functional assessment

Introduction

Assessment of functional status.

Functional status is the ability to function in the arena of everyday living.

Clinical significance

• essential to medical decision making
• not assessed in traditional medical problem list
• other measures (e.g. mental status) do not always predict function
• function inversely correlates with mortality & nursing home placement (& probably quality of life)

Procedure

use of formal measures of functional status:

• advantages
  • specificity, uniformity
  • uses prompts for acquistion of information
  • allows for monitor over time
  • identifies needs & elgibility for services
  • helps determine appropriate living situation
  • facilitates communication between professionals
• disadvantages
  • may dehumanize the evaluation
  • can oversimplify complex situations
  • can be time consuming
• issues of efficiency
  • target to appropriate patients
  • use brief screening measures
  • use self-assessment measures if appropriate
  • use office staff or other personnel
  • use key informants (family/friends), particularly if cognitive impairment is present
• issues in measurement
  • picking 'cutoffs' & normal vs abnormal
  • cultural & ethnic factors
  • gender differences
  • characteristics of measure
  • purpose of measurement
    • screening
    • comprehensive assessment
  • source(s) of information
  • 'Do you do?' vs 'Can you do?'

brief assessment includes:

• visual assessment
  • near visual acuity < 20/40 with correction suggests significant visual impairment
• hearing assessment*
• gait evaluation - normal gait speed > ~0.9 meters/second
• cognitive assessment

* remove impacted cerumen & retest prior to sending patient to audiology if hearing impairment noted

Notes

• the get-up & go test* can be use to assess multiple skills including lower-extremity strength, balance & to a lesser extent walking speed

* may be preferred functional assessment tool in patients with Parkinson's disease

More general terms

• assessment; evaluation

More specific terms

• 5-times sit-to-stand test (5xSST)
• activities of daily living (ADL)
• balance evaluation
• Barthel index
• functional assessment staging (FAST)
• functional independence measure (FIM)
• gait evaluation
• Karnofsky performance index (palliative performance scale)
• Pfeiffer functional activities questionnaire (FAQ)
• physical performance testing
• WHO/EGOG performance scale; Zubrod score

Additional terms

• functional improvement
• functional status; performance status
• performance scale