• Assesses functional limitations and the amount of difficulty experienced in performing specific actions with one or both arms and hands in people with tetraplegia.

  • There are different versions of the Capabilities of Upper Extremity (CUE) instrument:

    • Questionnaire (CUE-Q).

    • Performance measure (CUE – test [CUE-T]).

Clinical Considerations

  • The CUE has clinical appeal because it reflects hand and/or arm function and scores can be derived for either limb, which is useful particularly for people with incomplete injuries.
  • Items were generated through discussions with physical and occupational therapists, patients, colleagues and experts in scale design, increasing the acceptability of the scale by therapists and people with SCI.
  • While the CUE-T was developed initially for adults, research supports its use in people older than 6 years of age.

ICF Domain

Activity ▶ Mobility

Administration

  • Clinician-administered; interview format (can be in-person or over telephone)
  • Takes about 30 minutes to complete.

Number of Items

32 items (15 unilateral – left and right, and 2 bilateral).

Equipment

None.

Scoring

  • Responses are given on a 7-point scale representing self-perceived difficulty in performing the action, with scores ranging from 1 (unable to perform) to 7 (can perform without difficulty).
  • Responses are summed to give a total score (ranges from 32 to 124).
  • Left and right arm/hand function can be derived separately.
  • A percent of normal function score is also possible using the following algorithm (total score – 32) / 192 * 100%.

Languages

English and Hindi.

Training Required

Does not require advanced training.

Availability

The CUE worksheet can be found here.

The file above contains administration and scoring instructions, rating system, as well as a ready-to-use worksheet for data collection.

# of studies reporting psychometric properties: 5

Interpretability

  • Item by item results of the test are straightforward to interpret.
  • Total scores range from 32 to 124 with higher scores reflecting better function.

MCID: not established for SCI
SEM: 12.2

(Marino et al. 1998; n = 154, 140M/14F, mean (SD) age: 36.7 (11.1) yrs, tetraplegia)

MDC: 33.8

(Calculated from data in Marino et al. 1998; n = 154, 140M/14F, mean (SD) age: 36.7 (11.1) yrs, tetraplegia)

Typical Values

Mean CUE score: 78.8 (SD: 29, range: 4-124, median = 78)

(Kalsi-Ryan et al. 2012; n=72; mean age: 39.7 years; 39% complete tetraplegia, 61% incomplete tetraplegia; chronic SCI)

Reliability – High

Internal consistency for the CUE is High (Cronbach’s α = 0.96)

(Marino et al. 2012, n=30; 30 males; mean age: 44.8 years; 10 incomplete, 20 complete injury)

Validity – High

  • High Spearman’s ρ correlation with GRASSP subtests (All P<.0001):
    Sensation total (R+L): ρ = 0.77
    Strength total (R+L): ρ = 0.76
    Prehension performance total (R+L): ρ = 0.83

(Kalsi-Ryan et al. 2012; n = 72; mean age: 39.7 years; 39% complete tetraplegia, 61% incomplete tetraplegia; chronic SCI)

  • High Spearman’s ρ correlation with GRASSP V2 subtests (All P<.0001):
    GRASSP Sensibility: ρ = 0.79
    GRASSP Strength: ρ = 0.76
    GRASSP Prehension: ρ = 0.83

(Kalsi-Ryan et al. 2019; n=72; mean age: 39.7 years; ASIA A-D; chronic tetraplegia)

  • High correlation with ASIA Upper Extremity Motor Score:
    r = 0.782
  • High correlation with Functional Independence Measure:
    r = 0.738

(Marino et al. 1998; n=154; mean age: 37 years; ASIA A-D; chronic SCI)

Responsiveness

Effect Size:

  • Between admission and discharge: 0.92

(Values for CUE Questionnaire: Oleson and Marino 2014; n = 46, 42 males, acute inpatient rehab)

Floor/Ceiling Effect

  • One item (item-left hand-5) on the CUE had a borderline floor effect.

(Marino et al. 1998)

  • Ceiling effect: 88%-96% of sample had maximum scores on Push & Pull Items

(Values for CUE Test; Marino et al. 2015: n=50, 36 males, outpatient rehab)

Reviewers

Dr. William Miller, Dr. Carlos L. Cano-Herrera

Date Last Updated

31 December 2024

Administration

  • Two examiners are required to conduct this test. Examiners are responsible for counting repetitions, ensuring appropriate technique, and timing each task. If it is not possible to have two examiners, the test should be videotaped and repetitions counted afterwards.

  • For each item, the examiner needs to explain and demonstrate the task to each participant. Practicing each task by the participant should be allowed before testing it.

  • Takes about 30 minutes to complete.

Number of Items

17 items.

Equipment

  • Timer
  • Yardstick
  • Round marker
  • Wood block with L-bracket
  • Weights (1/2 kg, 1 kg, 2 kg)
  • Nonslip mat
  • Clamp
  • Height-adjustable table
  • Hand-held dynamometer and pinch dynamometer
  • Plastic container with lid
  • Credit card
  • Pencil
  • Calculator,
  • Cell phone.

For a detailed list of equipment, consult the CUE-T manual.

Scoring

  • Raw scores are recorded as indicated on the data collection sheet. These scores will be converted to a five-point scale (from 0 to 4).

  • The total score ranges from 0 to 128 points, including scores for the hand (36 points per side) for fine movements and the side (60 points per side), excluding bimanual movements.

Languages

English.

Training Required

Does not require advanced training.

Availability

The Capabilities of Upper Extremities Test (CUE-T) worksheet can be found for free here.

# of studies reporting psychometric properties: 5

Interpretability

  • Higher scores reflect better function.

MCIDadjust:

  • CUE-T total = 7.7
  • CUE-T hand = 2.0
  • CUE-T side = 3.7

MCIDdistribution:

  • CUE-T total = 3.4
  • CUE-T hand = 1.1
  • CUE-T side = 1.6

(Jimbo et al. 2023; n=52; 45 males, 7 females; mean (SD) age: 56.8 (13.5) years; ASIA A-D; level of injury: C1-T1; subacute SCI)

SEM: Not established in SCI.

MDC: Not established in SCI.

Typical Values

Cutoff values (CUE-T score by points) for independence in activities of daily living:

  • Feeding: 37
  • Bathing the upper body: 91
  • Bathing the lower body: 90
  • Dressing the upper body: 82
  • Dressing the lower body: 81
  • Grooming: 60

(Jimbo et al. 2024; n=71; 60 males, 11 females; median age: 61.0 years; ASIA A-D; level of injury: C1-T1; subacute SCI)

Reliability – High

  • Internal consistency for the CUE-T is High (Cronbach’s α = 0.96)

(Marino et al. 2012; n=30; 30 males; mean age: 44.8 years; 10 incomplete and 20 complete injury)

Validity – High

  • High Spearman’s ρ correlation with GRASSP subtests (All P<.0001):
    Sensation total (R+L): ρ = 0.77
    Strength total (R+L): ρ = 0.76
    Prehension performance total (R+L): ρ = 0.83

(Dent et al. 2018; n=39; mean age: 12.9 (all < 18 years); tetraplegia)

  • High correlation with ASIA Upper Extremity Motor Score:
    r = 0.83 – 0.91

(Marino et al. 2012; n=30; 30 males; mean age: 44.8 years; 10 incomplete and 20 complete injury)
(Marino et al. 2015; n=50, 36 male, 14 females; mean (SD) age = 48.1 (18.2) years); 20 motor complete (ASIA A-B), 30 motor incomplete (ASIA C-D))

  • High correlation with SCIM:
    SCIM Self-Care Score: r = 0.70
    SCIM Mobility Score: r = 0.55

(Marino et al. 2015; n=50, 36 male, 14 females; mean (SD) age = 48.1 (18.2) years; 20 motor complete (ASIA A-B), 30 motor incomplete (ASIA C-D))

Responsiveness

Effect Size:

  • Standardized response mean (SRM) in subacute period after SCI: 1.07

(Marino et al. 2018; n=69, mean (SD) age: 41.9 (18.1) years, ASIA A-D), acute and chronic)

Floor/Ceiling Effect

Not established in SCI.

Reviewers

Dr. William Miller, Dr. Carlos L. Cano-Herrera

Date Last Updated

31 December 2024

Aikat R, Prasad S. Cross-cultural adaptation, validity and reliability of the Hindi version of the capabilities of upper extremity (CUE-H). Spinal Cord Ser Cases. 2023 Oct 26;9(1):50. doi: 10.1038/s41394-023-00606-1.
https://pubmed.ncbi.nlm.nih.gov/37884505/

Dent K, Grampurohit N, Calhoun Thielen C, Sadowsky C, Davidson L, Taylor HB, Bultman J et al. Evaluation of the capabilities of upper extremity test (CUE-T) in children with tetraplegia. Top Spinal Cord Inj Rehabil 2018; 24: 239;251.
https://pubmed.ncbi.nlm.nih.gov/29997427/

Jimbo K, Miyata K, Yuine H, Takahama K, Yoshimura T, Shiba H, Yasumori T, Kikuchi N, Shiraishi H. Verification of the minimal clinically important difference of the Capabilities of Upper Extremity Test in patients with subacute spinal cord injury. J Spinal Cord Med 2023; 6:1-8.
https://pubmed.ncbi.nlm.nih.gov/37930635/

Jimbo K, Miyata K, Yuine H, Takahama K, Yoshimura T, Shiba H, Yasumori T, Kikuchi N, Shiraishi H. Classification of upper-limb dysfunction severity and prediction of independence in activities of daily living after cervical spinal-cord injury. Spinal Cord. 2024; 62: 507-513. doi: 10.1038/s41393-024-01005-5. Erratum in: Spinal Cord. 2024; 62: 553. doi: 10.1038/s41393-024-01017-1.
https://pubmed.ncbi.nlm.nih.gov/38886575/

Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, Fehlings MG, Verrier MC. The Graded Redefined Assessment of Strength Sensibility and Prehension: Reliability and Validity. Journal of Neurotrauma, 2012; 29: 905-914.
http://www.ncbi.nlm.nih.gov/pubmed/21568688

Kalsi-Ryan S, Chan C, Verrier M, Curt A, Fehlings M, Bolliger M, Velstra IM; GRASSP Cross Sectional Study Team; GRASSP Longitudinal Study Team. The graded redefined assessment of strength sensibility and prehension version 2 (GV2): Psychometric properties. J Spinal Cord Med. 2019 Oct;42(sup1):149-157.
https://pubmed.ncbi.nlm.nih.gov/31573454/

Marino RJ, Patrick M, Albright W, Leiby BE, Mulcahey M, Schmidt-Read M, Kern SB. Development of an objective test of upper-limb function in tetraplegia: The capabilities of upper extremity test. Am J Phys Med Rehabil 2012 Jun; 91(6): 478-486.
https://www.ncbi.nlm.nih.gov/pubmed/22469875

Marino RJ, Kern SB, Leiby B, Schmidt-Read M, Mulcahey MJ. Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injury. J Spinal Cord Med 2015; 38: 498-504.
https://www.ncbi.nlm.nih.gov/pubmed/25297342

Marino RJ, Shea JA, Stineman MG. The Capabilities of Upper Extremity Instrument: Reliability and Validity of a Measure of Functional Limitation in Tetraplegia. Arch Phys Med Rehabil 1998;79:1512-21.
http://www.ncbi.nlm.nih.gov/pubmed/9862292

Marino RJ, Sinko R, Bryden A, Backus D, Chen D, Nemunaitis GA, Leiby BE. 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; 24: 227-238. doi: 10.1310/sci2403-227.
https://pubmed.ncbi.nlm.nih.gov/29997426/

Mulcahey MJ, Calhoun Thielen C, Dent K, Sinko R, Sadowsky C, Martin R, Vogel LC, Davidson L, Taylor H, Bultman J, Gaughan J. Evaluation of the graded redefined assessment of strength, sensibility and prehension (GRASSP) in children with tetraplegia. Spinal Cord. 2018 Aug;56(8):741-749.
https://pubmed.ncbi.nlm.nih.gov/29626193/

Oleson CV, Marino RJ. Responsiveness and concurrent validity of the revised capabilities of upper extremity-questionnaire (CUE-Q) in patients with acute tetraplegia. Spinal Cord 2014 Aug; 52(8): 625-628.
https://www.ncbi.nlm.nih.gov/pubmed/24891011

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