Asymmetric involvement of hands: Psychometric properties of the Turkish version of the Bimanual Fine Motor Function 2.0 classification in children with cerebral palsy


Journal of Hand Therapy, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2023
  • Doi Number: 10.1016/j.jht.2023.08.006
  • Journal Name: Journal of Hand Therapy
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Biotechnology Research Abstracts, CINAHL, MEDLINE
  • Keywords: Cerebral palsy, Classification, Hand, Reliability, Upper extremity, Validity, Video-based
  • Hacettepe University Affiliated: Yes


Background: Manual functions affect more than a half of children with Cerebral palsy (CP). Asymmetric involvement of hands may also affect unilateral and bilateral activities of daily life. The Bimanual Fine Motor Function version 2.0 (BFMF-2.0) is a unique functional classification that categorizes the capacity of each hand (what the child can do) during bimanual functions. Purpose: The aim of this study was to investigate the validity and reliability of the Turkish version of the BFMF-2.0 in children with CP. Study Design: Clinical measurement and cross-sectional study. Methods: The study included 91 children with CP (56 girls, mean age; 7.41 ± 4.23 years [4–18 years]) and their parents. The Manual Ability Classification System (MACS), the Quality of Upper Extremity Skills Test (QUEST), and the Box and Block Test (BBT) were used for construct and concurrent validity. Experienced/inexperienced therapists and parents classified fine motor capacities of the children via live or video-based observation to assess inter-rater reliability. Three weeks later, the children were reclassified for intra-rater reliability. Results: The Turkish version of the BFMF-2.0 classification was strongly correlated with the MACS (rho = −0.88, p < 0.001), the QUEST (rho = 0.80, p < 0.001), and the BBT (rho = −0.77, p < 0.001). The inter-rater reliability scores were weak to excellent between the parents and the therapists (via live observation, κw = 0.57) and also between experienced/inexperienced therapists (via live or video-based observation, κw = 0.66–0.79). Intra-rater reliability scores were good to excellent (Intraclass Correlation Coefficient [ICC] = 0.87–0.95). Conclusions: The Turkish version of the BFMF-2.0 classification is valid and reliable and could be applied by experienced and inexperienced therapists via live or video-based observation and by parents via live observation.