FUNCTIONAL

ASSESSMENT TEST
• Functional assessment is an essential part of
obtaining a complete health history. The health
history may be supplemented by standardized
instruments on functional assessment. These
instruments objectively measure a person’s
present functional status and measure any
changes over time. (Katz, et al, 1963; Barthel,
1965)
•.
• Moreover, functional assessment measures a
person’s self-care ability in the areas of general
physical health or absence of illness: ADL’s such
as bathing, dressing, toileting, eating, walking;
IADLs (instrumental activities of daily living) or
those needed for independent living such as
housekeeping, shopping, cooking, doing laundry,
using telephone, managing finances, nutrition,
social relationships and resources, self- concept
and coping and home environment
Katz Activities of Daily Living (ADL) Scale
• Is the most appropriate instrument to assess
functional status as a measurement of patient’s
ability to perform activities of daily living
independently. Health care workers typically use
the tool to detect problems in the performing
activities of daily living and to plan care
accordingly.
• The index ranks adequacy of performance in the
six functions of bathing, dressing, toileting,
transferring, continence and feeding. Clients are
scored yes/no for independence in each of the six
functions. A score of 6 indicates full function, 4
indicates moderate impairment and 2 or less
indicates severe functional impairment.
• The instrument is most effectively used among
older adults in a variety of care settings. Baseline
measurements, taken when client is well, are
compared to periodic or subsequent measures.
• The tool is used extensively as a flag signaling
functional capabilities of older adults in clinical
and home environments.
• The Katz ADL tool assesses basic activities of
daily living. It does not assess more advanced
activities of daily living.
Link
• https://www.youtube.com/watch?v=91H0ORdYYkE
Barthel Activities of Daily Living Index
• The Barthel Index consists of 10 items that measure a
person’s daily functioning specifically the activities of daily
living and mobility.
• The items include feeding, moving from wheelchair to bed
and return, grooming, transferring to and from a toilet,
bathing, walking on level surface, going up and down
stairs, dressing, continence of bowel and bladder.
• The assessment can be used to determine a baseline
level of functioning and can be used to monitor
improvement in ADL over time.
• The person receives a score based on whether they have
received help while doing the task.
• The Barthel Scale/Index (BI) is an ordinal scale used to
measure performance in activities of daily living (ADL).
Ten variables describing ADL and mobility are scored, a
higher number being a reflection of greater ability to
function independently following hospital discharge.
• Time taken and physical assistance required to perform
each item are used in determining the assigned value of
each item. The Barthel Index measures the degree of
assistance required by an individual on 10 items of
mobility and self care ADL. [1]
• The scores for each of the items are summed to create a
total score.
• The higher the score the more independent the
person.
• Independence means that the person need no assistance
at any part of the task.
• If a person does about 50% independently, then the
middle score would apply.
Barthel Activities of Daily Living Index
• Guidelines
• 1. The index should be used as a record of what a patient
does, not as a record of what a patient could do.
• 2. The main aim is to establish degree of independence
from any help, physical or verbal, however minor and for
whatever reason.
• 3. The need for supervision renders the patient not
independent.
• 4. A patient's performance should be established using the
best available evidence. Asking the patient,
friends/relatives and nurses are the usual sources, but
direct observation and common sense are also important.
However direct testing is not needed.
• 5. Usually the patient's performance over the preceding
24-48 hours is important, but occasionally longer periods
will be relevant.
• 6. Middle categories imply that the patient supplies over
50 per cent of the effort.
• 7. Use of aids to be independent is allowed.
Intended Population
• Patients with stroke, patients with other neuromuscular or
musculoskeletal disorders, oncology patients.
Time to administer
• Self report: 2-5 minutes; Direct observation: 20 minutes,
Times may vary depending on clients tolerance and
abilities. The MBI/BI is simple to administer. Requires
training if administered by direct observation. It has been
developed in many forms that can be administered in
many situations and can be used for longitudinal
assessment.
• The Barthel includes 10 personal activities: feeding,
personal toileting, bathing, dressing and undressing,
getting on and off a toilet, controlling bladder, controlling
bowel, moving from wheelchair to bed and returning,
walking on level surface (or propelling a wheelchair if
unable to walk) and ascending and descending stairs.
• The original Index is a three-item ordinal rating scale
completed by a therapist or other observer in 2-5 minutes.
Each item is rated in terms of whether the patient can perform
the task independently, with some assistance, or is dependent
on help based on observation (0=unable, 1=needs help,
2=independent).
• The final score is x 5 to get a number on a 100 point score.
Proposed guidelines for interpreting Barthel scores are that
scores of 0-20 indicate “total” dependency, 21-60 indicate
“severe” dependency, 61-90 indicate “moderate” dependency,
and 91-99 indicates “slight” dependency.
• Most studies apply the 60/61 cutting point.
• Note- the Barthel Index should not be used alone for predicting
outcomes.[2]
The Barthel Index Items and Scoring
• Bowels • Transfer
• 0 = Incontinent (or needs to be given enema) • 0 = unable – no sitting balance
• 1 = occasional accident (once/week) • 1 = major help (one or two people, physical), can sit
• 2 = continent • 2 = minor help (verbal or physical)
• Bladder • 3 = independent
• 0 = incontinent, or catheterized and unable to • Mobility
manage • 0 = immobile
• 1 = occasional accident (max. once per 24 hours) • 1 = wheelchair independent, including corners, etc.
• 2 = continent (for over 7 days) • 2 = walks with help of one person (verbal or
• Grooming physical)
• 0 = needs help with personal care • 3 = independent (but may use any aid)
• 1 = independent face/hair/teeth/shaving • Dressing
(implements provided) • 0 = dependent
• Toilet use • 1 = needs help, but can do about half unaided
• 0 = dependent • 2 = independent (including buttons, zips, laces etc)
• 1 = needs some help, but can do something alone • Stairs
• 2 = independent (on and off, dressing, wiping) • 0 = unable
• Feeding • 1 = needs help (verbal, physical, carrying aid)
• 0 = unable • 2 = independent up and down
• 1 = needs help cutting, spreading butter, etc. • Bathing
• 2 = independent (food provided within reach) • 0 = dependent, 1 = independent (or in shower)
Link
• https://www.youtube.com/watch?v=0TyPiuvgfho&t=18s