Comparison of Responsiveness and Minimal Clinically Important Difference of the Capabilities of Upper Extremity Test (CUE-T) and the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP)

Top Spinal Cord Inj Rehabil, 2018 · DOI: 10.1310/sci2403-227 · Published: July 1, 2018

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

The Capabilities of Upper Extremity Test (CUE-T) and the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) were developed to measure changes in upper extremity function for individuals with tetraplegia. This study compares how well each test can detect meaningful changes in upper extremity function after a spinal cord injury, focusing on responsiveness and the smallest amount of change that patients perceive as important. Both tests were found to be responsive to changes in upper extremity function, but the CUE-T was able to detect some changes that the GRASSP did not.

Study Duration

3 months

Participants

69 persons with tetraplegia: 60 with acute and 9 with chronic injuries

Evidence Level

Not specified

Key Findings

1
Both the CUE-T and QtP-GRASSP are responsive to change in persons with acute cervical spinal cord injury with large SRMs.
2
The MCID for the total CUE-T score was 12 points (out of 128) based on a small change in the subjective and objective anchors.
3
The CUE-T detects some changes in UE function not seen with the QtP-GRASSP.

Research Summary

This study compared the responsiveness and minimal clinically important difference (MCID) of the CUE-T and the quantitative prehension (QtP) scale of the GRASSP in persons with cervical SCI. Both the CUE-T and QtP-GRASSP demonstrated large responsiveness in persons with acute tetraplegia, with similar responsiveness to the UEMS. The CUE-T detected changes in some subjects that the QtP-GRASSP did not, primarily due to the arm items in the CUE-T.

Practical Implications

Clinical Practice

The CUE-T may be more suitable for detecting subtle changes in upper extremity function, especially in individuals with limited hand function.

Research

Researchers can use the MCID values to determine if interventions result in clinically meaningful improvements in upper extremity function.

Assessment Choice

The choice between CUE-T and GRASSP may depend on the specific goals of the assessment, with the CUE-T offering a more comprehensive evaluation of upper limb functional capacity.

Study Limitations

1
Study sample had relatively few motor complete subjects, limiting the ability to compare responsiveness by level of injury and AIS grade.
2
Detailed analysis of the CUE-T items should be performed to see if some items can be eliminated in order to reduce the burden of testing.
3
The CUE-T takes longer to perform than the QtP-GRASSP.

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