title: The push-off test: development of a simple, reliable test of upper extremity weight-bearing capability.
abstract: METHODS
  Longitudinal clinical measurement study.
  
  
  BACKGROUND
  The push-off test (POT) is a novel and simple measure of upper extremity weight-bearing that can be measured with a grip dynamometer. There are no published studies on the validity and reliability of the POT. The relationship between upper extremity self-report activity/participation and impairment measures remain an unexplored realm.
  
  
  OBJECTIVE
  The primary purpose of this study is to estimate the intra and inter-rater reliability and construct validity of the POT. The secondary purpose is to estimate the relationship between upper extremity self-report activity/participation questionnaires and impairment measures.
  
  
  METHODS
  A convenience sample of 22 patients with wrist or elbow injuries were tested for POT, wrist/elbow range of motion (ROM), isometric wrist extension strength (WES) and grip strength; and completed two self-report activity/participation questionnaires: Disability of the Arm, Shoulder and the Hand (DASH) and Work Limitations Questionnaire (WLQ-26). POT's inter and intra-rater reliability and construct validity was tested. Pearson's correlations were run between the impairment measures and self-report questionnaires to look into the relationship amongst them.
  
  
  RESULTS
  The POT demonstrated high inter-rater reliability (ICC affected = 0.97; 95% C.I. 0.93-0.99; ICC unaffected = 0.85; 95% C.I. 0.68-0.94) and intra-rater reliability (ICC affected = 0.96; 95% C.I. 0.92-0.97; ICC unaffected = 0.92; 95% C.I. 0.85-0.97). The POT was correlated moderately with the DASH (r = -0.47; p = 0.03). While examining the relationship between upper extremity self-reported activity/participation questionnaires and impairment measures the strongest correlation was between the DASH and the POT (r = -0.47; p = 0.03) and none of the correlations with the other physical impairment measures reached significance. At-work disability demonstrated insignificant correlations with physical impairments.
  
  
  CONCLUSIONS
  The POT test provides a reliable and easily administered quantitative measure of ability to bear the load through an injured arm. Preliminary evidence supports a moderate relationship between loading bearing measured by the POT and upper extremity function measured by the DASH.
  
  
  METHODS
  1b.
authors.affiliation: University of Western Ontario, Health and Rehabilitation Sciences, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada. Electronic address: jisrael2@uwo.ca.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Vincent
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada.
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Cayuga Hand Therapy PT, Ithaca, NY, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Michlovitz
authors.affiliation: School of Physiotherapy, University of Western Ontario, London, Ontario, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Rafuse
authors.affiliation: School of Physiotherapy, University of Western Ontario, London, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Wells-Rowsell
authors.affiliation: School of Physiotherapy, University of Western Ontario, London, Ontario, Canada.
authors.forename: Owen
authors.initials: O
authors.lastname: Wong
authors.affiliation: School of Physiotherapy, University of Western Ontario, London, Ontario, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Bisbee
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000503:physiopathology* / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D057566:Self Report; D034941:Upper Extremity / Q000503:physiopathology*; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult
keywords: Construct validity; Impairment measures; Push-off test; Reliability; Self-report measures; Upper limb; Weight-bearing