Validity of the Buttoning Test in Hand Disability Evaluation of Patients With Stroke

OBJECTIVE: To investigate the relationship between the buttoning test and Jebsen-Taylor Hand Function Test (JTHFT), and to determine the validity of using the buttoning test as a tool to evaluate hand disability in patients with stroke. METHODS: This was a retrospective study of the medical records of 151 ischemic stroke patients affecting the dominant hand. Patients underwent the buttoning test and JTHFT for their affected hand. All patients were divided into three groups depending on how quickly they fastened a button (group A, not completed; group B, slowly completed over 18 seconds; and group C, completed within 18 seconds). RESULTS: The button fastening time was negatively correlated with the total score and subtest scores of the JTHFT. Patients who experienced difficulty during the buttoning test had lower mean scores in the JTHFT (group A, 28.0±23.9; group B, 62.9±21.7; group C, 75.4±13.3; p<0.0001, Jonckheere-Terpstra test). We observed significant differences in JTHFT scores among the three groups (p<0.017, Mann-Whitney U-test), although there were considerable overlaps in JTHFT scores between the groups. Significant differences were also found in the subtest scores of the JTHFT, which include fine hand motor function (writing letters, p=0.009; moving small objects, p=0.003; stacking checkers, p=0.001 between groups B and C), among the three groups. CONCLUSION: Considering its relationship with the JTHFT and validity, the buttoning test can be considered appropriate for evaluation of hand disability in patients with stroke.