roughly five to six thousand 

amputations are undertaken in the United Kingdom each 

year.4 Of these amputations, roughly one fifth are upper limb 

amputations.5 A solution to assist those with amputation in 

carrying out ADL lies in prosthetic devices. It has been 

noted that statistics relevant to the prevalence of limb 

amputation and prosthetic device provision are limited and 

often inconsistent.6 Studies have also shown that hand 

prostheses prescribed to users are not reaching their 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: The human hand is critical in assisting with activities of daily living (ADL). Amputation 

of the hand can affect a person physically, socially and psychologically. Knowledge of outcome 

measures used to assess upper limb activity of intact and amputee populations may aid in guiding 

research to develop applicable measurement tools specific to the amputee population. Tools could aid 

developments in prosthetic design and prescription, which benefit both users and healthcare 

researchers.  

OBJECTIVE(S): This literature review examined outcome measurement tools used with non-amputee 

and amputee populations to assess hand activity. The objectives were to identify which characteristics 

of hand activity are captured by currently available measurement tools.  

METHODOLOGY: Searches were conducted using PubMed, Cochrane and ProQuest for studies 

investigating hand activity for amputee and non-amputee populations. A total of 15 studies were 

included. PRISMA guidelines were used to assist with study selection. Data extraction and narrative 

synthesis were carried out.  

FINDINGS: A total of 32 outcome measures were found. Frequently used tools were: Box and Block 

Test, Swedish Disabilities of the Arm Shoulder and Hand Questionnaire, and range of motion. Studies 

employed a combination of 2 to 12 tools. Themes extracted were: importance of function and quality of 

life, the need for realistic tasks, and the need for outcome measures specific of the population. 

CONCLUSION: There is a gap in research surrounding outcome measurement tools used to assess 

hand activity in the amputee population. A combination of outcome measures are required to obtain 

insight into the hand activities of intact and amputee populations. Function and quality of life are 

important aspects to consider when describing hand activity.  

ARTICLE INFO 

Received: July 22, 2022 

Accepted: December 12, 2022     

Published: December 25, 2022 

CITATION 

Carlyle K, Day S. Outcome 

measures used to assess hand 

activity in amputee and intact 

populations: A literature review. 

Canadian Prosthetics & Orthotics 

Journal. 2022; Volume 5, Issue 2, 

No.4. 

https://doi.org/10.33137/cpoj.v5i2.3

9023 

KEYWORDS 

Outcome Measures, Healthcare, 

Amputee, Upper Limb, Amputation, 

Rehabilitation, Prosthetics 

 

* CORRESPONDING AUTHOR: 

Kirsty Carlyle, MEng 
Department of Biomedical Engineering, Faculty of Engineering, University 
of Strathclyde, Glasgow, United Kingdom. 

Email: kirsty.carlyle@strath.ac.uk  

ORCID ID: https://orcid.org/0000-0002-0291-4717 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 5, Issue 2, Article No.4. 2022 

 

 

https://doi.org/10.33137/cpoj.v5i2.39023
https://doi.org/10.33137/cpoj.v5i2.39023
https://doi.org/10.33137/cpoj.v5i2.39023
mailto:kirsty.carlyle@strath.ac.uk
https://orcid.org/0000-0002-0291-4717
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

desired potential as users find them difficult to control and 

not fully functional.6 Despite advancements in prosthetic 

technology, people with amputations have significantly high 

rates of device rejection compared to other levels of 

prosthetic use.7 There are a range of devices and options 

available to people with amputation and their clinicians, 

however, more knowledge with respect to prosthetic 

performance may allow better prescription and design of 

prosthetics.  

Recording patient and user outcomes is a recognised 

means of driving further research and development of 

technology.8 Outcome measurement tools have been used 

widely in research to assess limb activity. Such tools include 

quantitative functional tests and qualitative questionnaires. 

For health practitioners, standardised outcome measure-

ment tools may allow them to better prescribe treatments for 

their patients.  

This review contributes to healthcare research by reviewing 

the current state-of-the-art outcome measures used to 

assess hand activities. The review has an overarching aim 

of providing a basis for further research into outcome 

measurement tools for assessing real world use of upper 

limb prosthetics. The specific aim is to examine outcome 

measurement tools used to assess hand activities as no 

such review exists in the literature. The review achieves this 

by meeting the following objectives:  

• Evaluating the range of existing outcome 

measurement tools for intact and amputee populations 

when assessing hand activity  

• Examining and comparing various outcome 

measurement tools used for hand activities. 

METHODOLOGY 

Reporting findings in a non-biased, usable format aids in 

advancing research and informing clinical decision making 

in the field of prosthetics and orthotics, and related fields. 

Since qualitative and quantitative tools are used to report 

outcome measures related to hand activity, a literature 

review was selected as a strong approach to synthesise 

such data and put it into context.9 Due to the different 

natures of the outcome measures expected to be found in 

the review, a narrative synthesis was performed to 

summarise data.10 

The literature review was conducted in accordance with 

PRISMA guidelines11 as shown in Figure 1. Searches were 

run in PubMed, Cochrane, ProQuest databases. Relevant 

keywords used in the search were ("outcome measures" 

OR "outcome measurement tool" OR "outcome 

measurement tools" OR "outcome measurement") AND 

("hand activity" OR "hand activities" OR "hand function") 

AND (function* OR "quality of life" OR satisfaction) AND 

(amputee OR intact OR amputation) NOT (foot OR feet OR 

lower limb).  

Results were filtered to meet the following inclusion criteria: 

written in English, including adult human participants, 

published between August 2009 and August 2021. 

Duplicates were removed. Study titles were screened and 

excluded if they reported on children, measurement tools 

that focus on arm movement (not hands), interventions not 

specific to population, feasibility studies and participants 

with neurological conditions without involvement of healthy 

controls.  

The following types of study were excluded: systematic 

reviews, pilot studies, protocol developments, narrative 

reviews, feasibility studies and non-peer reviewed articles. 

Systematic reviews were excluded so the study only 

considered original research. Studies were included if they 

reported outcome measures and tools to assess adult 

human hand function and quality of life of unilateral upper 

limb amputees, bilateral upper limb amputees and the intact 

population.  

Abstracts were screened from studies which passed or 

remained unclear following title screening. Full texts were 

obtained from studies which passed or remained unclear 

following screening. Full text screening was then 

conducted. The final studies were assessed for quality 

using a method derived from the CASP checklists.12 This 

method involved applying a set of questions to each study 

which took into account the validity of results, risk of bias, 

quality of data, ethical considerations and the applicability 

of results in the context of the research question and study 

population (Table 1).  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1: Study selection flowchart. 

Records identified 
from databases  
(n = 761) 

 

Records removed before 
screening: 

Records marked as ineligible 
by automation tools (n = 382) 

Records screened 
(n = 379) 

Records excluded (n = 330) 

Full-text articles 
assessed for 
eligibility (n = 49) 

Reports excluded: 

- Wrong population (n = 20) 
- Wrong study focus (n = 6) 
- Live trial with no results 

published (n = 3) 
- Wrong study type (n = 3) 
- Wrong intervention (n = 1)  
- Limited data (n = 1) 

Studies included in this review (n = 15) 

Identification of studies via databases and registers 

Id
e

n
ti
fi
c
a

ti
o

n
 

S
c
re

e
n
in

g
 

 
In

c
lu

d
e

d
 

https://doi.org/10.33137/cpoj.v5i2.39023


 

3 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

Ethical approval was not required to complete this review as 

no subject participation or handling of sensitive information 

were carried out. Ethics surrounding the studies included in 

this review were considered. All studies involving subjects 

and confidential information were checked to ensure quality 

data was collected with appropriate ethical approval.  

Data Analysis  

All outcome measures used in each study were recorded 

and the frequency of use of each outcome measure was 

noted. Modified or adapted versions of tools - such as the 

original DASH and QuickDASH – were grouped together. 

Measures which were similar in nature through describing 

the same variables were grouped together. Strength 

variables such as grip strength and precision force were 

grouped together to represent force control (FC). Joint 

angle measures were grouped together (ROM). Shape 

texture identification test and self-rating of tactile gnosis 

were grouped together (tactile gnosis/TG). Upper extremity 

functional scale and patient specific functional scales were 

grouped together (functional scales/FS). Duration of hand 

movements and task movement times were grouped 

together (temporal measures/TM). Outcome measures 

were also grouped into the following types: ‘functional’, 

‘quality of life (QoL)’ and ‘functional and QoL’ measures. 

Narrative synthesis was carried out with the aid of thematic 

analysis to determine themes. 

RESULTS 

Following searching and screening, 15 studies were 

reviewed (Table 2).  

A data extraction table (Table 3) was used to record number 

of outcome measures, types of outcome measures, 

participant demographics and ethical considerations.  

 

Table 1: Quality appraisal checklist. 

Author (year) 

S
o
b
u

h
 e

t 
a
l.
, 
(2

0
1
4
)1

3
 

L
a
w

re
n

c
e
 e

t 
a
l.
, 
(2

0
1
5

)1
4
 

R
e
s
n
ik

 a
n

d
 B

o
rg

ia
 (

2
0

1
6

)1
5
 

R
a
v
e

h
 e

t 
a
l.
, 
(2

0
1

8
)1

6
 

L
e
e

 e
t 

a
l.
, 

(2
0
2

0
)1

7
 

E
k
lu

n
d

 e
t 

a
l.
, 

(2
0
0

9
)1

8
 

H
ru

b
y
 e

t 
a
l.
, 
(2

0
1

9
)1

9
 

R
e
s
n
ik

 e
t 

a
l.
, 

(2
0
2

0
)2

0
 

R
e
s
n
ik

 e
t 

a
l.
, 

(2
0
2

0
)2

1
 

S
p
e
th

 e
t 

a
l.
, 

(2
0
2

0
)2

2
 

W
a
n
g

 e
t 

a
l.
, 

(2
0
2

1
)2

3
 

H
ru

b
y
 e

t 
a
l.
, 
(2

0
1

7
)2

4
 

d
e
 B

o
e
r 

 e
t 

a
l.
, 

(2
0
1

6
)2

5
 

B
o
u
m

a
 e

t 
a
l.
, 
(2

0
1
8

)2
6
 

B
e
rn

a
rd

o
n

 e
t 

a
l.
, 

(2
0
1

5
)2

7
 

Did the study address a 
clearly focused research 
question? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Was the recruitment 
strategy appropriate to the 
aims? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Are there any conflicts of 
interest? 

N N N N N N N 

Y 
(declared 
financial 
grant) 

N 

Y 
(declared 
financial 
grant) 

N N N N N 

Was there a clearly 
defined study protocol? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Do the benefits of the 
experimental intervention 
outweigh the harms and 
costs? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Have ethical issues been 
taken into consideration? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Is there a clear statement 
of findings? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Can the results be applied 
to the context of hand and 
upper limb activity? 

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

Does the study find 
anything new or useful?  

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 

 

 

https://doi.org/10.33137/cpoj.v5i2.39023


 

4 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

 

Table 2: List of included papers 

Authors Title  Year 

Sobuh et al.,13 Visuomotor behaviours when using a myoelectric prosthesis 2014 

Lawrence et al.,14  
Outcome measures for hand function naturally reveal three latent domains in older adults: strength, coordinated upper 

extremity function, and sensorimotor processing 
2015 

Resnik and Borgia15 Responsiveness of outcome measures for upper limb prosthetic rehabilitation 2016 

Raveh et al.,16 
Myoelectric prosthesis users improve performance time and accuracy using vibrotactile feedback when visual feedback is 

disturbed 
2018 

Lee et al.,17 Clip-On IMU system for assessing age-related changes in hand functions  2020 

Eklund et al.,18 Hand function and disability of the arm, shoulder and hand in Charcot-Marie-Tooth disease 2009 

Hruby et al.,19 Bionic upper limb reconstruction: a valuable alternative in global brachial plexus avulsion injuries-a case series 2019 

Resnik et al.,20 A national survey of prosthesis use in veterans with major upper limb amputation: comparisons by gender 2020 

Resnik et al.,21 Function and quality of life of unilateral major upper limb amputees: effect of prosthesis use and type 2020 

Speth et al.,22 
Assessment of tree-based statistical learning to estimate optimal personalized treatment decision rules for traumatic finger 

amputations 
2020 

Wang et al.,23  
Application of machine learning to the identification of joint degrees of freedom involved in abnormal movement during 

upper limb prosthesis use  
2021 

Hruby et al.,24 Algorithm for bionic hand reconstruction in patients with global brachial plexopathies  2017 

de Boer et al.,25 Intermanual transfer effects in below-elbow myoelectric prosthesis users 2016 

Bouma et al.,26 Musculoskeletal complaints in individuals with finger or partial hand amputations in the Netherlands: a cross-sectional study  2018 

Bernardon et al.,27 
Bilateral hand transplantation: functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4-

13 years) 
2015 

 
Table 3: Data extraction table. 

Authors/ 
year 

Title 
Ethical 
Concerns? 

Type of 
Study 

Participant 
Demographics 

Number of 
Participants 

Intact, 
amputee, 
prosthesis 
user or 
combination 

Setting 

Self-reported, 
clinician 
observed or 
combination? 

Sobuh  
et al., 

2014 13 

Visuomotor 
behaviours 
when using a 
myoelectric 
prosthesis 

No quantitative 
intact adults and 
adult myoelectric 
prosthesis users 

11 

combination 
(intact and 
prosthesis 

user) 

university 
clinician 
observed 

Lawrence 
et al., 

2015 14 

Outcome 
measures for 
hand function 
naturally reveal 
three latent 
domains in older 
adults: strength, 
coordinated 
upper extremity 
function, and 
sensorimotor 
processing 

No quantitative 

healthy older adults 
and older adults 
with osteoarthritis of 
the CMC joint 

99 intact 
university/rehab 

centre 
clinician 
observed 

Resnik 
and 
Borgia, 

2016 15 

Responsiveness 
of outcome 
measures for 
upper limb 
prosthetic 
rehabilitation 

No 
quasi-

experiment
al study 

adult upper limb 
amputees 

39 amputee  
veterans affairs 

sites 
combination 

Raveh  
et al., 

2018 16 

Myoelectric 
prosthesis users 
improve 
performance 
time and 
accuracy using 
vibrotactile 
feedback when 
visual feedback 
is disturbed 

No quantitative 

transradial 
amputees using a 
myoelectric 
prosthesis with 
normal or corrected 
eyesight 

12 prosthesis user laboratory combination 

 

 

https://doi.org/10.33137/cpoj.v5i2.39023


 

5 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

 

Table 3: Data extraction table (continued) 

Authors/ 
year 

Title 
Ethical 
Concerns? 

Type of 
Study 

Participant 
Demographics 

Number of 
Participants 

Intact, 
amputee, 
prosthesis 
user or 
combination 

Setting 

Self-reported, 
clinician 
observed or 
combination? 

Lee et al., 

2020 17 

Clip-On IMU 
system for 
assessing age-
related changes 
in hand 
functions 

No quantitative 
healthy adults 
(aged 20-31 and 
75-89) 

34 intact university 
clinician 
observed 

Eklund  
et al., 

2009 18 

Hand function 
and disability of 
the arm, 
shoulder and 
hand in charcot-
marie-tooth 
disease 

No quantitative 
adults with charcot 
marie tooth and 
healthy controls 

60 intact hospitals/clinics combination 

Hruby  
et al., 

2019 19 

Bionic upper 
limb 
reconstruction: 
a valuable 
alternative in 
global brachial 
plexus avulsion 
injuries-a case 
series 

No quantitative 

adults with 
complete bracial 
plexus injury who 
underwent bionic 
reconstruction after 
high level upper 
limb amputation 

5 prosthesis user university combination 

Resnik  
et al., 

2020 20 

A national 
survey of 
prosthesis use 
in veterans with 
major upper 
limb amputation: 
comparisons by 
gender 

No 
cross-

sectional 
survey 

adult veterans with 
upper limb 
amputation who 
had been treated 
between 2010 and 
2015 

808 amputee 
telephone 

survey 
self-reported 

Resnik  
et al., 

2020 21 

Function and 
quality of life of 
unilateral major 
upper limb 
amputees: 
effect of 
prosthesis use 
and type 

No 
cross-

sectional 
survey 

adult veterans with 
unilateral upper 
limb amputation 
who had been 
treated between 
2010 and 2015 

755 amputee 
telephone 

survey 
self-reported 

Speth  
et al., 

2020 22 

Assessment of 
tree-based 
statistical 
learning to 
estimate optimal 
personalized 
treatment 
decision rules 
for traumatic 
finger 
amputations 

No 
cohort 
study 

adult patients who 
underwent revision 
amputation or 
replantation 

185 amputee  
various 

research 
centres 

combination 

Wang  
et al., 

2021 23 

Application of 
machine 
learning to the 
identification of 
joint degrees of 
freedom 
involved in 
abnormal 
movement 
during upper 
limb prosthesis 
use 

No quantitative 

adults with no 
upper limb 
disability, trained on 
deka bypass or 
body powered 
bypass 

24  intact laboratory 
clinician 
observed 

Hruby  
et al., 

2017 24 

Algorithm for 
bionic hand 
reconstruction in 
patients with 
global brachial 
plexopathies 

No quantitative 

adults with 
posttraumatic global 
brachial 
plexopathies 

5 prosthesis user university combination 

 

 

https://doi.org/10.33137/cpoj.v5i2.39023


 

6 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

Studies were published between the years 2009 and 2021. 

Across the studies, participants were categorised in the 

following populations: able bodied, able bodied using upper 

limb bypass equipment, upper limb prosthesis users; people 

with osteoarthritis, Charcot-Marie-Tooth disease, upper 

limb/finger/hand amputation and recipients of hand and 

forearm allotransplantation. Studies were conducted using 

intact only, intact and amputee/prosthesis user, and 

amputee/prosthesis user only populations. Studies 

involving participants with osteoarthritis and Charcot-Marie-

Tooth used healthy controls, enabling their inclusion within 

the review. 

A total of 32 outcome measures were identified within the 

studies reviewed (Table 4). 

The most frequently used tools and measures, as shown in 

Figure 2, were the BBT (7), DASH (7), ROM (7) and FC (6). 

All studies used a combination of measures, ranging from 2 

to 12 outcome measures assessed per study. 

The majority (59%) of outcome measures listed in Table 4 

are functional based measures. While function-based 

outcome measures were more prevalent within studies, 

some outcome measurement tools (19%) assess both 

function and quality of life (Figure 3). 

The following quotes of relevance to the research topic were 

extracted from included studies: 

• "the most objective of the commonly used upper limb 

evaluation tools are based on time to perform a 

structured set of tasks, but use of these in isolation gives 

limited insight into ease of use of a prosthesis"13 

• "the central question here is, what should we use to 

quantify hand function considering that we have so 

many choices of assessment tools and even more 

outcome measures stemming from these tools?"14 

• "leaders in upper limb prosthetic rehabilitation 

understand the importance of choosing outcome 

measures that have been evaluated for persons with 

upper limb amputation and that are reliable, valid, and 

responsive to change"18 

• “another important aspect in prosthetic rehabilitation 

research is the use of valid outcome measures"19  

The following themes were derived from the papers in 

relation to assessing hand activity: the importance of 

function and quality of life, the need for realistic tasks, and 

the need for outcome measures specific to the population. 

DISCUSSION 

A The review depicts a range of outcome measures used to 

measure hand activity in amputee and intact populations. 

There was a clear indication that use of multiple outcome 

measures is optimum to evaluate hand activity. It could be 

true that it is difficult to select one tool due to lack of tools 

which bring together various aspects of hand activity such 

as function, pain, and satisfaction. 

Table 3: Data extraction table (continued) 

Authors/ 
year 

Title 
Ethical 
Concerns? 

Type of 
Study 

Participant 
Demographics 

Number of 
Participants 

Intact, 
amputee, 
prosthesis 
user or 
combination 

Setting 

Self-reported, 
clinician 
observed or 
combination? 

de Boer  
et al., 

2016 25 

Intermanual 
transfer effects 
in below-elbow 
myoelectric 
prosthesis users 

No 
case-
control 
study 

myoelectric 
prosthesis users 
and controls  

44 

combination 
(intact and 
prosthesis 

user) 

university/rehab 
centre 

clinician 
observed 

Bouma  
et al., 

2018 26 

Musculoskeletal 
complaints in 
individuals with 
finger or partial 
hand 
amputations in 
the Netherlands: 
a cross-
sectional study 

No 
cross-

sectional 
study 

adult finger and 
hand amputees and 
healthy controls 

201 
combination 
(intact and 
amputee) 

questionnaire 
sent to 

participants 
self reported 

Bernardon 
et al., 

2015 27 

 
Bilateral hand 
transplantation: 
functional 
benefits 
assessment in 
five patients 
with a mean 
follow-up of 7.6 
years  
 

No quantitative 

adults who 
underwent hand 
and forearm 
allotransplantation 
following trauma 

5 
intact (post 

transplantation) 
rehabilitation 

clinic 
combination 

 

 

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7 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

  

Table 4: List of outcome measures, acronyms, type and description of measures. 

Outcome Measure Acronym Type Description 

Box and Block test28 BBT Functional Test of manual dexterity 

Swedish Disabilities of the Arm Shoulder and 

Hand Questionnaire29 
DASH Functional & QoL 

Self-reported measure of disability and symptoms in relation 
to the upper limb 

Range of Motion ROM Functional Measure of level of movement achieved 

Force Control  FC Functional Measure of strength achieved 

Southampton Hand Assessment Procedure30 SHAP Functional Test of hand function using abstract objects and ADL  

Orthotics and Prosthetics User's Survey31 OPUS Functional & QoL 
Self-reported survey of outcomes and satisfaction with 
orthotic/prosthetic devices and services 

Tactile Gnosis  TG Functional Ability to detect information through touch 

9 Hole Peg test32 9HPT Functional Measure of finger dexterity 

36-Item Short Form Survey33 SF-36 QoL Self-reported measure of quality of life 

Temporal measures TM Functional Time-based activities and tasks 

Edinburgh Handedness Inventory34 EHI Functional Assessment of hand dominance 

Modified Action Research Arm test35  mARAT Functional 
Assessment of hand function during grasp, pinch, grip and 
gross movements 

Visual Analogue Scale36 VAS QoL Measure of severity of symptoms 

Trinity Amputation and Prosthetic Experience 

Scale37 
TAPES QoL 

Self-reported measure of experiences and satisfaction with 
regards to acquired amputation and prosthesis adjustment 

Veterans SF-12 Health Survey with physical and 

mental components38 
VR-12 Functional & QoL Self-reported measure of health 

Jebsen-Taylor Hand Function tests39 JTHFT Functional 
Test of hand function carrying out a range of different ADL-
based tasks 

Functional Scales FS Functional Measure of function  

Pain Pain QoL Assessment of patient/user pain 

Activity measure for upper limb amputation40 AM-ULA Functional Measure of upper limb activity performance 

Michigan Hand Outcomes Questionnaire41 MHQ Functional & QoL 
Self-reported measure of hand outcomes including pain, 
function, aesthetics, ADL, work and satisfaction 

Gaze Behaviour GB Functional Assessing visual responses during tasks 

University of New Brunswick Skill and Spontaneity 

tests42 
UNB-SST Functional Non-timed measure of function  

Prevalence of Musculoskeletal Complaints MSC QoL Self-reported indication of physical symptoms 

Upper extremity work demands score  UEWD Functional & QoL Measure specifically related to work tasks 

Patient-reported work productivity   PR-WP QoL Self-reported indication of level of ability to participate in work 

Modified Kapandji Index43 mKI Functional Measure of hand mobility 

Carroll Upper Extremity Function test44 UEFT Functional Measure of functional impairment and severity 

Purdue Pegboard test45  PPT Functional Measure of gross upper limb movement and finger dexterity 

Self-subjective global evaluations SSGE QoL Self-reported measure of quality of life 

400 Point Assessment46  400-PA Functional Test of function in tasks, strength, mobility and handling 

Direct observation by therapist while performing 
tasks  

DTO Functional 
Clinician-researcher observing participant without using a 
specific measure 

Hand Transplantation Score System47 HTSS Functional & QoL 
Measure of ability and quality of life following hand 
transplantation 

 

 

 

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8 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

Figure 2: Graph depicting number of times each outcome measure 

was used across the included studies. 

 

 

Figure 3: Pie chart showing that most outcome measures assess 

function, with a smaller proportion assessing QoL. 

 

The reason behind choice of tool may be due to location of 

the study – for example in-clinic or telephone surveys. 

Additionally, choice of tool may be a consequence of the 

fact that not all tools are validated for use in amputee 

populations. It is possible that researchers select tools 

based on personal preference rather than appropriateness. 

Tools involving participant-reporting of data may not reflect 

physical performance, thus may not be sufficient.  

Nonetheless, self-reported studies, which occur as surveys 

or interviews can attract larger sample sizes. No specific 

guidelines related to hand activities or therapy were 

highlighted within the included studies, emphasising the 

need for their development. There was a lack of diverse 

devices included in the studies with most studies involving 

prostheses featuring only myoelectric devices. Finally, there 

is limited information on outcome measures for cosmetic 

devices. 

Theme 1: The importance of function and quality of life 

when assessing hand activity 

A key theme was the value of both functional and quality of 

life assessments of hand activity. Despite this finding, 59% 

of outcome measures used were functional measures and 

only 22% quality of life measures. By using a combination 

of outcome measurement tools, the researchers were 

frequently able to capture functional, and quality of life data. 

However, there is no standard combination, or designed 

pairing of tools to obtain all information. This highlights the 

need for development of guidelines that are comparative of 

both contexts.  

While functional domains and tasks were considered 

repeatedly throughout studies, it is evident that these 

variables affect quality of life. These variables can affect 

ability to participate in work and social environments which 

subsequently attributes to an improved quality of life. 

Pain was another common theme found throughout studies. 

Pain should be considered throughout performance of 

various functional tasks as such tasks may conversely 

impair function. Presence of pain is likely to have a negative 

effect on quality of life. It is important to involve the 

participants’ self-reported outcomes of parameters such as 

pain to create a picture of their overall satisfaction. 

Nonetheless, self-reported outcomes are limited due to self-

reporting bias. 

Outcome measures, which account for functional failures, 

may be advantageous in the amputee and prosthetic user 

population to account for actions such as failed prehension. 

This could provide key information about device 

performance as well as participant function. 

Theme 2: Need for realistic tasks when assessing hand 

activity 

Another major theme was the importance of ADL. Many of 

the functional outcome measures were used in combination 

with other tools to put function into context. Most of the 

studies investigating hand function, and the outcome 

measures included were structured in that the participants 

were given precise instructions to complete tasks. It must 

be noted that the ability to place pegs in a board, as required 

within the 9HPT and PPT, does not correlate to information 

about key parameters such as strength or function. Similarly 

this process does not correlate with the skill required to 

carry out typical ADL. Likewise, the BBT was one of the 

most frequently used measures and is simple to set up - but 

transferring blocks between compartments is one repetitive 

process which is not likely implemented in most ADL.  

An overlooked element is participant-led activities during 

assessment. In prosthetic user populations, it would be 

pragmatic to ask the participant to complete tasks with their 

prosthesis on and off to account for a range of scenarios. It 

should not be assumed that users wear their device 

consistently. Studies should include both unilateral and 

19%

22%59%

Ratio of function and QoL based outcome measure

Function+QoL

QoL

Function

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3

4

5

6

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A

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H

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T
G

9
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F

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6

T
M

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H

I

m
A

R
A

T

V
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S

T
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S

V
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 m

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Outcome Measure

FREQUENCY OF USE OF OUTCOME MEASURES

https://doi.org/10.33137/cpoj.v5i2.39023


 

9 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

bilateral tasks to represent a wider range of real-life 

scenarios. In addition, most studies were carried out in 

research laboratories, clinics, and universities. This means 

the researcher has control within the study and this 

weakens the link between the hand activities and real-world 

applications.  

Shifting from basic tasks to real world object manipulation, 

such as turning keys or picking up a mug, would provide an 

extra dimension in relating clinical studies to applications in 

the real world.  

Theme 3: Need for outcome measures specific to 

population 

Different populations are known to have different key 

components of hand function, so the focus of functional 

assessment tools should be tailored to the prosthesis user 

population. It was also highlighted within the reviews that 

people value parameters differently, for example dexterity 

may be of more importance than strength. It would be 

advantageous to understand the parameters which are of 

importance to prosthesis users before using tools to assess 

hand activity. Performance-based outcome measures used 

to assess hand activity often compare the performance of 

an amputee or prosthesis user with the intact population. 

This is not an optimal comparison since the populations 

have various levels of function and goals. Low level strength 

is required to facilitate ADL and functional tasks, so people 

with amputation who may have a level of strength too low to 

carry out such tasks may be unable to be assessed with 

such tools. Also, there is a level of dexterity required for 

tools such as tactile gnosis assessments. If outcome 

measurement tools can only be used in populations with a 

baseline level of ability, then tools must be adapted or 

developed to involve people who do not satisfy this criterion. 

Further, many of the tools used are temporal based and 

therefore do not give indications into ease of use, which is 

an important parameter when investigating the amputee 

and prosthesis user populations. Another argument for 

using outcome measures specific to the population is that a 

specific measurement may alleviate the need for recruiting 

healthy, intact participants when researchers are interested 

in outcomes of amputee or prosthesis users only. 

Limitations 

A limitation of this review is that data from pilot studies, 

reviews and protocol development studies were not 

included. Therefore, outcome measures considered are not 

a comprehensive list. Inclusion was limited to studies 

published in more recent years to ensure conclusions were 

reflective of the current state of technology and practice. 

Studies which only included participants with neurological 

conditions were excluded to ensure the correct population 

was analysed. Studies which used stroke-specific tools 

were excluded as outcome measurement tool selection by 

the research may be biased towards the stroke population 

and thus not a true reflection of amputee or intact 

populations. Small sample sizes within many included 

studies are another limiting factor, as this restricts data 

available for assessment. Studies with larger sample sizes 

were self-reported surveys which are limited in terms of 

outcome measurement tools which can be used. Only one 

reviewer screened and selected articles for inclusion, thus 

presenting a potential element of bias in terms of study 

selection. 

CONCLUSION 

There is a definite gap in research surrounding outcome 

measurement tools used to assess hand activity in the 

amputee and prosthesis user population. Results from this 

review of outcome measures used in amputee and intact 

populations, showed that a combination of outcome 

measures are currently used to obtain insight into hand 

activities of intact and amputee populations. There are no 

set guidelines or recommended pairings of tools, and key 

information about hand activity could potentially be missed 

during investigations.  

The reason a combination of tools are used is partially 

because currently used outcome measurement tools are 

limited for use in amputee and prosthesis user populations. 

Some measurement tools were not validated for upper limb 

amputees, and some involving temporal based tasks may 

not have been appropriate for assessing function in 

prosthesis users. Additionally, combinations of tools are 

used because both function and quality of life 

measurements are deemed important. These aspects are 

of particular interest in amputee and prosthetic user 

populations where factors such as pain, social participation 

and satisfaction are of high importance to both the person 

themselves, healthcare practitioners and prosthesis 

developers.  

Tools should be developed with both functional and quality 

of life measurements taken into consideration as well as 

tasks which pose a likeness to carrying out ADL. Finally, 

tools should be developed specific to the population to 

ensure that measurements are valid, useful, and specific.   

ACKNOWLEDGEMENTS 

N/A  

DECLARATION OF CONFLICTING INTERESTS 

The Authors declare that there is no conflict of interest. 

AUTHORS CONTRIBUTION 

Kirsty Carlyle: Designed the research question and study design, 

conducted the literature search and study selection, writing the 

manuscript. 

Sarah Day: Designed the research question and study design, 

writing the manuscript. 

https://doi.org/10.33137/cpoj.v5i2.39023


 

10 

Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 
2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X OUTCOME MEASURES USED TO ASSESS HAND ACTIVITY 
Carlyle and Day, 2022 

SOURCES OF SUPPORT 

This work was supported by the UK Engineering and Physical 

Sciences Research Council (EPSRC) grant EP/S02249X/1 for the 

Centre for Doctoral Training in Prosthetics and Orthotics. 

ETHICAL APPROVAL 

Ethical approval was not needed.   

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2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

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