Tools of Disability Outcomes Research
The tools of disability outcomes research functional status measures,☆☆

https://doi.org/10.1053/apmr.2000.20620Get rights and content

Abstract

Cohen ME, Marino RJ. The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil 2000;81 Suppl 2:S21-S29. Objective: To review the major functional status measures currently used in rehabilitation research, including the domains and scope of functional status measures, as well as the psychometric properties of selected functional status measures and their use in adult rehabilitation populations. Data Sources: Measures of physical functioning widely used in rehabilitation research. Study Selection: Major generic measures included the following activities of daily living and instrumental activities of daily living: the FIM™ instrument, the Katz Activities of Daily Living Scale, the Level of Rehabilitation Scale, the Barthel index, and the Patient Evaluation and Conference System. Measures were evaluated based on published evidence of validity, reliability, and sensitivity. Data Extraction: Measures were chosen on the basis of the amount and quality of published research on the functional measures widely used in rehabilitation medicine. Independent research of computer databases and reviews of functional measures were conducted to determine suitability for inclusion. The quality and validity of the measures were assessed using standard psychometric guidelines. Data Synthesis: Measures were evaluated based on published evidence of validity, reliability, sensitivity response and administrative burdens and instrument bias. Each criterion was graded on a 3-point scale reflecting the level of evidence. Conclusion: Researchers in the field of disabilities research need to consider carefully study objectives when measuring physical functioning in people with disabilities. © 2000 by the American Congress of Rehabilitation Medicine

Section snippets

Background

Functional assessment can occur across many levels of the disablement process. In the 1980, World Health Organization's (WHO) International Classification of Impairment, Disability, and Handicap (ICIDH), functional status assessment was the measure of the impact of disability. Recently, WHO, in the International Classification of Functioning and Disability1 (ICIDH-2), classified level of functioning for the whole person as an activity. Activity is characterized by what a person does in the

Generic functional status assessments

This section presents the generic functional status assessments in chronological order of publication. A brief discussion of each scale, its development, validity, and reliability will be presented. Table 1 summarizes each scale.

Conclusion

Table 1 compares the 5 functional status measures evaluated in this paper. All measures, with the exception of the Katz index, adequately cover the domain of disability. The LORS, the PECS, and the FIM have published comparative data for people with varying disabilities. The FIM is the least biased of the measures. The Katz index, Barthel index, and FIM instrument are relatively brief, requiring little time from the respondent, while the administrative burden is less with the Barthel index and

Acknowledgements

The authors thank Richard R. Brown, a master's student in the Department of Occupational Therapy, Thomas Jefferson University, for his efforts in conducting the literature search for this review.

References (101)

  • AW Heinemann et al.

    Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain injury and spinal cord injury

    Arch Phys Med Rehabil

    (1997)
  • MG Stineman et al.

    Impairment-specific dimensions within the Functional Independence Measure

    Arch Phys Med Rehabil

    (1997)
  • MG Stineman et al.

    The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories

    Arch Phys Med Rehabil

    (1996)
  • KJ Ottenbacher et al.

    The reliability of the functional independence measure: a quantitative review

    Arch Phys Med Rehabil

    (1996)
  • KM Hall et al.

    Characteristics of the Functional Independence Measure in traumatic spinal cord injury

    Arch Phys Med Rehabil

    (1999)
  • MP Dijkers et al.

    Short versions of the telephone motor Functional Independence Measure for use with persons with spinal cord injury

    Arch Phys Med Rehabil

    (1999)
  • EA Eastwood et al.

    Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury

    Arch Phys Med Rehabil

    (1999)
  • World Health Organization

    International classification of impairments, activities, and participation (ICIDH-2); 1997

  • I McDowell et al.

    Measuring health: a guide to rating scales and questionnaires

    (1987)
  • Staff of the Benjamin Rose Hospital

    Multidisciplinary studies of illness in aged persons: II, a new classification of functional status in activities of daily living

    Chron Dis

    (1959)
  • MP. Lawton

    The functional assessment of elderly people

    J Am Geriatr Soc

    (1971)
  • RF Harvey et al.

    Functional performance assessment: a program approach

    Arch Phys Med Rehabil

    (1981)
  • S Katz et al.

    Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function

    JAMA

    (1963)
  • FI Mahoney et al.

    Functional evaluation: the Barthel Index

    Md State Med J

    (1965)
  • DT Wade et al.

    The Barthel ADL Index: a standard measure of physical disability

    Int Disabil Stud

    (1988)
  • Guide for the Uniform Data Set for Medical Rehabilitation (Adult FIM)

    (1993)
  • RG Carey et al.

    Program of a physical medicine and rehabilitation unit: a new approach

    Arch Phys Med Rehabil

    (1978)
  • SI Weingarden et al.

    Independent dressing after spinal cord injury: a functional time evaluation

    Arch Phys Med Rehabil

    (1989)
  • GH Kirschner et al.

    A methodological framework for assessing health indices

    J Chron Dis

    (1985)
  • S Katz et al.

    Progress in development of the index of ADL

    Gerontologist

    (1970)
  • MLC Labi et al.

    Some research applications of functional assessment instruments used in rehabilitation medicine

  • S Katz et al.

    Prognosis after strokes. Part II. Long-term course of 159 patients

    Medicine

    (1966)
  • S Katz et al.

    Long-term course of 147 patients with fracture of the hip

    Surg Gynecol Obst

    (1967)
  • S Katz et al.

    Comprehensive outpatient care in rheumatoid arthritis, a controlled study

    JAMA

    (1968)
  • RT Grotz et al.

    A comparison of the functional and intellectual performance of phenylketonuric, anoxic, and Down's syndrome individuals

    Am J Mental Def

    (1972)
  • S Katz et al.

    A measure of primary sociobiological functions

    Int J Health Serv

    (1976)
  • S Katz et al.

    The measurement of long-term care needs and impact

    Health Med Care Serv Rev

    (1979)
  • GE Gresham et al.

    ADL status in stroke: relative merits of three standard indexes

    Arch Phys Med Rehabil

    (1980)
  • MT Hartig et al.

    Accuracy of nurse aides' functional health assessments of nursing home residents

    J Gerontol

    (1997)
  • KH Asberg et al.

    Early prognosis of stroke outcome by means of Katz Index of activities of daily living

    Scand J Rehabil Med

    (1991)
  • P Gillen et al.

    Functional and residential status transitions among nursing home residents

    J Gerontol

    (1996)
  • CV Granger et al.

    Outcome of comprehensive medical rehabilitation: measurement of PULSES profile and Barthel Index

    Arch Phys Med Rehabil

    (1979)
  • CV. Granger

    Health accounting: functional assessment of the long-term patient

  • GE Gresham et al.

    Functional assessment instruments currently available for documenting outcomes in rehabilitation medicine

  • GM Yarkony et al.

    Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients

    Arch Neurol

    (1987)
  • NM Crewe et al.

    Functional assessment

  • PG Mattison et al.

    Rehabilitation status: the relationship between the Edinburgh Rehabilitation Status Scale (ERSS), Barthel Index, and PULSES Profile

    Int Disabil Stud

    (1991)
  • J Schuling et al.

    The Frenchay Activities Index. Assessment of functional status in stroke patients

    Stroke

    (1993)
  • C Anderson et al.

    Validation of the Short Form 36 (SF-36) Health Survey Questionnaire among stroke patients

    Stroke

    (1996)
  • Cited by (0)

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    ☆☆

    Correspondence to Michelle E. Cohen, PhD, Dept of Occupational Therapy, Thomas Jefferson University, 130 S 9th St, Ste 810, Philadelphia, PA 19107, e-mail: [email protected]

    View full text