Functional Assessment
Dr Sonali Soumyashree
BPT, MPT(Neurology)
Lecturer, GDGU
Function in the International Classification of Functioning, Disability, and
Health (ICF) encompassing all body functions and structures, activities, and
participation.
disability is a term that encompasses impairments in body functions and
structures, activity limitations, and participation restrictions
EXAMINATION OF FUNCTION
Purpose of Examination of Function:
Analysis of function focuses on the identification of pertinent activities and measurement of an
individual’s ability to successfully engage in them
Application of selected functional tests and measures yield data that can be used as
(1) baseline information for setting function-oriented goals and outcomes of intervention;
(2) indicators of a patient’s initial abilities and progression toward more complex functional levels;
(3) criteria for placement decisions, for example, the need for inpatient rehabilitation, extended care,
or community services;
(4) manifestations of an individual’s level of safety in performing a particular task and the risk of injury
with continued performance; and #
(5) evidence of the effectiveness of a specific intervention (medical, surgical, or rehabilitative) on
function.
Testing Perspectives
Function tests can utilize two highly divergent perspectives on what is
to be tested or measured by the physical therapist.
These are:
habitual level of a patient’s ability to do certain tasks and activities, or
to identify the patient’s capacity to perform certain tasks and activities,
whether the patient habitually performs up to that level or not, or even performs
them at all
Types of Instruments
Performance-Based Tests
A performance-based test involves observing the patient during the
performance of an activity.
These are:
6-Minute Walk Test
the Physical Performance and Mobility Examination,
the Functional Reach Test,
the Get Up and Go Test,
the Timed Up and Go Test,
the Physical Performance Battery
Self-Reports
In this the patient is asked directly either by the therapist or a trained
interviewer (interviewer report) or through the use of a self-administered
report instrument.
Self-report is a valid method of determining function and may be preferable
to performance-based methods in some circumstances
Performance-based and self-report instruments grade performance on a
number of different criteria in a variety of formats
Functional Examination and Impairment Terminology
1. Independent: patient is able consistently to perform skill safety with no one present.
2. Supervision: patient requires someone within arm’s reach as a precaution; low probability of patient
having a problem requiring assistance.
3. Close guarding: person assisting is positioned as if to assist, with hands raised but not touching patient;
full attention on patient; fair probability of patient requiring assistance.
4. Contact guarding: therapist is positioned as with close guarding, with hands on patient but not giving any
assistance; high probability of patient requiring assistance.
5. Minimum assistance: patient is able to complete majority of the activity without assistance.
6. Moderate assistance: patient is able to complete part of the activity without assistance. 7.
7. Maximum assistance: patient is unable to assist in any part of the activity
SINGLE DIMENSION VERSUS MULTIDIMENSIONAL
MEASURES OF FUNCTION
single dimension measures may include a specific construct such as balance,
gait, or reaching
multidimensional measures would include a combination of these constructs
or have items that represent impairments, activity limitations, and
participation restrictions.
INSTRUMENTS TO ASSESS FUNCTION
The Barthel Index
Barthel Index specifically measures the degree of assistance required by an individual on
10 items of mobility and self-care ADL.
Levels of measurement are limited to either complete independence or needing assistance
Each performance item is scored on an ordinal scale with a specified number of points
assigned to each level or ranking.
Scoring: A single global score, ranging from 0 to 100, is calculated from the sum of all
weighted individual item scores, so that 0 equals complete dependence for all 10
activities, and 100 equals complete independence in all 10 activities
Barthel Index has been used widely to monitor functional changes in
individuals receiving inpatient rehabilitation, particularly in predicting the
functional outcomes associated with stroke.
Barthel Index has demonstrated strong interrater reliability (0.95) and test–
retest reliability (0.89)
Items Included in the Barthel Index
Feeding: scores range from independent (able to use utensils and other apparatus) to dependent (needs assistance)
Bathing: scores range from independent to dependent
Personal Toilet: scores range from independent (able to wash, comb hair, brush teeth or shave) to dependent (needs
assistance)
Dressing: scores range from independent (able to dress, fasten closures, tie shoes, apply orthosis as needed) to
dependent (needs assistance)
Bowels: scores range from independent (accident-free, able to use suppositories or enemas as needed) to dependent
(occasional accidents, needs assistance)
Bladder: scores range from independent (accident-free, able to use collection device as needed) to dependent
(occasional accidents, needs assistance)
Transfers–Toilet: independent (able to use toilet or bedpan) to dependent (needs assistance)
Transfers–Chair and Bed: scores range from independent (able to manage wheelchair as needed) to dependent (needs
assistance)
Ambulation: scores range from independent (able to use assistive devices as needed) to dependent (needs assistance)
Stair Climbing: scores range from independent (able to use assistive devices as needed) to dependent (needs
assistance)
The Functional Independence Measure
Functional Independence Measure (FIM)52,53 is an 18-item measure of
physical, psychological, and social function that is part of the Uniform Data
System for Medical Rehabilitation (UDSMR)
FIM uses the level of assistance an individual needs to grade functional status
from total independence to total assistance .
A person may be regarded as independent if a device is used, but this is
recorded separately from “complete” independence.
The instrument lists six selfcare activities: feeding, grooming, bathing, upper
body dressing, lower body dressing, and toileting. Bowel and bladder control,
aspects of which some may consider as impairments rather than function, are
categorized separately
Functional mobility is tested through three items on transfers.
Under the category of locomotion, walking and using a wheelchair are listed
equivalently, whereas stairs are considered separately.
The FIM also includes two items on communication and three on social cognition
Interrater reliability of the FIM: 0.86 to 0.88
WeeFIM, an 18-item instrument based on the FIM, has been developed for use
for children between the ages of 6 months and 18 years
The Outcome and Assessment Information Set
Outcome and Assessment Information Set (OASIS) was designed to
ensure the collection of pertinent data on the adult patient in the
home care setting that would Information Set he Outcome and
Assessment Information Set (OASIS) was designed to ensure the
collection of pertinent data on the adult patient in the home care
setting that would
allow home health agencies to assess the quality of care by measuring
the outcomes of care
The SF-36
The SF-36 contains 36 items based on questions used in the RAND
Health Insurance Study. hese 36 items were culled from the 113
questions used by RAND in the Medical Outcomes Study (MOS) to
explore the relationship between physician practice styles and patient
outcomes.
SF-36 demonstrated high reliability and validity (correlation
coefficients ranging from 0.81 to 0.88)
