Quality of Upper Extremity Skills Test (QUEST)

Posted on: March 5, 2017 | By: edekraker | Filed under: General Information
  1. Descriptive Information
    1. Title, Edition, Dates of Publication and Revision – The Quality of Upper Extremity Skills Test (QUEST) was published in Physical and Occupational Therapy in Pediatrics in 1993. There is only one edition and no revisions have been made, although reliability and validation studies have been completed.
    2. Author (s) – Carol DeMatteo, Mary Law, Dianne Russell, Nancy Pollock, Peter Rosenbaum, Stephen Walter
    3. Source – CanChild, a research centre of McMaster University; To order visit https://canchild.ca/en/shop/19-quality-of-upper-extremity-skills-test-quest
    4. Costs – Instrument begins at $99 + cost of equipment
    5. Purpose – A criterion-referenced measure designed to evaluate movement patterns and hand function in children 18 months to 8 years with spasticity. The four domains evaluated by the QUEST include: dissociated movement, grasp, protective extension, and weight bearing.
    6. Type of Test – Evaluative
    7. Target Population and Ages – children ages 18 months to 8 years with spasticity from cerebral palsy, congenital muscular dystrophy, or an acquired brain injury
    8. Time Requirements – 30-45 minutes
  2. Test Administration
    1. Administration
      1. Conducted in a play environment
      2. 34 activity items separated among four domains: dissociated movement, grasp, protective extension, and weight bearing
      3. 3 items for the tester to rate the child’s hand function, spasticity, and cooperativeness
      4. Item activities require a variety of UE movement
    2. Scoring
      1. Item-level scores of 1 or 2, determined by quality of assessed position or movement; 1 if movement quality is not achieved, 2 if movement quality is achieved
      2. Item scores are summed; formulas are used to calculate percentages for each domain
      3. Domain percentages are summed and divided by number of domains to obtain total score
      4. Minimum score = 0, Maximum score = 100
    3. Type of information, resulting from testing – The QUEST was developed to describe quality of movement and plan intervention programs. The QUEST provides an evaluation of a child’s ability to move in/out of pathological pattern against gravity and helps therapists determine specific goals for intervention. No cut-off scores have been established.
    4. Environment for Testing – This test is to be utilized in a play environment.
    5. Equipment and Materials Needed – chair or seating system, table just above waist level, four 1-inch cubes, cup, regular size crayon or pencil, blank paper, cheerios cut into quarters, mat, toys including puppet and bubbles
    6. Examiner Qualifications – reading an article/manual
    7. Psychometric Characteristics – N/A
    8. Standardization/normative data
      1. Mean (SD) QUEST Total Score
        1. Cerebral Palsy (Sorsdahl et al, 2008): Assessor 1 = 61.8(20.1), Assessor 2 = 60.2(22.9)
        2. Congenital Muscular Dystrophy (Meilleur et al, 2015): Raw score = 5.62 (1.05)
        3. No normative data for acquired brain injury
      2. Evidence of Reliability
        1. Cerebral Palsy
          1. Excellent test-retest reliability (ICC = .95) (DeMatteo et al, 1993) (n=17)
          2. Excellent test-retest reliability (p=.92) (Haga et al, 2007) (n=21)
          3. Excellent inter-rater reliability (ICC=.95) (DeMatteo et al, 1993)
          4. Excellent inter-rater reliability (ICC=.91), adequate intra-rater reliability for A1 (ICC=.69), excellent intra-rater reliability for A2 (ICC=.89) (Sorsdahl et al, 2008)
        2. Congenital Muscular Dystrophy – no reliability data
        3. Acquired Brain Injury – excellent inter-rater reliability (ICC = .91 and .92)
      3. Evidence of Validity
        1. Cerebral Palsy
          1. Excellent concurrent and construct validity with the Peabody Developmental Fine Motor Subscale (PDMS-FM) total score (r=.84) (Law et al, 1991)
        2. Congenital Muscular Dystrophy
          1. Adequate concurrent validity with the Motor Function Measure 32 total score (r=.392) (Meilleur et al, 2015)
        3. Acquired Brain Injury – no validity data
        4. Overall, the QUEST was developed based on extensive literature and discussions with clinicians; items were selected if they were part of normal development, but effected by spasticity
        5. Face validity has not been established
      4. Evaluative – this measure is used to evaluate the quality of UE function in children 18 months to 8 years of age with spasticity
      5. MCID – only data available for CP population: MCID=4.89 score units (Law et al, 1991)
  3. Summary Comments
    1. Strengths
      1. The outcomes within each domain of the test helps to guide intervention
      2. Reliable and valid in different pediatric populations
    2. Weaknesses
      1. Does not have structured administration guidelines, so it may not be a great measure for novice therapists to use
      2. Since the QUEST is an assessment of quality, a change in score may not equate to a change in function/skill level
      3. The QUEST is administered in a play context, but is reportedly not playful or engaging, especially for children who are younger and have significant impairments
      4. QUEST scores related to the child’s level of disability without regard to age
      5. Normative data doesn’t appear “normal” because there is great variability based on diagnosis and severity of diagnosis
      6. Cost ($99) and time (30-45 minutes)
    3. Clinical Applications
      1. Helps to describe quality of movement
      2. The outcomes within each domain of the test helps to guide intervention
      3. Helps therapists determine specific goals for intervention

 

Adapted from:

http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=1307

https://canchild.ca/en/resources/49-quality-of-upper-extremity-skills-test-quest

DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1993). The reliability and validity of Quality of Upper Extremity Skills Test. Physical and Occupational Therapy in Pediatrics 13(2), 1-18.

Sorsdahl, A.B., Moe-Nilssen, R., et al. (2008). “Observer reliability of the gross motor performance measure and the quality of upper extremity skills test, based on video recordings.” Dev Med Child Neurol 50:146-151.

Meilleur, K.G., Jain, M.S., et al. (2015). “Results of a two-year pilot study of clinical outcome measures in collagen VI and laminin alpha2-related congenital muscular dystrophies.” Neuromuscul Disord 25:43-54.

Haga, N., van der Heijden-Maessen, H.C., et al. (2007). “Test-retest reliability and inter and intrareliability of the quality of the upper extremity skills test in preschool age children with cerebral palsy.” Arch Phys Med Rehabil 88:1686-1689.

Law, M., Cadman, D., et al. (1991). “Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy.” Dev Med Child Neurol 33:379-387.

 

Article Summary

Case-Smith, J., DeLuca, S.C., et al. (2012). “Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up.” Am J Occup Ther 66:15-23.

The purpose of this study was to explore the benefits of pediatric constraint-induced movement therapy (CIMT) for children with unilateral cerebral palsy (CP). This was a RCT that tested the hypothesis that 6 hr vs. 3 hr/day of CIMT would produce larger maintenance of gains and improvements in functional use 6 months post treatment.

Eighteen children ages 3-6 years with unilateral CP were recruited for this study. Children were randomly assigned to 3 or 6 hr/day of CIMT for 21 days. All participants wore a cast on the unaffected extremity. The protocol involved an intensive intervention protocol to improve UE skills and movements. They attempted to provide intervention in natural environments to hope for carry over after therapy ended. Intervention was provided 21 days over a 4-week period. Interventions included UE WB, reaching, grasping, and manipulating objects. The therapists also structured movement practice into ADLs (dressing, grooming, eating) and play activities.

Occupational therapists administered tests including the Assisted Hand Assessment and Quality of Upper Extremity Skill Test, and parents completed the Pediatric Motor Activity Log before and after treatment at 1 week, 1 month, and 6 months.

A strength of this study is its feasibility during therapy sessions. I’m not an OT and don’t have experience with casting, but I do know the benefit of CIMT s/p stroke in adults. Putting a child in a sling or some other type of constraint seems like a feasible thing to do during therapy. Another strength of this study is how children came from multiple sites and were able to follow the patients for 6 months. Lastly, they used a variety of outcome measures so their data can be compared to future studies.

One limitation is the small sample size/low power. This study also did not change other components of the protocol like casting for 24 hr/day or constraint only during the intervention sessions.

Both 3 hr and 6 hr groups showed significant gains from the intensive therapy; however, there were no significant group differences at the 6-month follow up. CIMT is an effective means of improving UE function and effects were moderately maintained 6 months post intervention, but more (double) the constrained time did not mean greater improvements in function.

 

One response to “Quality of Upper Extremity Skills Test (QUEST)”

  1. rcanfield says:
    March 5, 2017 at 9:10 pm

    QUEST seems like it is an affordable outcome measure that can provide good information and is easily applied without many extra instructions. With the prevalence of CP, this seems like an outcome measure that can be used in the clinic often. However, as I was reading the weaknesses of this test and measure, it says that the measure may not correlate with a change in function and skill, the research article used the QUEST outcome measure to monitor changes in function after CIMT and good results were seen, which is interesting! I wonder how common this test actually shows changes in function, since that it what we’re most interested in as physical therapists.

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