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Quality of Upper Extremity Skills Test (QUEST)
Availability
Classification
Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: Measures the quality of upper extremity movement and grasp.
Generic vs. disease specific: Disease specific.
Means of administration: Evaluator administered items in a play context.
Intended respondent: Child.
Background: The purpose of the QUEST is to evaluate quality of upper extremity movement in four domains: dissociated movement, grasp, protective extension, and weight bearing. The scale is validated on children with CP ages 18 months–8 years.
Comments/Special Instructions
Thorley et al. (2012) investigated the construct validity of the QUEST using Rasch analysis (sample=94 children with CP, GMFCS levels I-V, ages 2–16 years). Based upon findings authors had the following recommendations:
  1. QUEST results should be reported by domain; QUEST total scores lacked unidimensionality and thus should not be reported.
  2. Administer more than one domain to increase sensitivity.
  3. When reporting domain scores calculate unimanual scores (instead of adding scores together for both limbs) as good results from one limb may mask poor results of the other.
  4. Do not report the posture items from the grasp domain as these were problematic.
Scoring
Thirty-six items assessing dissociated movements, grasp, protective extension, and weightbearing. A percentage score for each domain is calculated. The four domain scores can be summed for a total percentage score. Domain scores are based on summation of the raw scores from both limbs, but unilateral scores (one side only) can be calculated. Higher scores represent better quality of movement.
 
Administration time: 30–45 minutes.
Rationale/Justification
Strengths/Weaknesses: Based on Rasch analysis (Thorley et al., 2012) further revision or refinement of the scales may be indicated.
 
Psychometric Properties:
Content validity: established through literature review and expert panel.
Construct validity: significant correlations with QUEST total score and PDMS fine motor subtest (r=0.84) and MUUL (r=0.83). Later testing using Rasch analysis (Thorley et al., 2012) showed that the QUEST total score lacks unidimensionality, domains demonstrated higher construct validity and thus QUEST scores should be reported by domain, posture items from the grasp domain were problematic and should not be reported. Person separation values were below the expected value for grasp, weightbearing and protective extension subdomains showing that the scale was unable to distcriminated between children with different levels of ability. Sensitivity to change: smallest difference of clinical significance in casting trial was 4.89 score units (p < 0.03). Klingels et al. (2008) calculated the SEM (3.2%) and the smallest detectable difference SDD (7.11%) for the QUEST total score.
Reliability of the QUEST is well established and has been found to be high for interrater and intrarater reliability (Thorley et al., 2012). DeMatteo et al. (1993) demonstrated good interrater (ICC’s = 0.91–0.96) and test–retest (ICC = 0.95) reliability.
References
DeMatteo C, Law M, Russel D, Pollock N, Rosenbaum P, Walter S. QUEST: Quality of Upper Extremity Skills Test. Hamilton, ON: McMaster University, CanChild Centre for Childhood Disability Research, 1992.
 
DeMatteo C, Law M, Russel D, Pollock N, Rosenbaum P, Walter S. The Reliability and Validity of the Quality of Upper Extremity Skills Test. Phys Occup Ther pediatr. 1993;13(2):1–18.  
 
Gilmore R, Sakzewski L, Boyd R. Upper limb activity measures for 5- to 16-year-old children with congenital hemiplegia: a systematic review. Dev Med Child Neurol. 2010;52(1):14–21.
 
Haga N, van der Heijden-Maessen HC, van Hoorn JF, Boonstra AM, Hadders-Algra M. Test-retest and inter- and intrareliability of the quality of the upper-extremity skills test in preschool-age children with cerebral palsy. Arch Phys Med Rehab. 2007;88(12):1686–1689.   
 
Klingels K, De Cock P, Desloovere K, Huenaerts C, Molenaers G, Van Nuland I, Huysmans A, Feys H. Comparison of the Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test in hemiplegic CP. Dev Med Child Neurol. 2008;50(12):904–909.   
 
Law M, Cadman D, Rosenbaum P, Walter S, Russell D, DeMatteo C. Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy. Dev Med Child Neurol. 1991;33(5):379–387.   
 
Thorley M, Lannin N, Cusick A, Novak I, Boyd R. Construct validity of the Quality of Upper Extremity Skills Test for children with cerebral palsy. Dev Med Child Neurol. 2012;54(11):1037–1043.   
 
Thorley M, Lannin N, Cusick A, Novak I, Boyd R. Reliability of the quality of upper extremity skills test for children with cerebral palsy aged 2 to 12 years. Phys Occup Ther Pediatr. 2012;32(1):4–21.
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