The frail elderly functional assessment questionnaire: Its responsiveness and validity in alternative settings (original) (raw)
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Journal of The American Geriatrics Society, 2009
OBJECTIVES: To evaluate the function component of the Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI, German version) in geriatric inpatients and compare it with established performance-based and self-rated assessment tools.SETTING: Geriatric inpatient rehabilitation unit.PARTICIPANTS: One hundred fifty-six geriatric rehabilitation inpatients (44 men, 112 women) with a mean age of 81.7 who were capable of walking at baseline.MEASUREMENTS: Weekly assessments were performed from admission until discharge (3 weeks later) using the function component of the SF-LLFDI, the Barthel Index (BI), the Falls Efficacy Scale International (FES-I), gait characteristics, the Timed Up and Go Test, and the Short Physical Performance Battery. Baseline characteristics were measured at admission. Construct validity was evaluated using Spearman correlation coefficients, internal consistency was measured using Cronbach alpha, and sensitivity to change was estimated using standardized response means.RESULTS: The SF-LLFDI did not show significant floor or ceiling effects. Internal consistency was good, with alpha (function component sub-scores) equal to 0.80 to 0.86. Convergent validity measures concerning performance-based scores were moderate to good, and correlations increased over time (correlation coefficient (r)=0.35–0.64). There was a high correlation with the FES-I (admission: r=0.61, discharge: r=0.76). Sensitivity to change was significant for all examined scores, with the BI outperforming all other instruments, although the SF-LLFDI showed better responsiveness than the BI regarding change characteristics over time.CONCLUSION: The SF-LLFDI is a reliable and valid self-report instrument to measure functional status in geriatric rehabilitation inpatients. It improves the assessment of clinically relevant responsiveness. Further research is warranted to improve its sensitivity to change.
Validation of Medicare Rehabilitation Functional Assessments in Routine Care
JAMA Network Open, 2020
IMPORTANCE Assessment of functional outcomes is currently limited by a lack of large data sets. Functional assessments are included in Medicare rehabilitation assessment files, yet the validity of these measures in routine care is unknown. OBJECTIVE To evaluate the validity of individual-level routine care functional assessments in Medicare rehabilitation settings compared with criterion-standard National Health and Aging Trends Study (NHATS) research assessments obtained no more than 90 days later. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of individuals aged 65 years and older used the 2011 to 2015 NHATS linked with Medicare assessment files. Individuals with a discharge assessment from inpatient rehabilitation facilities, skilled nursing facilities, or home health agencies and a criterion-standard NHATS assessment were included. Data analysis was performed June 2019 to November 2019. MAIN OUTCOMES AND MEASURES Summary functional assessment based on independence with eating, toilet hygiene, bathing, dressing, transfers, and mobility or walking. Linear regression was used to assess agreement between the 2 scales, adjusting for time between assessments and rehabilitation setting. RESULTS A total of 1036 adults aged 65 years and older (671 [64.8%] aged Ն80 years; 670 [64.7%] women; 685 [66.1%] white participants) met the study criteria. The correlation of the assessments was 0.63 (95% CI, 0.59 to 0.66; mean [SD] rehabilitation score, 27.5 [7.2]; mean [SD] NHATS score, 30.5 [10.1]). The correlation increased to 0.66 (95% CI, 0.60 to 0.71) for assessments no more than 30 days apart. The linear regression model adjusting for rehabilitation setting and days between evaluations found the assessments were strongly correlated (β = 1.00 [95% CI, 0.93 to 1.08]; intercept, 0.72 [95% CI, −1.79 to 3.24]; R 2 = 0.42). Differences in scores were generally small (mean [SD] of NHATS − rehabilitation score, 2.96 [7.91]), and only 59 assessments (5.7%) differed by more than 2 SDs of the mean difference. Rehabilitation service scores were typically higher than NHATS scores in individuals with lower mean scores; however, the population with lower mean scores was small (156 [15.1%]). CONCLUSIONS AND RELEVANCE In this large sample of older US adults, routine care rehabilitation facility functional assessments had overall moderate correlation with criterion-standard research assessments.
Reliability and Validity of the Patient-Specific Functional Scale in Community-Dwelling Older Adults
Journal of geriatric physical therapy (2001), 2018
Clinical measurement of physical function that is both specific to the individual and generates comparable outcome data is a fundamental need in physical therapy examination. The Patient-Specific Functional Scale (PSFS) has been found to be a reliable and valid measure of physical function in patients with musculoskeletal disorders and may have applications for other patient populations. However, the reliability and the validity of the PSFS have not been evaluated in older adults. The purpose of this study was to investigate the reliability and the validity of the PSFS in community-dwelling older adults. Thirty-one community-dwelling older adults (11 males, 20 females), mean age = 81.1 (8.3) years, were included. Participants completed the PSFS, Lower Extremity Functional Scale (LEFS), Activity-specific Balance Confidence Scale (ABC), Short Physical Performance Battery (SPPB), Berg Balance Scale, and the Timed Up and Go on 2 separate days, 48 hours apart. Assessment scores were comp...
Archives of Physical Medicine and Rehabilitation, 2010
Objectives: To assess and compare the ability of the Timed Up & Go (TUG) and subscales of the Functional Autonomy Measurement System (SMAF) to detect change in people undergoing geriatric rehabilitation in inpatient geriatric rehabilitation units (GRUs) and day hospitals. Design: Longitudinal design with repeated measures obtained at admission and discharge from rehabilitation and at 2 follow-up interviews. Setting: Inpatient and outpatient hospital-based settings. Participants: Subjects (Nϭ237, age 80Ϯ7y) had data at admission and discharge from rehabilitation (changing time frame), and of these, 160 had data at 2 subsequent follow-ups (stable time frame). Interventions: Not applicable. Main Outcome Measures: The TUG was used to estimate basic mobility, and subscales of the SMAF were used to estimate general mobility (SMAF-mobility), basic activities of daily living (SMAF-ADL), and instrumental activities of daily living (SMAF-IADL). Professionals' perception of change was used as a criterion. Results: The TUG generated large values for the standardized response mean (SRM) and Guyatt's responsiveness index in GRUs (.98 and 1.12) and day hospitals (.89 and 1.85). Professionals' perception of change in mobility was explained by a perceptible change in the TUG in day hospitals (15%) but not in GRUs. The SMAF-mobility, SMAF-ADL, and SMAF-IADL were associated with large values of SRM and Guyatt's responsiveness index in GRUs (.97-2.17) and with small to moderate values in day hospitals (.29-.54). Moderate to large portions in the professionals' perceptions of change for mobility (20%, 17%), basic ADLs (10% and 14%), and IADLs (23% and 19%) were associated with the respective change scores of the subscales of the SMAF in both GRUs and day hospitals. Conclusions: Progress of older adults in the areas of mobility, basic ADLs, and IADLs can be captured using the TUG, SMAF-mobility, SMAF-ADL, and SMAF-IADL in both GRUs and day hospitals. The results support their use in settings of high-and low-intensity rehabilitation, thus suggesting their adequacy for use in these 2 settings.
An Evaluation of the Reliability and Validity of the Functional Assessment Inventory
Journal of the American Geriatrics Society, 1983
he reliability of the Functional Assessment Inventory (FAI) was evaluated using a sample of VA domiciliary and nursing home patients. The interobserver and interrater reliability coefficients of the summary rating scales, based on a single assessment, tended to be higher than their test-retest reliability coefficients, based on two independent assessments separated by a modal four-week interval. Validity coefficients, using the OARS instrument ratings as criteria, also based on two independent assessments several weeks apart, were, on the average, as high as the test-retest reliability coefficients. More specifically, the mental health, physical health, and activities of daily living rating scales, along with the objectively scored Short Portable Mental Status Questionnaire and Short Psychiatric Evaluation Schedule, tended to yield relatively similar scores with repeated measurement, while the social resources and economic resources scales were somewhat less stable, a discrepancy possibly explained by the homogeneous nature of the social and economic status of most of the patients (institutionalized veterans). Thus the reliability and validity of the FAI are satisfactory, but the stability of some of its scales requires further investigation. Recent years have witnessed the development of several multidimensional assessment instruments which, though they vary markedly in content and length, all purport to assess the health, mental health, and functional status of elderly persons. Unfortunately, in spite of the availability of such instruments, representing both original and hybridized versions of published multidimensional as
Archives of Physical Medicine and Rehabilitation, 2007
Objective: To examine the relations among cognitive and emotional function and other patient impairment and demographic variables and the performance of daily activities. Design: Cohort. Setting: Acute inpatient rehabilitation, skilled nursing facilities, home care, and outpatient clinics. Participants: Adults (Nϭ534) receiving services for neurologic (32.3%), lower-extremity orthopedic (42.7%), or complex medical (24.9%) conditions. Mean age was 63.8 years; 55% were women; 88.6% were white; and the time since condition onset ranged from 0.2 to 3.9 years. Interventions: Not applicable. Main Outcome Measures: Activity Measure for Post-Acute Care: applied cognitive, personal care and instrumental, and physical and movement scales; Mental Health Inventory-5 (MHI-5); and patient-identified problems (vision, grasp). Results: Path analyses resulted in good model fit both for the total sample and 3 patient subgroups (2 test, PϾ.05; comparative fit index Ͼ.95). There was a significant (PϽ.05) direct relation between the applied cognitive, grasp, and personal care and instrumental variables in all patient groups. There were also significant indirect relations between the MHI-5, visual impairment, and grasp problems with the personal care and instrumental scale through an association with the applied cognitive scale. Strength and significance of associations between age, sex, and physical and movement and personal care and instrumental scales varied more across patient groups. The model R 2 for the personal care and instrumental scale for the total sample was .60, with R 2 values of .10, .72, and .62 for the lower-extremity orthopedic, neurologic, and complex medical groups, respectively. Conclusions: Results suggest that variations in cognitive function, along with visual impairment and lower perceived well-being are associated with a patient's ability to complete daily activities. Rehabilitation professionals should consider cognitive and emotional factors as well as physical performance when planning treatment programs to restore daily activity function.
Development of a Test of Physical Performance for the Nursing Home Setting
The Gerontologist, 2001
This study was undertaken to develop a performance-based instrument to measure a range of function present among nursing home (NH) residents and to establish the reliability and validity of the measures. Design and Methods: Fourteen items integral to daily life in a NH setting were administered to 95 NH residents with sufficient cognitive ability to follow a one-step command at baseline, 1 week later, and 6 months later. Intraclass correlation coefficients and Cronbach's coefficient alpha were calculated for reliability estimates. The Minimum Data Set (MDS), Katz, and Multidimensional Observational Scale for Elderly Subjects (MOSES) were used to establish concurrent validity. Factor analysis, correlation matrices, and other objective criteria were used for item reduction. Results: Testretest reliability for items ranged between .73 and .93. Factor analysis and correlations between Nursing Home Physical Performance Test (NHPPT) items and scales with measures of activities of daily living (ADL) suggest that the NHPPT taps aspects of gross motor function (Factor 1) and fine motor coordination and task sequencing (Factor 2) required for ADL function and mobility. The NHPPT may also tap aspects of ADL function and mobility not measured by the MDS (r ϭ-.72-.75), MOSES (r ϭ-.82-.84), or Katz (r ϭ-.75-.77) scales. Effect sizes based on mean change scores were larger for the NHPPT scales (.38-.53) than for the other functional scales (.27-.33). Implications: The NHPPT is a reliable performance-based instrument that discriminates among frail NH residents. Further studies are necessary to assess the value of this instrument for prediction and monitoring of functional status in the NH.