FUNCTIONAL ASSESSMENT Flashcards
Function
characteristic action of body parts
characteristic performance of an individual
refers to all body functions, activities, and participation (WHO-ICF)
Impairment
body function is implicated in a condition
Goal of Any Rehabilitation Program
restore the highest level of physical, vocational, and social functions
ADLs
eating
bathing
dressing
transferring
toileting
walking/ moving around
2 Kinds of Assessment
Direct Assessment: physical body functions of the pt
Indirect Assessment: vocational and social functions of the pt
Functional Assessment
task analysis
take note of the difficulties, complaints, compensation
should be performed even if the pt is unconscious
ocular inspection
give minimal cues
observation of certain patient activities
evaluation of effects of injury on ADLs
highest level of function
Importance
for goal setting
establishing what is important and pt’s expectations
determine effect of condition or injury
indicators of initial abilities and progression
criteria for decision on admission and discharge
evidence of treatment effectiveness
3 Main Categories of Function
physical
psychological
social
Physical Function
basic ADLS
instrumental ADLs
Psychological Function
indirectly assessed by PT
observed and referred to another HCP
mental function
affective function
What do PT’s Assess?
ADLs
instrumental ADLs
work activities
sports and recreational activities
Level of Assistance
maximum assistance
moderate assistance
minimum assistance
stand by assist
independent
- modified independence
Kinds of Guarding
contact guard assist
close guarding
Maximum Assistance
PT does 70% of the movement
therapist applies 3 or more points of contact
Moderate Assistance
PT does 50% of the movement
therapist applies 2 points of contact
Minimum Assistance
PT does 25% of the movement
therapist applies 1 point of contact
Stand By Assist
no contact but PT is not comfortable leaving the pt
PT is ready to assist
arm’s length; farther from pt
Independent
no SBA
no assistance
pt can independently execute the task
Points of Contact
contact on the body should give assistance to the pt
Modified Independence
assistance from furniture
Contact Guard Assist
contact but only mainly stabilizes pt
Close Guarding
no contact but very close to the Pt
2 Types of Balance
static: stationary/ maintain posture
dynamic: movement
Balance Grading for Stationary
4: Normal (steady, no handhold support, no swaying)
3: Good (no support, limited postural sway)
2: Fair (with handhold support; occasional minimal assist, more swaying)
1: Poor (with handheld support; moderate to maximum assist; cannot stand alone)
0: Absent (unable to maintain balance)
Balance Grading for Dynamic
4: Normal (max challenge; shift easily w/ full range in all directions)
3: Good (mod challenge, maintain balance while picking object from floor)
2: Fair (min challenge; maintain balance while turning head/ trunk)
1: Poor (unable to accept challenge or move w/o loss of balance)
0: Absent (unable to maintain balance)
Balance is an Impairment
true, but is placed under FA
Functional Assessment Documentation Contents
difficulty of performance (min, mod, max)
observation of compensation/ complications
assistance (max, mod, min, indep, modified indep)
SBA/ CGA/ CG
balance grading (standing and dynamic; N, G, F, P, A)
Outcome Measures
objective tests to determine baseline function of a pt at the beginning of the treatment and determine progress and treatment efficacy once commenced
Types of instruments
Performance based
- 5x STS
- Timed Up and Go Test (TUG)
- Step Test
- 2 Minute Walk Test
Self Assessment
- ODI
- NDI
- LEFS
- DASH
Oswestry Low Back Pain Disability Questionnaire/ Oswestry Disability Index (ODI)
for lower back pain
higher the score more disabled
MDC= 90% confidence; 10% points
FA > OMT > NDI = 42% (severe disability)
Neck Disability Index (NDI)
for upper back pain
higher the score, more disabled
MDC= 90% confidence; 10% points
FA> OMT> NDI> 42% (severe disability)
Lower Extremity Functional Scale (LEFS)
for LE
higher the score, more independent
no standard interpretation
FA> OMT> LEFS> 34/80
Disabilities of the Arm, Shoulder, and the Hands (DASH)
higher the score, more disabled
additional optional work module, sports/ performing arts module
no standard interpretation
score cannot be calculated if there are greater than 3 unanswered items
FA> OMT> DASH= 48.33
> DASH (Work Module)= 50
Psychometric Properties
validity
reliability
responsiveness to change
clinical utility
Validity
is the test measuring what it’s supposed to measure
results satisfy the objectives
Reliability
inter rater
intra rater
test-retest
Responsiveness to Change
ceiling and floor effects: ceiling= score s too high, floor= too low (did not reflect difficulty/ not appropriate)
SEM: standard error of measurement (differences in test re test does not signify maximum change)
MDC: minimal detectable change (significant statistical change but pt does not feel it, real but unimportant change)
MCID: minimal clinically important difference (significant statistical change supported by pt’s perception of change)
Clinical Utility
are there outcome measurements that your facility requires you to do?
how much time do you have to administer outcome measures?
do you have the equipment needed to use the outcome measures?
Guidelines for OMT
select an instrument with known reliability, validity, and sensitivity to change
(research)
administer the instrument on intake, reassessment, and upon discharge, and know the suggested time frame for repeat administration
(so you can see the progress of the patient)
be familiar with the scoring procedure for the instrument
(some inaallow yung questions na blank, some will consider it as void. Understand the instructions)
complete the scoring
understand the clinical meaning of the range of scores
be familiar with the MDC and MCID for the scale
establish a treatment goal for change of the HRQL score that is greater than the MDC or MCID for the instrument, if these are known
Testing Frequency
in patient: 2x within 3 days of admission and within 3 days of discharge
outpatient: admission and every month
Computation for Scores ODI and NDI
each section= 5 points (subtract if there is/are unanswered section/s)
add scores / total number of section x 100
Computation of Scores for DASH
[(sum of responses/ n)- 1] x 25
n= num of completed responses
