Functional Screening Tools

8/6/2019 Functional Screening Tools

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Functional Screening Tools

Meri Goehring, PT, PhD

Geriatric Clinical Specialist


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Introduction

Experience

Why I became a physical therapist

Clinical practice

Education

Where and when

Research


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Other

Geriatric Clinical Specialist

Due for recertification in 2009

Federation of State Board of Physical Therapists Education Committee

North Central District Illinois Physical Therapy Association

Recorder, in the run for district chairperson

American Physical Therapy Association Geriatric Section, Editorial board for Geri-Notes

State Advocate for Geriatric Section of APTA

Write for local newspapers on geriatric issues


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Introduction

An unexamined life is not worth living.

Socrates


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Life is a Mad, SublimeDance

Morris Graves,

Artist (1910-2001)


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Functional assessment

Provides an objective measure of relevant

patient abilities

Provides an insight into the functional abilities Provides ability to measure change


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Screening tools: Quiz

What is the purpose of a screen?

A. To rule out or differentiate specific systeminvolvement?

B. To establish a baseline to examine theeffectiveness of interventions?

C. To determine the need to document changes instatus?

D. To progress the patient from one interventionto the next?


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Domains of aging***

Physical

Mental

Social

Environmental

Financial

Spiritual

These 6 domains influence the day-to day existenceof the aging individual and can provide a measureof their health and well being.


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Screening tools

There are not many screening tools thatinclude all of the domains

We will be looking at many different tools

We will be splitting up into small groups topractice and discuss the tools

You may be asked to demonstrate how these

tools can be used Two main types of screenings are self-report

measures and performance measures


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Performance Versus Self-Report

Measures of the Physical Domain***

Advantages of performance based screenings

of physical functioning;

Better reproducibility

More sensitive to change

Excellent for showing validity of task being

performed

Measures usual activity versus maximal activity


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Performance Versus Self-Report

Measures of the Physical Domain***

Disadvantages of performance based screeningsof physical functioning;

Difficult with cognitively impaired

Influenced by language, culture, and education More time consuming

May need special training for examiners

May need modification or different settings

Performance on test may not represent performancein real life

Potential injuries


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Choosing the tool

1. Decide how much time you have to devote to

a functional measure.

2.Identify the problem or problems. You may

wish to test more than one domain.

3. Determine if the environment or setting

where the screening will occur is appropriate.

4. Determine how often to use the tool.

5. Collect information from the tool.


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Reliability and Validity***

Reliability of a measure is defined as the

degree to which the measure produces

consistent results when reproduced under

similar circumstances.

Validity of a measure is the extent to which a

test measures what it was designed to

measure.


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Reliability

Internal Consistency: This type of reliability

refers to the way that a group of measures

work together. Internal consistency may be

evaluated by the spilt measure technique. This

involves splitting a group of items and

comparing their scores. The more similar the

scores the higher the internal consistency.


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Reliability

Test-retest reliability

The test-retest procedure involves testing the

same group of individuals on two or more

occasions. The statistical correlation may then be

calculated between the separate tests resulting in

a range from 0 (bad) to 1, excellent. A score in the

range of 0.6 or above is considered a good score.

Advantages of performance based screenings of

physical functioning;


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Reliability

Inter-rater reliability

This measure tests how well different observersscore the same test. If a test is reliable then the

score should not be affected by who the observeris.

Intra-rater reliability

This measure is similar to the inter-rater reliability

but differs in the sense that it is the sameobserver applying the test at two different pointsin time.


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Validity

Content validity

This type of validity refers to the extent to which a

measure represents all aspects of a concept.

Construct validity

Construct validity is how the responses relate to

the measuring instrument. This form of validity

checks to see if the test accurately measures theconcepts it was designed to measure.


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Validity

Criterion validity

This type of validity refers to how well the measurerelates to a particular standard criteria.

Concurrent criterion validity: This is the degree to which aparticular measure relates to a criterion at the same point intime.

Predictive criterion validity: This form of validity is a measureof how well a test will predict a future criterion.

Responsiveness validity This measure refers to how well a test measures

clinically important change.


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Groups

Take time to form groups.


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Geriatric Functional Rating Scale

Pages 2 and 3

Designed to measure the level of the patients

physical and mental disability in relation to hisor her ability to function and the availability of

social networks. The scale is designed to serve

as a practical tool to aid in the placement of

patients either in a hospital or rehabilitationcenter.


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20 to 30 minutes

Physical and mental disability are given minus

scores Support measures are given plus scores

A final score is obtained by adding all of the

pluses and minuses together


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Geriatric Functional Rating

Scale*** A score above 40 indicates that the patient is

able to remain in their own home, functioningindependently.

A score between 20 and 40 indicates that thepatient needs some help with ADLs but doesnot require a nursing home setting.

A score below 20 indicates that the patientrequires nursing home placement orhospitalization.


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Reliability was not reported

Validity of scale to predict patient function

reported to be good This scale includes the domains mentioned

where few others are as inclusive


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COOP Measures of Functional Status

Pages 4 and 5

Actually called the Dartmouth COOP

Three of the charts focus on function, twofocus on feelings, three focus on the patients

perceptions, and the last is a health measure.

Can be self-administered. A high score indicates poor level of health

Good test-re-test reliability and criterion

validity


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Mini-Mental Status Exam

Page 6

Designed to screen for cognitive deficits.

Administered orally by a tester to the patient.

Takes 5-10 minutes.

Lower score indicates lower congintive

functioning Good test-retest reliability and inter-rater

reliability, good validity


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Life Satisfaction Index

Page 7

Actually called the Life Satisfaction Index K

Designed to measure subjective well-being.

Measures cognitive/short-term, cognitive/long

term and emotional/short-term perception of

well-being. Self-administered

Takes 3-5 minutes


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Scoring

With the exception of questions 1 and 3, the YES

answers are given a score of 1, the NO answers

are given a score of 0

Questions 1 and 3

Question 1: Almostnone is given 1, a little and a lotare

given 0

Question 3: Satisfiedis given 1 point, reasonably

satisfiedand notsatisfiedare given 0 points


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The total score is calculated by adding all the

individual items resulting in a score with a

range of 0-9

The higher the score the more satisfied the

patient is with their life

High (excellent) reliability, good construct

validity


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Geriatric Depression Scale

Page 8

A 30 question survey designed to screen for

depression in elderly patients. The survey iseasy to administer.

Can be self-administered or administered by

another person

Takes 5 minutes


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Scoring: of the 30 survey questions on the

Geriatric Depression scale

10 indicate depression when answered negatively

1,5,7,9,15,19,21,27,29,30

20 indicate depression with a positive response

2,3,4,6,8,10,11,12,13,14,16,17,18,20,22,23,24,25,26,28


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Scoring

The cutoff for the scale is as follows;

Normal: 0-9

Mild depressive: 10-19

Severe depressive: 20-30


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High test- retest reliability and internal

consistency

Strong content validity Only a screen, more measures are needed

Good indicator of need for additional services

for older adults


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Zung Self-Rating depression Scale

Page 9

Brief, simple scale of 20 questions

Self-administered

Takes about 5 minutes

Scoring

Questions 1,3,4,7,8,9,10,13,15,19

Alittle ofthe time = 1

Some ofthe time = 2

A good partofthe time = 3

Mostofthe time = 4


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Scoring

Questions 2,5,6,11,12,14,16,17,18,10

Alittle ofthe time = 4

Some ofthe time = 3

A good partofthe time = 2

Mostofthe time = 1


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Scoring

The individual points are then added to form a raw score

which is then divided by 80 to get a percentage score. For

example, a raw score of 40 would be divided by 80 toequal 0.50 for the percentage score

The less depressed individual will have a low score, the

more depressed a high score

A score of 0.63 and higher is a good indicator of

depression, a score of 0.38 to 0.71 may indicate another

problem that needs to be addressed


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Good test-retest reliability

High (good) content validity


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Functional Status Index

Page 10 (page 11 is blank)

Designed to be used to determine level of

function in three dimensions; level ofassistance, difficulty with the task and pain.

It is a self-assessment

Can take 20 minutes up to one hour

depending on the individual

Takes 10 minutes to score


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Functional Status Index

Scoring

Higher scores indicate the individual requiresmore assistance, experiences pain and has

difficulty with the tasks Reliability

Good internal consistency, good test-retestreliability

Validity

Good convergent validity


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The Activities-specific Balance

Confidence (ABC) scale

Pages 12-13

Specific instructions are provided on the

sheets you have I do not have information on validity and

reliability at this time

If you wish to see further research on this test,

please contact me


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Functional Reach

Page 14

Quick screen for balance

Excellent inter-rater and intra-rater reliability Good content validity and concurrent validity

There is also a Multi-directional reach test but

validity and reliability are not reported


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Timed Up and Go

Page 15

Fallers- 21.5 seconds

Non-fallers 11.3 seconds No reliability measures

Validity appears good


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Tinetti Performance Oriented Mobility

Assessment

Pages 16-19

Good reliability and validity

Less than 19 is high risk for falls Between 19 and 24 moderate risk for falls


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Berg Balance Scale

Pages 20-23

Designed as a balance measure

Task performance, cannot be self-administered

Takes 15-20 minutes

Scored as it is administered 0 indicates inability, 4 is independence, points

are added up for total score


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Berg Balance Scale

The higher the score, the more independentthe individual is in keeping their balancewithout assistance

Fall risk Reliability

Good internal consistency, excellent inter-raterand intra-rater reliability

Validity

Good content validity


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Physical Performance Test

Pages 24-26

Designed to assess level of physical function

by observing performances of tasks which

simulate activities of daily living

There are 9 subsets which cover areas of

writing, eating, lifting, dressing, bending,

turning, walking, and stair climbing


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Physical Performance Test

Task performance exam, cannot be self-

administered

Takes about 10 minutes

Scored while administered

Reliability

Good inter-rater reliability,

Validity

Good construct and concurrent validity


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References Grauer, H, Birnborm, F. A Geriatric Functional Rating Scale to Determine the need for Institutional Care.

JAGS, 1975, 23 (10): 472-476 Beaufait DW, Nelson ED, Langdgraf JM, Hays RD, Kirk JW, Wasson JH, Keller, A. Coop Measures of

Functional Status. Toolsfor PrimaryCare Research 1987

Folsetin MF, Folstein SE, McHugh PR. Mini-Mental State: A Practical Method for Grading the CognitiveState of Patients for the Clinicians. JournalofPsychiatric Research 1975; 12: 189-198

Koyano W, Shibata H. Development of a Measure of Subjective Well-Being in Japan: Construct Validity andReliability of the Life Satisfaction Index K. Facts and Researchin Gerontology1994; 181-187

Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and Validation of aGeriatric Depression Screening Scale: A Preliminary Report.JournalofPsychiatric Research1983; 17(1):

37-49 Zung WK. A Self-Rating Depression Scale. ArchivesofGeneralPsychiatry1965; 12:63-70

Jette AM. The Functional Status Index: Reliability and Validity of a Self-Report Functional DisabilityMeasure. JournalofRheumatology1987; 14:15-19

Hospital extra. The Tinetti Performance-Oriented Mobility Assessment Tool. (includes abstract) AbbruzzeseLD; American JournalofNursing, 1998 Dec; 98 (12): 16J-L

Balance and ankle range of motion in community-dwelling women aged 64 to 87 years: a correlationalstudy. (includes abstract) Mecagni C; PhysicalTherapy, Oct2000; 80 (10): 1004-11

Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary

development of an instrument. PhysiotherapyCanada 1989; 41(6): 304-311 Ruben, DB, Siu AL. An Objective Measure of Physical Function of Elderly Outpatients: The Physical

Performance Test. JAGS 1990; 38: 1105-1112

The Activities-specific Balance Confidence (ABC) Scale. (eng; includes abstract) By Powell LE, The JournalsOf Gerontology. Series A, Biological Sciences And Medical Sciences [JGerontolA BiolSciMed Sci], 1995Jan; Vol. 50A (1), pp. M28-34;


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Questions?

Contact information

Meri Goehring, PT, PhD

Northern Illinois University

College of Health and Human SciencesSchool of Allied Health and Communicative Disorders

Physical Therapy Program, 209 Wirtz Hall

DeKalb, IL 60115

[email protected]

815-753-6245

Documents

Functional Screening Tools