• The Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) is a test to measure unilateral gross motor function of the hand (focusing on lateral pinch, pulp pinch, and palmar grasp) in people with SCI.
  • It consists of 2 parts and is designed to assess both proximal and distal hand function.
    • The first part assesses the individuals’ ability to manipulate different everyday objects.
    • The second part measures the ability to withstand eccentric forces (Bar test), the strength of lateral pinch using a dynamometer (instrumented credit card test) and the strength of palmar grasp using a dynamometer (instrumented cylinder).

Clinical Considerations

The TRI-HFT has potential for high clinical utility (i.e., low cost, minimal training required to administer). Recently, to improve the accessibility of the test (regarding the objects needed), a 3D printed format has been developed.

ICF Domain

Activity ▶ Mobility

Administration

Performance-based test.

Length

Less than 30 minutes.

Items – Equipment

Items for palmar grasp object manipulation (part 1):

  • Mug
  • Book
  • Soda can
  • Isosceles triangular sponge
  • Wireless home telephone
  • Paper sheet
  • Ziploc bag filled with five golf balls
  • Dice
  • Credit card
  • Pencil
  • Nine rectangular blocks in sets of 3 x 100 g, 3 x 200 g, and 3 x 300 g. Each of the three blocks in each weight category have surfaces with different levels of friction.

Items for strength test (part 2):

  • Instrumented credit card
  • Instrumented cylinder
  • Wooden bar

Scoring

  • The ability to reach, grasp and manipulate is scored on a scale of 0–7, where greater scores indicate better performance.
  • If the individual was able to hold objects (in part 2), then torque, force, and eccentric load are measured; however, this part of the TRI-HFT is not validated.

Languages

English

Training Required

It should preferably be administered by a hand or upper extremity specialist (e.g., physiotherapist or occupational therapist).

Availability

The Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) worksheet can be found here

Measurement Property Summary

# of studies reporting psychometric properties: 3

Interpretability

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

Reliability – High

  • High Inter-rater Reliability:
    • Pretherapy: ICC = 0.98
    • Posttherapy: ICC = 0.99

(Kapadia et al. 2012; n=21; ASIA B-D; level of injury: C4-C7; time since injury < 6 months)

    • ICC = 1.0 (P < 0.01)

(Nagai et al. 2018; n=20; 10 participants with SCI; injury level: C5-C7)

  • High Inter-rater Reliability of the 10-object manipulation component of the 3D TRI-HFT:
    • Sub-acute study: ICC = 0.994 (95% CI: 0.985–0.998; P < 0.000)
    • Chronic study: ICC = 0.990 (95% CI:0.976–0.996; P < 0.000)

(Kapadia et al. 2021; sub-acute study: n=4, 3 males and 2 females, mean age: 51.8 years, injury level C4-C5, ASIA B-D; chronic study: n=3, 2 males and one female, mean age: 57.5 years, injury level C4, ASIA B-C) 

  • High Intra-rater Reliability: ICC = 1.0 (P < 0.01)

(Nagai et al. 2018; n=20; 10 participants with SCI; injury level: C5-C7)

  • High Intra-rater Reliability of the 10-object manipulation component of the 3D TRI-HFT:
    • Sub-acute study: ICC = 0.995 (95% CI: 0.992–0.998; P < 0.000)
    • Chronic study: ICC = 0.999 (95% CI: 0.999–1.00; P < 0.000)

(Kapadia et al. 2021; sub-acute study: n=4, 3 males and 2 females, mean age: 51.8 years, injury level C4-C5, ASIA B-D; chronic study: n=3, 2 males and one female, mean age: 57.5 years, injury level C4, ASIA B-C)

Validity – Low to High

  • Moderate to High correlation with FIM self-care:
    • Right hand: r = 0.56
    • Left hand: r = 0.73
  • Low to High correlation with SCIM self-care:
    • Right hand: r = 0.48
    • Left hand: r = 0.62

(Kapadia et al. 2012; n=21; ASIA B-D; level of injury: C4-C7; time since injury < 6 months)

  • Moderate to High correlation between 3D TRI-HFT individual test components and GRASSP Strength:
    • Sub-acute study: r = 0.774 – 0.946
    • Chronic study: r = 0.601 – 0.938
  • Moderate to High correlations between 3D TRI-HFT individual test components and GRASSP Quantitative Prehension:
    • Sub-acute study: r = 0.804 – 0.938
    • Chronic study: r = 0.633 – 0.997

(Kapadia et al. 2021; sub-acute study: n=4, 3 males and 2 females, mean age: 51.8 years, injury level C4-C5, ASIA B-D; chronic study: n=3, 2 males and one female, mean age: 57.5 years, injury level C4, ASIA B-C)

Responsiveness

No values were reported for the responsiveness of the TRI-HFT for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the TRI-HFT for the SCI population.

Reviewers

Dr. Janice Eng, Dr. Carlos L. Cano-Herrera, Matthew Querée

Date Last Updated

31 December 2024

Kapadia N, Zivanovic V, Verrier M, Popovic MR. Toronto rehabilitation institute-hand function test: assessment of gross motor function in individuals with spinal cord injury. Top Spinal Cord Inj Rehabil. 2012; 18: 167-86. doi: 10.1310/sci1802-167.
https://pubmed.ncbi.nlm.nih.gov/23459270/

Kapadia N, Jovanovic L, Musselman K, Wang R, Marquez-Chin C, Popovic MR. Preliminary evaluation of the reliability and validity of the 3D printed Toronto Rehabilitation Institute-Hand Function Test in individuals with spinal cord injury. J Spinal Cord Med. 2021; 44: S225-S233. doi: 10.1080/10790268.2021.1961055.
https://pubmed.ncbi.nlm.nih.gov/34779739/

Nagai MK, Contway C, Zivanovic V, Boschen KA, Popovic MR. Toronto Rehabilitation Institute Hand Function Test: Unilateral Gross Motor Function Assessment. 2018.
https://www.sralab.org/sites/default/files/2017-07/IFESS2008_008_Nagai.pdf

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