1. PT 142 – Assessment in Physical Therapy Prepared by: Almira A. Tagala-Manuel, PTRP Prepared by ATM for PT 142 students AY 2009-2010

2. Learning Objectives Review concepts of the ICF Define common terms associated with functional assessment Discuss the importance of functional assessment Identify different approaches to functional assessment Discuss the most common methods and tools used for functional assessment Prepared by ATM for PT 142 students AY 2009-2010

3. Learning Objectives Identify guidelines for selecting an assessment instrument Discuss the issues of validity and reliability of commonly used functional assessment methods or tools Prepared by ATM for PT 142 students AY 2009-2010

4. Goal of Rehabilitation Prepared by ATM for PT 142 students AY 2009-2010

5. Model of Functioning and Disability Prepared by ATM for PT 142 students AY 2009-2010

6. Functional Activity Any activity identified by an individual as vital to support physical and psychological well- being as well as to create a personal sense of meaningful living. Encompasses all those tasks, activities and roles that identify a person as an independent adult or as a child progressing toward adult independence. Prepared by ATM for PT 142 students AY 2009-2010

7. Functional Limitation The inability of an individual to perform an action or activity in the way it is done by most people, usually as the result of an impairment. Prepared by ATM for PT 142 students AY 2009-2010

8. Categories of Function Physical function Psychological function Mental function Affective function Social function Prepared by ATM for PT 142 students AY 2009-2010

9. Activities of Daily Living Basic Activities of Daily Living (BADLs) Instrumental Activities of Daily Living (IADLs) Prepared by ATM for PT 142 students AY 2009-2010

10. BADLs “DEATH” Dressing Eating Ambulating Toileting Hygiene Prepared by ATM for PT 142 students AY 2009-2010

11. IADLs “SHAFT” Shopping Household chores Accounting Food preparation Transportation/Telephone use Prepared by ATM for PT 142 students AY 2009-2010

12. Functional Assessment Measure of how a person performs certain tasks or takes on certain roles in the various dimensions of living. Prepared by ATM for PT 142 students AY 2009-2010

13. Purpose of Functional Assessment Baseline information Performance indicators Criteria for placement decision Level of safety / risk of injury Evidence Prepared by ATM for PT 142 students AY 2009-2010

14. Types of Instruments Performance-Based Tests May be used to describe current or maximum level of function Conditions and setting must be similar to the patient’s actual environment Instructions must be specific Prepared by ATM for PT 142 students AY 2009-2010

15. Types of Instruments Self-reports Therapist / medical or health professional / trained interviewer May also be in self-administered report format Accuracy is key Interviewers must be trained and must have adequate practice Extremely important to distinguish between questions that indicate a person’s habitual performance and those that identify a person’s perceived capacity to perform a task Prepared by ATM for PT 142 students AY 2009-2010

16. Instrument Parameters and Formats Descriptive Parameters Terms used should be well-defined and unambiguous Terms should be clear to all accessing the medical record Additional terms in qualifying function: dependence and difficulty Difficulty can be measured either by quantifying the level of difficulty or by quantifying the frequency that the difficulty is encountered Prepared by ATM for PT 142 students AY 2009-2010

17. Instrument Parameters and Formats Quantitative Parameters Time scores Used when needed to enhance quantification of function when a given speed of performance is required or an improvement in performance speed is expected Prepared by ATM for PT 142 students AY 2009-2010

18. Response Formats Nominal Measures Ordinal Measures Summary or additive measures Visual analog scales Video recordings Prepared by ATM for PT 142 students AY 2009-2010

19. Selection of Instruments Quality Reliability Validity Other factors Questions to ask when selecting assessment tools What are the domains or categories that the assessment instrument focuses on? How adequately does the instrument measure the domain or domains being sampled? What areas of physical function are included? Does the instrument measure ADL? IADL? FMS? Prepared by ATM for PT 142 students AY 2009-2010

20. Selection of Instruments (cont’d) What aspect of function is being measured? Is the level of dependence-independence considered? What is the length of time required to complete the functional task? Degree of difficulty? Influence of pain? What is the time frame sampled in the instrument? What is the mode of administration? What type of scoring system is used? Are multiple instruments necessary to provide a more complete picture of functional status? Prepared by ATM for PT 142 students AY 2009-2010

21. Desirable Attributes of Self-Care Assessment Tools Standardization Scalability Reliability Validity Comprehensive Performance Based Practical Prepared by ATM for PT 142 students AY 2009-2010

22. Global Functional Assessment Tools Prepared by ATM for PT 142 students AY 2009-2010

23. Barthel Index Developed by Dorothea W. Barthel, a physical therapist, over 50 years ago Useful in scoring improvement in the rehabilitation of the chronically ill (neuromuscular or musculoskeletal conditions Measures the degree of assistance required by an individual on mobility and self-care ADL Has been widely used in monitoring functional changes in individuals receiving inpatient rehabilitation Prepared by ATM for PT 142 students AY 2009-2010

24. Psychometric properties of the Barthel Index Strong interrater reliability (0.95) and test-retest reliability (0.89) High correlations with other measures of physical disability (0.74-0.80) Prepared by ATM for PT 142 students AY 2009-2010

25. Katz ADL Index Characterizes the degree of dependence Has been primarily used in the elderly Not disease specific Focuses on patient performance and the degree of assistance required Prepared by ATM for PT 142 students AY 2009-2010

26. Psychometric Properties of the Katz Index of ADL High agreement ratio (reliability) of 0.68 and 0.98 between different professional raters Intraclass correlation of test-retest reliability of respondent self-reports ranges from 0.61 to 0.78 Prepared by ATM for PT 142 students AY 2009-2010

27. Functional Independence Measure (FIM) Measures physical, psychological, and social function Part of the Uniform Data System for Medical Rehabilitation (UDS MR ) Grades functional status from total independence to total assistance Measures what the individual does and not what that person can do under certain circumstances Prepared by ATM for PT 142 students AY 2009-2010

28. Psychometric Properties of the FIM Interrater reliability at an acceptable level of psychometric performance (intraclass correlation coefficients ranging from 0.86-0.88) For persons with stroke, the motor scale of the FIM has been shown to have high concurrent validity with the Barthel Index (ICC≥0.83) Prepared by ATM for PT 142 students AY 2009-2010

29. Documentation Prepared by ATM for PT 142 students AY 2009-2010