The Development of a Hand Assessment for Multiple Sclerosis (HAMS)

Background: Hand function, such as grip strength, uni- and bi-manual coordination, and sensation is often compromised in individuals living with Multiple Sclerosis (MS). Impairment in these domains affect one’s ability to complete self care, productivity and leisure activities thereby impacting independence and quality of life. Until now, no single performance hand assessment specific to MS has been developed. 

Objectives: (1) To describe a comprehensive, performance based, client-centered hand assessment, designed to identify hand function difficulties for persons living with MS and to guide intervention decisions. (2) To evaluate clinimetrics of this assessment including feasibility, clinical utility and content validity.

Methods: This study is conducted in two phases: assessment development, then refinement and evaluation. This assessment was developed based on the literature and experience assessing hand function difficulties among people with MS. Refinement and evaluation included an initial consultation phase with clinician participants who made suggestions and the assessment was revised.  This version was then administered to people with MS to test instrument’s clinimetrics.

Results: (1) The developed hand assessment includes both an activity and environment questionnaire as well as a physical and performance-based component which evaluates (a) muscle strength (grip and pinch), (b) peripheral sensation (light touch and stereognosis), (c) vibration, and (d) coordination (uni- and bi-manual). (2) In terms of content validity, the overall impression of clinicians was favorable with minor suggestions included in revision of assessment. The HAMS was shown to be feasible and is establishing criterion validity.

Conclusions: This comprehensive assessment provides practitioners with an efficient, yet comprehensive assessment of hand function that directs appropriate treatment planning for people with MS. This study builds practice knowledge with the development and application of a novel client-centered hand assessment for persons living with MS who experience hand impairment. Additionally, assessment results help to enlighten clients about their current hand function, provide information to tailor appropriate treatment planning, and direct future interventions.