Arthritis Hand Function Test (AHFT)

The Arthritis Hand Function Test (AHFT) is a standardized, performance-based test that measures hand strength and dexterity in individuals with different types of arthritis, especially rheumatoid arthritis (RA) and osteoarthritis (OA). It was developed by Catherine Backman and Hazel Mackie in 1997 and is widely used in both clinical practice and research to evaluate hand function and track treatment effects over time.¹ ²

Target Population

AHFT is specifically designed for patients with:

• Rheumatoid arthritis (RA)

• Osteoarthritis (OA)

• Systemic sclerosis

It is useful for both pre- and postoperative assessment and for measuring the effectiveness of various treatment approaches aimed at improving hand function.²

Test Structure

The AHFT is divided into four subscales, covering different dimensions of hand function:

• Strength

• Applied strength

• Dexterity

• Applied dexterity

All tasks are performed bilaterally.

Required Equipment

• Sphygmomanometer

• Pinch meter

• 9-hole pegboard

• Shoe

• Button board

• Two safety pins

• Theraflex putty

• Plate

• Knife and fork

• Coins and container

• Tray

• 12 soup cans

• Pitcher and glass

• 1-liter water container

• Measuring cup

• Stopwatch

A complete test kit and manual can be purchased from the University of British Columbia, Canada.

Test Procedure

The test takes approximately 20 minutes to administer and requires no special training.

Dexterity

• Performed one hand at a time, one round per hand.

• 9-Hole Peg Test: Time to insert and remove pegs is recorded.

Strength

• Performed one hand at a time, three repetitions per test.

• Grip strength (mm Hg, via sphygmomanometer)

• Tip pinch (kg)

• Three-point pinch (kg)

Applied Dexterity

Performed bilaterally, consisting of five tasks:

• Buttoning and unbuttoning four buttons

• Tying a shoelace

• Fastening and unfastening two safety pins

• Picking up coins and placing them into a box

• Cutting putty into four pieces with a knife and fork

Applied Strength

Performed bilaterally, consisting of two tasks:

• Lifting a tray with six soup cans (adjustable number of cans)

• Lifting a 1-liter water container (weight adjusted to ability)

Scoring

Scoring follows the official manual instructions and is compared to normative data.

• Each subscale has its own scoring system.

• Results are combined to provide an overall assessment of hand function.

Evidence

Reliability

• Interrater reliability:

  • RA: ICC 0.89–1.0

  • OA: ICC 0.99–1.0

  • Indicates excellent agreement between test administrators.³ ⁴

• Test–retest reliability:

  • RA: ICC 0.53–0.95

  • OA: ICC 0.74–0.96

  • Demonstrates consistency over time.³ ⁴

Validity

• Strong correlation with Jebson’s Hand Function Test for the right hand (r = 0.63) and moderate to low for the left hand (r = 0.08).⁵

• Strong correlation with the Dexterity component of the Arthritis Impact Measurement Scales (r = 0.71).⁵

Clinical Relevance

The AHFT provides clinically meaningful data for assessing hand strength and dexterity in patients with arthritic conditions.

• Useful for evaluating rehabilitation outcomes and monitoring disease progression.

• Offers therapists a comprehensive view of patients’ ability to manage self-care, work, and leisure activities.

• Cost-effective, practical, and widely applicable in clinical and research settings.

Sources:

1. Poole JL. Measures of hand function: Arthritis Hand Function Test (AHFT), Australian Canadian Osteoarthritis Hand Index (AUSCAN), Cochin Hand Function Scale, Functional Index for Hand Osteoarthritis (FIHOA), Grip Ability Test (GAT), Jebsen Hand Function Test (JHFT), and Michigan Hand Outcomes Questionnaire (MHQ). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S189-99. doi: 10.1002/acr.20631. PMID: 22588744.

2. Poole, J.L. (2003), Measures of adult hand function: Arthritis Hand Function Test (AHFT), Grip Ability Test (GAT), Jebsen Test of Hand Function, and The Rheumatoid Hand Functional Disability Scale (The Duruöz Hand Index [DHI]). Arthritis & Rheumatism, 49: S59-S66. doi:10.1002/art.11406

3. Backman C, Mackie H. Reliability and Validity of the Arthritis Hand Function Test in Adults with Osteoarthritis. The Occupational Therapy Journal of Research, 1997. 17:1,55-66.

4. Backman C, Mackie M, Harris J. Arthritis Hand Function Test: Development of a Standardized Assessment Tool. The Occupational Therapy Journal of Research, 1991.11:4, 245-256

5. Duruöz MT, Poiraudeau S, Fermanian J, Menkes C, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol 1996; 23: 1167– 72.