Responsiveness of the Manual Ability Measure—36
(MAM–36): Changes in Hand Function Using
Self-Reported and Clinician-Rated Assessments
MeSH TERMS
 activities of daily living
 hand strength
 recovery of function
 reproducibility of results
 task performance and analysis
Christine C. Chen, MA, MS, ScD, OTR/L, FAOTA, is
Associate Professor, Department of Rehabilitation and
Regenerative Medicine (Occupational Therapy), College of
Physicians and Surgeons, Columbia University, 710 West
168th Street, Eighth Floor, New York, NY 10032;
ccc2114@columbia.edu
Orit Palmon, MS, OTR, is Adjunct Lecturer, Department
of Occupational Therapy, University of Haifa, Haifa, Israel,
and Occupational Therapist, Linn Medical Center, Clalit
Medical Services, Haifa, Israel.
Debbie Amini, EdD, OTR/L, CHT, is Assistant
Professor, Department of Occupational Therapy,
East Carolina University, Greenville, NC.
The American Journal of Occupational Therapy
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Christine C. Chen, Orit Palmon, Debbie Amini
OBJECTIVE. To examine the responsiveness of the Manual Ability Measure–36 (MAM–36) compared with
a clinician-administered functional assessment.
METHOD. The MAM–36 was administered to 46 patients (Cohort A, n 5 20; Cohort B, n 5 26) with
various upper-extremity conditions. All patients received occupational therapy intervention for 2–37 wk and
were retested at discharge. Additionally, the Smith Hand Function Test (SHFT), including task performance
speeds and grip strength measurements, was administered to Cohort B at intake and discharge.
RESULTS. Manual ability improved significantly at discharge in all patients. Patients also showed sig-
nificant improvement on the SHFT. The correlation between gain in MAM–36 and gain in grip strength was
moderate. The standardized response mean for the MAM–36 was 1.18.
CONCLUSION. The MAM–36 was responsive to changes in hand function in patients receiving
occupational therapy services. MAM–36 results correlated positively with improvements in task perfor-
mance speeds and grip strength.
Chen, C. C., Palmon, O., & Amini, D. (2014). Responsiveness of the Manual Ability Measure—36 (MAM–36): Changes in
hand function using self-reported and clinician-rated assessments. American Journal of Occupational Therapy, 68,
187–193. http://dx.doi.org/10.5014/ajot.2014.009258
O ccupational therapy advocates client-centered practice to promote client
function and occupational performance (Law, Baum, & Dunn, 2005).
However, research documenting therapy effectiveness in promoting actual
functional outcome is sparse (Aldehag, Jonsson, & Ansved, 2005; Case-Smith,
2003; Jack & Estes, 2010; Rønningen & Kjeken, 2008; van der Giesen et al.,
2007), with the measurement of treatment effectiveness often limited to
impairment-focused measurement (Schoneveld, Wittink, & Takken, 2009).
For example, although occupational therapists often treat patients with ten-
donitis who receive steroid injections and those who are not fit for steroid
injections, no studies have systematically compared short-term functional im-
provement or long-term outcomes in these two groups. Likewise, no studies
have compared treatment outcomes in patients who received steroid injections
alone with those of patients who received a combination of injections and
occupational therapy. As a result, whether and to what extent patients with
tendonitis benefit from occupational therapy hand rehabilitation is not known.
This phenomenon is not unique to occupational therapy. In the field of hand
surgery, studies have often reported pain and impairment reduction and seldom
addressed short- or long-term functional outcomes. Hand surgeons providing
steroid injection to treat patients with tendonitis have found that it is effective
(for pain reduction) in only about 60% of patients; its long-term effect on
function is unknown (Bailey, Kaskutas, Fox, Baum, & Mackinnon, 2009;
McAuliffe, 2010). In a recent study, Swedish researchers reported that patients
187
 adopted different strategies using their hands after trau-
matic hand injuries, but again the researchers did not
measure function; therefore, they did not know whether
patients had improved function over time or not (Kingston,
Tanner, & Gray, 2010).
Clinicians and researchers have agreed that patients’
ultimate goals for seeking treatment are to relieve
symptoms and improve function, that is, to perform daily
tasks with ease and comfort (Bailey et al., 2009; Davis
et al., 1999). At this time, much information related to
functional outcomes either is derived from outcome tools
that assess component- or factor-level deficits (e.g., pain,
sensation, range of motion, and strength are categorized
as body function under client factors; see the Occupa-
tional Therapy Practice Framework: Domain and Process,
2nd Edition; American Occupational Therapy Associa-
tion [AOTA], 2008) and performance skills (e.g., task
performance that requires integrated skills such as dex-
terity or coordination) or comes from a patient’s self-
report. Moreover, research has suggested that improvement
in body function or component deficits does not always
translate into improvement in activity participation or
quality of life (Bindra et al., 2003; Rallon & Chen,
2008; Schoneveld et al., 2009).
Several functional assessments used in occupational
therapy hand settings are self-reported (Disabilities
of Arm, Shoulder and Hand Questionnaire [Hudak,
Amadio, Bombardier, & the Upper Extremity Collabo-
rative Group, 1996], Patient-Rated Wrist–Hand Evaluation
Questionnaire [MacDermid & Tottenham, 2004],
Michigan Hand Outcomes Questionnaire [Chung,
Pilsbury, Walters, & Hayward, 1998]) and are supported
in the literature as having reasonable construct validity
and responsiveness (Hoang-Kim, Pegreffi, Moroni, &
Ladd, 2011). However, a need does exist to correlate
patient-reported outcome tools, which are subjective in
nature, with those professionally administered by the
clinician (Carlsson, Haak, Nygren, & Iwarsson, 2012)
as an additional step toward expanding their use and
thereby providing clinicians and researchers with a greater
number of outcome measures that can be used to assess
changes in participation.
The 36-item Manual Ability Measure–36 (MAM–36;
Chen & Bode, 2010) is a newly developed assessment.
Although the MAM–36 has gone through rigorous vali-
dation processes and demonstrated excellent internal
validity, its responsiveness is unknown because it has not
been used to investigate treatment effectiveness. There-
fore, we sought to determine its responsiveness to func-
tional change after treatment intervention compared with
improvements in component deficits (i.e., grip strength)
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or performance skills (i.e., activities of daily living [ADL]
task performance speed). This study posed two questions:
(1) Is the MAM–36 sensitive enough to measure func-
tional changes and, if so, (2) does the change detected by
the MAM–36 correlate with changes measured by an-
other performance-based, clinician-rated assessment?
Method
Research Design
We used a one-group pretest–posttest design to collect
data. The study was approved by the institutional review
boards of the participating institutions, and all patients
provided consent before their participation in the study.
Participants
Patients who had various upper-extremity injuries or
conditions and received occupational therapy outpatient
services at an urban Israeli medical center were recruited to
participate in the research. The exclusion criteria were as
follows: (1) The patient was unable to understand or
communicate with the therapist regarding items on the
MAM–36 and (2) the patient’s injury or condition was
too acute (or not safe) to perform the required performance-
based assessments. The data consist of 2 cohorts of patients:
Cohort A’s (n 5 20) data were collected from late 2008 to
early 2009 and Cohort B’s (n 5 26) data were collected
from mid-2009 to mid-2010.
Assessments
Manual Ability Measure–36. The MAM–36 is a task-
oriented, patient-reported functional assessment tool
(Chen & Bode, 2010). It has 2 sections: The first section
contains demographic and clinical information; the sec-
ond section is a rating scale of 36 items. The 4-point
rating scale (ranging from 1 5 cannot do to 4 5 easy)
requires the patient to rate perceived ease or difficulty of
performing 36 everyday tasks (e.g., cutting meat on
a plate, taking things out of a wallet, opening a medicine
bottle with a childproof cap or top) regardless of which
hand is used and without the use of assistive devices. The
psychometric properties of the MAM–36 were previously
investigated with a diverse patient population using
a Rasch measurement model (Chen & Bode, 2010), and
it demonstrated adequate structural integrity and internal
validity (i.e., .93 and .99 for person and item reliability,
respectively).
The MAM–36 was first translated into Hebrew and
back-translated into English by a therapist who was not
involved in the study. The wording of the items was
March/April 2014, Volume 68, Number 2
 mostly retained, although some minimal modification
was necessary as a result of inherent cultural or semantic
differences; one such example was “squeezing a kitchen dish
rag” instead of “wringing a towel,” as in the English version.
Smith Hand Function Test. The Smith Hand Function
Test (SHFT; Smith, 1973) is a performance-based hand
function test in which the speeds of task performance and
grip strength are used to measure component deficits and
performance skills. The original test consists of 4 subtests:
(1) unilateral grasp–release tasks (blocks, nails, coins,
pegs), (2) bilateral simulated ADL tasks (safety pins,
buckle, buttons, zipper, tying knot, tying bow, lacing
shoes; each mounted on separate wooden board), (3)
writing task, and (4) grip-strength measurement. Smith
(1973) described the test in detail and published the
norms for male and female participants comparing right-
and left-hand performances regardless of hand domi-
nance. However, no additional psychometric studies
about the test were published. The bilateral tasks were
mounted on wooden boards so that they could be ad-
ministered to patients in a standardized manner. The
writing task was only administered to patients whose
symptoms were in their dominant hands and who could
perform the task.
Procedures
Three occupational therapists from the same hospital
volunteered to participate in the project and collected data.
From late 2008 to early 2009, the therapists administered
the MAM–36 to 20 patients (Cohort A) at intake and
discharge to determine whether it was feasible to use in
a clinical environment. The overall response from the
patients and therapists was positive. Therefore, therapists
decided to use it along with the SHFT and collected data
(Cohort B) from mid-2009 to mid-2010 to examine the
correlation between patient-reported function-based gain
measured by the MAM–36 and clinician-assessed factor-
level and skill-level gain measured by the SHFT.
All patients (Cohorts A and B) were assessed with the
MAM–36 at the beginning of outpatient rehabilitation
(i.e., during the 1st week of occupational therapy treat-
ment) and again right before discharge (i.e., during the
last week of occupational therapy treatment). Patients
in Cohort B were also assessed with the SHFT. The
MAM–36 and SHFT could be administered in one or
two sessions, depending on the time needed, the patient’s
tolerance for assessments, or both. The order of the two
tests was randomized.
Occupational therapy treatments were provided
2 times/wk; the treatment period lasted 2–33 wk (Cohort B).
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Treatments incorporated the principles of tissue healing,
edema reduction, scar tissue management, and promotion of
range of motion, sensation tolerance, strength, endurance,
coordination, dexterity, and so forth. Treatment techniques
included the use of modalities (heat and cold), retrograde
massage, manual scar mobilization, splinting, therapeutic
exercises, occupation-based interventions, work hardening,
and patient education. All treatments were provided by the
three therapists.
Data Analysis
A series of preliminary analyses were conducted to ex-
amine the equivalence of the two cohorts. We found no
significant difference in age, gender, hand dominance, and
duration of treatment (Table 1); the MAM–36 data from
both cohorts were therefore combined for subsequent
analyses.
MAM–36 Variables: Mean Item Ratings and Rasch-
Derived MAM. The MAM–36 produces two levels of
measures for each participant: mean item rating and an
overall Rasch-derived manual ability measure (or the
“MAM measure”; Bond & Fox, 2001; Chen & Bode,
2010). Mean item ratings at intake and discharge for each
participant were calculated from their individual item
ratings at Time 1 and Time 2. We use the terms intake
and Time 1 and discharge and Time 2 interchangeably
from this point on.
To calculate the scale-based overall MAM measures,
we used Rasch analysis. First, intake and discharge MAM
ratings from both cohorts were combined. Next, we used
step and item anchoring procedures. Third, we converted
MAM measures in log-odds units, or logits, into a 0–100
scale denoted as MAMT1 (intake MAM measure) and
MAMT2 (discharge MAM measure). The step and item
anchors were obtained from the earlier validation study
based on a large sample of more than 300 patients (Chen
& Bode, 2010). Anchoring was an important Rasch
measurement technique, because the step and item an-
chors held the rating scale structure and the position of
the items stable while allowing for the calibration of the
Table 1. Demographic and Clinical Characteristics of the
Participants
Cohort A Cohort B Combined
Characteristic (n 5 20) (n 5 26) (n 5 46)
Gender, male/female 6/14 8/18 14/32
Dominance, right/left 18/2 25/1 43/3
Affected hand, right/left/both 9/10/1 13/11/2 22/21/3
Age, M ± SD 59.6 ± 16.7 53.6 ± 21.9 56.2 ± 19.8
Treatment duration, wk, M ± SD 11.4 ± 8.0 9.1 ± 4.2 10.1 ± 6.2
Note. M 5 mean; SD 5 standard deviation.
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 MAM (person) measures. Higher MAM measures in-
dicated greater manual ability.
Smith Hand Function Test Variables. Because of a large
amount of missing data in the writing subtest, we did not
include it in the final data analyses. Therefore, the SHFT
outcome variables included three speed variables (uni-
lateral, bilateral, and total speed) and a strength variable.
The speeds were measured by a stopwatch. Speedunilat1
and Speedunilat2 represent the average time needed to
perform one-handed (or unilateral) tasks at intake (i.e.,
Speedunilat1 ) and discharge (i.e., Speedunilat2). (We
summed up left-hand and right-hand speed separately
and calculated the average time needed to perform the
unilateral tasks at both intake and discharge.) Speedbilat1
and Speedbilat2 represent the time needed to perform the
two-handed (or bilateral) tasks at intake and discharge,
respectively. Speedtot1 and Speedtot2, respectively, repre-
sent the total time needed for all (unilateral and bilateral)
tasks at intake and discharge. Strength was obtained by
measuring patients’ affected hand using a Jamar dyna-
mometer. For patients who had both hands affected,
we obtained the average grip strength from both hands.
Parametric Analyses. We conducted paired t tests to
examine whether significant differences occurred from
intake to discharge on (1) MAM measures (i.e., MAMT1
and MAMT2); (2) mean item ratings; (3) time needed to
perform the SHFT (i.e., the three speed variables mea-
suring unilateral, bilateral, and all (total) tasks (Cohort B
only); and (4) grip strength in the affected hand (Cohort
B only). We conducted Pearson correlation analyses to
examine the associations between gains in MAM mea-
sures, strength, and speeds of performance among Cohort
B patients. Last, we calculated the standard response
mean (SRM), a measure of effect size, to estimate the
responsiveness of the MAM. The SRM is computed by
dividing the mean score change by the standard deviation
of the change (Liang, Fossel, & Larson, 1990).
Results
Participants
A total of 46 patients participated in the study. Among
them, 70% were female with an average age of 56.2 yr
(standard deviation 5 19.8). All but 3 persons were right
handed; about half had injuries or pathology in their
dominant hand. Twelve (26%) patients were working;
another 12 were on leave from work because of their
injuries; and 22 (48%) were not working, including those
who were retired. Data on education and occupations
were collected only from Cohort B patients: Eight had
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baccalaureate or graduate degrees, 10 had high school
diplomas, and 5 had elementary or middle school edu-
cation; 3 did not report education. Patients’ occupations
varied and included manual laborers, managers, secretaries,
teachers, homemakers, and other professionals. The
patients’ diagnoses included a variety of upper-extremity
injuries and conditions typically seen in an outpatient hand
therapy setting: traumatic injuries to the fingers (n 5 5),
such as deep cuts, amputation, and crush injuries; various
types of fractures (n 5 27) of the finger, hand, wrist (i.e.,
distal radius, radius, ulnar), elbow, and shoulder; dislocated
elbow (n 5 1); status post–carpal tunnel release (n 5 3);
trigger finger release (n 5 2); Dupuytren’s contracture re-
lease surgery (n 5 1); status post–trapezectomy (n 5 6); and
neuropathy (n 5 1).
Manual Ability Measure–36 (n 5 46)
Change in Manual Ability. We found a significant change
in mean MAM measures between intake (MAMT1) and
discharge (MAMT2), t(45)5 8.03, p < .0001, suggesting
that manual ability improved over time. The means and
standard deviations of the MAM measures and MAM
gains are presented in Table 2. The gain in manual ability
ranged from 1.9 to 76; 16 patients gained <10 points; 15
gained 11–20 points, 8 gained 21–30 points, 4 gained
31–40 points, and 3 gained >40 points.
Perceived Change in Task Difficulty. Paired t tests
showed that the mean item ratings of all MAM items
increased significantly (all ps < .01) from intake to dis-
charge, suggesting that the patients rated the tasks easier
at discharge than at intake. The mean changes ranged
from 0.5 to 1.5 points. The items on which ratings
changed the least were shuffling cards (changed only 0.52
points), turning pages (0.54), eating a sandwich (0.59),
and washing hands (0.59). The items on which ratings
changed the most were tying shoes with laces (1.5),
peeling fruits and vegetables (1.3), cutting meat on a plate
(1.39), and wringing a towel (1.41).
Smith Hand Function Test (n 5 26)
Improvement in the Speed of Performance. We used
paired t tests to examine Time 1 (intake) and Time 2
(discharge) speeds of performance on one-handed, two-
Table 2. MAM–36 Measures (N 5 46)
Cohort A (n 5 20), Cohort B (n 5 26), Combined (n 5 46),
MAM–36 M ± SD M ± SD M ± SD
Time 1 52.26 ± 6.82 50.16 ± 12.79 51.07 ± 10.56
Time 2 67.31 ± 10.36 70.65 ± 10.92 69.2 ± 10.69
Gain 15.06 ± 9.70 20.49 ± 18.35 18.13 ± 15.30
Note. M 5 mean; MAM–36 5 Manual Ability Measure–36; SD 5 standard
deviation.
March/April 2014, Volume 68, Number 2
 handed, and total SHFT tasks. All speed variables (i.e.,
Speedunilat, Speedbilat, and Speedtot) for the SHFT de-
creased significantly at discharge, indicating that less time
was required for patients to perform the SHFT tasks. The
means, standard deviations, and t values for the speed
variables are presented in Table 3.
Improvement in Grip Strength in the Affected Hand. Grip
strength of both hands was measured at intake and dis-
charge as part of the SHFT among Cohort B patients;
however, only strength of the affected hand was the focus
of this study. Paired t tests showed that, for Cohort B
patients as a group, grip strength of the affected hand
increased significantly, t(25)5 4.44, p < .01. On in-
spection of individual patients, grip strength of the af-
fected hand did not change in 2 patients, decreased in 2,
and improved in 22. Among these 22 patients, the
gain in strength ranged from 1.7 to 29.4 kg (mean 5
9.89 kg, standard deviation 5 7.75). With all patients
included, however, the mean increase in grip strength
of the affected hand was 7.79 (standard deviation 5
8.93 kg).
Responsiveness of the Manual Ability Measure–36
We calculated the SRM of the MAM–36 (n 5 46) by
dividing the mean gain by the standard deviation of the
gain. The SRM was 1.18, suggesting that the responsiveness
is more than adequate (Liang et al., 1990).
Relationship Among Gain in Manual Ability, Strength,
and Speed of Performance
On the basis of Cohort B’s data, gain in MAM measures
correlated moderately with gain in grip strength of the
affected hand (r 5 .69, p < .001) and gain in total speed
of performing the SHFT tasks (r 5 .71, p < .001). Note
that MAM measure gains were strongly and negatively
Table 3. SHFT at Admission and Discharge (Cohort B, n 5 26)
Intake Discharge
SHFT (Time 1) (Time 2)
Speed (s), M ± SD
Unilateralb 60.89 ± 17.49 47.81 ± 13.33
Bilateral 139.69 ± 40.95 106.77 ± 30.49
Totalc 261.46 ± 68.20 202.39 ± 53.07
Grip strength in the
affected hand, kg
M ± SD 8.13 ± 6.00 15.92 ± 8.15
Range 0.3–23 4–32
Note. M 5 mean; n/a 5 not applicable; SHFT 5 Smith Hand Function Test;
SD 5 standard deviation.
a
All ps < .01. bAverage of the speeds of performing unilateral tasks by the
right and left hands. cTime needed for performing unilateral tasks (right hand 1
left hand) and bilateral tasks.
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correlated with MAM measures at intake (r 5 2.81, p <
.001), suggesting that patients with low manual ability at
intake tended to improve more. However, MAM gains
were also strongly and positively correlated with MAMs
at discharge (r 5 .73, p < .001), suggesting that patients’
improvement was strongly associated with discharge
manual ability.
Discussion
The ultimate goal of occupational therapy upper-
extremity treatment and rehabilitation is to improve
patients’ function and their ability to assume their
occupational roles and participate in everyday activities
(Jack & Estes, 2010). However, few assessment tools
currently in use provide evidence of the improvement in
functional engagement and participation after intervention.
The results of this study showed that patients’ scores on the
MAM–36 improved—demonstrating enhanced self-
reported or perceived hand ability—after occupational
therapy treatment and that the changes were observed
using tools that measure performance skills and factor-
level abilities such as hand strength and control of move-
ment. In all, patients made an average improvement of
15 points on the MAM measures, gained between 7.8 kg
(all patients included) and 9.9 kg (among only those who
improved) in grip strength in their affected hand, and
performed the SHFT tasks faster.
The results of this study also demonstrate that the
MAM–36 is capable of detecting changes over time. The
SRM of the MAM measure gain was 1.18, which is
considered large (Liang et al., 1990). Moreover, the
improvement in manual ability was moderately corre-
lated with the gain in grip strength (in the affected
hand) and with the gain in performance speed of var-
ious unilateral and bilateral tasks. These results (i.e.,
correlations) are encouraging because they show that
the patients’ perception (and report) of their manual
ability improvement is coherent with their actual func-
ta tional improvement: Not only did they gain strength in
their affected hands, but they also performed the tasks
4.36 faster.
5.66 The MAM–36 can be a useful tool in clinical settings
5.58 in two different ways: (1) on the scale level and (2) on the
item level. On the scale level, the MAM–36 produces
4.44 a MAM person measure, which quantifies each person’s
n/a manual ability. The MAMs allow comparison of patients’
perception of their overall hand function over time. In
our study, we noticed that all patients improved (i.e., the
MAM measures improved at discharge when compared
with intake). We were somewhat surprised to see the large
191
 range of MAM gains. However, close inspection of the
cases showed that these results were reasonable.
The patient who improved the most (i.e., 75.9 points
on MAM measure) was a high school boy who had
a contusion of the dominant hand and wrist (with pain
and swelling) and had great difficulty with most tasks at
intake but showed substantial improvement after 3 wk of
occupational therapy and rated almost all activities as easy.
The patient who improved the least (i.e., 1.9 points on
MAM) was a young man who was left handed and had
a left arm (radius shaft) fracture. At intake, he rated most
tasks as easy and rated only a few items as a little hard,
very hard, or unable to do. Although the ratings of some
items at discharge improved, the ratings of the most
difficult items (e.g., opening medicine bottles, cutting
nails, shuffling cards) did not change. We noticed,
however, that the strength of his affected (and dominant)
hand improved 6 kg. It is possible that as a left-handed
individual, the patient had to be somewhat ambidextrous
before the injury to survive in a right-handed world. As
a result, although he had a fracture in his dominant arm,
he was able to adapt from the beginning and therefore
rated most MAM–36 items as easy or a little hard. Al-
though he made some improvement, this improvement
was not large enough to change the ratings on the most
difficult items.
The MAM–36 can be examined on the item level.
We noticed that item rating averages decreased at least
0.5 points, suggesting that the patients, as a group, per-
ceived the tasks as easier to do at discharge than at intake.
We can compare a patient’s item ratings at intake and
discharge and assess his or her capabilities and difficulties
with specific tasks, as the example given in the preceding
paragraph shows. When examining item ratings, thera-
pists can assess and document treatment outcomes in
a very specific and evidence-based fashion. This level of
understanding of the client’s performance capabilities will
assist the clinician with demonstrating the effectiveness of
interventions and with assisting the client to prepare for
future functional challenges through education and ad-
aptation if needed.
Limitations and Future Research
This study has several limitations. The sample size was
small, and it was a convenience sample; no control group
was used, and the treating therapists were also the assessors
and were not blind to the purpose of the study. Therefore,
the results should be interpreted with caution. Further
research with a larger sample size and a more stringent
research design is warranted.
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Implications for Occupational
Therapy Practice
The results of this study have the following implications
for occupational therapy practice:
• Provides evidence that function-based, patient-
reported outcome assessments such as the MAM–36
may correlate well with traditional factor-level, clinician-
rated assessments often used in hand rehabilitation
settings
• Provides evidence that patient-reported outcome tools
have a place as part of a comprehensive assessment of
upper-extremity functioning in a hand rehabilitation
population
• Provides support for occupational therapists interested
in adopting a more functional outcome-based perspec-
tive with regard to hand rehabilitation outcomes
• Expands the profession’s knowledge of the effective-
ness of occupational therapy intervention as a means
to enhance functional performance.
Conclusion
The results of this study demonstrate that the MAM–36
was responsive to changes in hand function in patients
receiving occupational therapy outpatient rehabilitation
services. These changes were identified on both the scale
level and the average item level. In addition, the perceived
manual ability gain correlated positively with improve-
ments in task speed and grip strength assessed using the
SHFT. These findings support the use of the MAM–36
as an outcome measure for occupational therapy hand
rehabilitation patients when determination of activity- or
participation-level functional outcome is desired. s
Acknowledgments
We thank Hagit Harel, occupational therapist, for trans-
lating the MAM–36 into Hebrew; Sharon Werech and
Hadas Pfizer, occupational therapists, for assisting in data
collection; and the patients who participated in the study.
An earlier version of the study was presented in the 2010
Joint Conference of American Congress of Rehabilitation
Medicine and American Society for Neurorehabilitation.
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