Frenchay Activities Index (FAI)

Purpose

The Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index (FAI) is a measure of instrumental activities of daily living (IADL)Complex tasks that involve social or societal issues (shopping, bill paying, cooking, housework, etc.) that are done on a regular basis. for use with patients recovering from strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI assesses a broad range of activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
associated with everyday life. The benefit of the FAI is that while activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living scales tend to focus on issues related to self-care and mobility (Holbrook & Skilbeck, 1983), the FAI provides a broader measurement of actual activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
patients have undertaken in the recent past (Wade, Legh-Smith, & Langton, 1985).

In-Depth Review

Purpose of the measure

The Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index (FAI) is a measure of instrumental activities of daily living (IADL)Complex tasks that involve social or societal issues (shopping, bill paying, cooking, housework, etc.) that are done on a regular basis. for use with patients recovering from strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI assesses a broad range of activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
associated with everyday life. The benefit of the FAI is that while activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living scales tend to focus on issues related to self-care and mobility (Holbrook & Skilbeck, 1983), the FAI provides a broader measurement of actual activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
patients have undertaken in the recent past (Wade, Legh-Smith, & Langton, 1985).

Available versions

The FAI was published by Margaret Holbrook and Clive E. Skilbeck in 1983.

Features of the measure

Items:

The FAI contains 15 items or activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
that can be separated into 3 subscales; Domestic chores, Leisure/work and Outdoor activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
.

The items of the FAI are as follows:

1. Preparing main meals
   Must play a substantial part in organization, preparation and cooking.
2. Washing up
   Must do all or share equally, e.g. washing or wiping and putting away.
3. Washing clothes
   Organization of washing and drying clothes. Sharing task equally, e.g. loading, unloading, hanging, folding.
4. Light housework
   Dusting, ironing, tidying small objects. Anything heavier is included in item 5.
5. Heavy housework
   Changing beds, cleaning floors, windows, vacuuming, moving chairs, etc.
6. Local shopping
   Substantial role in organizing and buying groceries. Can include collection of pension or going to the Post Office.
7. Social outings
   Going out to clubs, cinema, theatre, drinking, dinner with friends, etc. May be transported there, provided patient takes an active part once arrived. Includes social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
   at home, initiated by the patient.
8. Walking outdoors over 15 minutes
   Sustained walking for at least 15 minutes (allowed short stops for breath).
9. Pursuing active interest in hobby
   Must require ‘active’ participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations., e.g. caring for houseplants, knitting, reading specialist magazines or window-shopping.
10. Driving a car
    Must drive a car, or get to a bus/coach and travel on it independently.
11. Outings/car rides
    Train, bus, or car rides to some place for pleasure, not for a routine social outing. Must involve patient organization and decision-making. Holidays within the last 6 months are divided into days/month (e.g. a 7-day holiday = 1 or 2 days/month).
12. Gardening
    Light = occasional weeding or sweeping; Moderate = regular weeding, raking, pruning; Heavy = all necessary work including heavy digging.
13. Household and/or car maintenance
    Light = repairing small items, replacing lightbulb or plug; Moderate = spring cleaning, hanging a picture, routine car maintenance; Heavy = painting/decorating, most necessary household/car maintenance.
14. Reading books
    Full-length books, not magazines or newspapers. Can be talking books.
15. Gainful work
    Paid work, not voluntary work. The time worked should be averaged out over six months (e.g., 1 month working for 18 hours/week over the 6-month period would be scored as ‘up to 10 hours/week’).

Time:

The FAI takes approximately 5 minutes to complete when administered in an interview format (with or without the patient’s family) (Segal & Schall, 1994).

Scoring:

The frequency with which each item or activity is undertaken over the past 3 or 6 months (depending on the nature of the activity) is assigned a score of 1 – 4 where a score of 1 = lowest level of activity. The scale provides a summed score from 15 – 60.

A modified 0-3 scoring system introduced by Wade et al. (1985) yields a score of 0 – 3 for each item, and a summed score from 0 – 45.

Note: In patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., the FAI should be used to assess pre-morbid IADL at 3 and 6 months before strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., and subsequently to record changes in IADL following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., at specific intervals (Holbrook & Skilbeck, 1983). Studies typically examine change in post-stroke IADL by examining patients at 1 year after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., and looking retrospectively at the past 3 and 6 months.

Subscales:

There are 3 subscales to the FAI:

• Domestic (items 1-5)
• Leisure/work (items 7, 9, 11, 13, 15)
• Outdoors (items 6, 8, 10, 12, 14)

Equipment:

Only the questionnaire and a pencil are needed to complete the FAI.

Training:

No training is required to complete the FAI. The FAI is most often interview-administered.

The FAI can be used as a mailed questionnaire. Carter, Mant, Mant, Wade, and Winner (1997) reported an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between mailed questionnaire FAI scores and face-to-face interview scores (r = 0.94).

The FAI can also be used with a proxy respondent. Proxy agreement was excellent for the FAI (intraclass correlation coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance. = 0.85) (Segal & Schall, 1994). Holbrook and Skilbeck (1983) found that information obtained by relatives were interchangeable with information acquired from the patient. Segal and Schall (1994) reported proxy agreement for the three subscales as ranging from adequate (ICC = 0.59 for Leisure/work) to excellent (ICC = 0.77 for Domestic and Outdoors).

Alternative Forms of the FAI

• FAI-18 (Miller, Deathe, & Harris, 2004).
  Three items (sport/recreation and visiting in the last 3 months, and banking in the last 6 months) were added to the FAI and the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
  was examined in patients with lower limb amputation. The total score of the FAI-18 ranges from 0 to 54. Support for the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
  (r = -0.46), the Prosthetic Evaluation Questionnaire-Mobility Scale (r = 0.40) and the Activities-specific Balance Confidence Scale (r = 0.52). The FAI-18 was not found to offer any advantage over the original FAI and therefore use of the original FAI is recommended to ensure results are comparable between populations and studies. Further, the FAI-18 has not been examined in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• Modified FAI (Tooth, McKenna, Smith, & O’Rourke, 2003).
  A 13-item modified version has been developed based on the recommendations by Schuling, de Haan, Limburg, and Groenier (1993) to omit the items ‘reading books’ and ‘gainful work’. At 6 months post-stroke, the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the 13 FAI items was excellent when scored by patients (alpha = 0.85) and when scored by proxies (alpha = 0.83). However, the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of each subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
  examined separately varied widely.

Client suitability

Can be used with

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• Can also be used with patients with cognitive impairment, using a proxy respondent. The focus of the FAI is on frequency of activity rather than quality of activity. This may reduce elements of subjectivity, which typically undermine the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
  of proxy assessment (Segal & Schall, 1994).

Should not be used with

• When examining FAI scores, male and female scores should be considered separately as there is evidence of a gender bias in FAI scores (Holbrook & Skilbeck, 1983). Sveen, Bautz-Holter, Sodring, Wyller, and Laake (1999) reported that men had significantly higher scores in the Outdoor activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
  subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
  , and there was a trend towards women having higher scores in the Domestic activity subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
  .
• Due to individual variability, the FAI should not be administered by interview and by mailed questionnaire, sequentially (Carter et al., 1997).
• Use caution when examining proxy ratings at the item level, because there is less agreement than what has been observed with the total score (Wyller, Sveen, & Bautz-Holter, 1996; Tooth et al., 2003).
• Be aware of the biases involved with proxy use. Tooth et al. (2003) reported that patients tend to score themselves as performing activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
  more frequently than proxy respondents especially in meal preparation, heavy housework, social outings, driving and home maintenance. In addition, male proxy respondents and respondents who are relatives (rather than spouses) tend to give higher ratings, particularly in the area of domestic activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
  .

In what languages is the measure available?

• English
• Dutch – translated (Schuling, de Haan, Limburg, & Groenier, 1993)
• Chinese – translated and validated (Hsueh & Hsieh, 1997)

Summary

What does the tool measure?	Instrumental ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of Daily Living
What types of clients can the tool be used for?	Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment
Time to administer	Interview: 5 minutes (with or without the patient’s family)
Versions	FAI-18, Modified FAI
Other Languages	Chinese (translated and validated), Dutch (translated)
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: Out of three studies examining internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency., three reported excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.. Test-retest: Out of four studies examining test-retest, three reported excellent test-retest, and one reported a range from poor to excellent depending on item examined. Inter-rater: Out of two studies examining inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. , two studies reported excellent inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. as measured by intraclass correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. coefficients. Using Cohen’s kappa, one study reported adequate to excellent reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest . and one study reported poor to excellent reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest . .
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: Three studies examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. of the FAI suggesting the presence of a single underlying construct in that each item contributes to each of the three identified factors (Domestic; Leisure/work; Outdoors) Criterion: Excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between postal and interview FAI scores, however individual differences on scores ranged widely between mailed and postal responses taken 10 days later. Construct: Excellent correlations with Rankin Scale ; SF-36 (Physical Functioning subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). ). Adequate to excellent correlations with the Sickness Impact Profile ; Barthel Index ; Functional Independence Measure (Motor subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). ); Euroqol. Adequate correlations with StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Adapted Sickness Impact Profile ; SF-36 (Social Functioning and Vitality subscales); two-minute walk test, Timed Up and Go test ; Prosthetic Evaluation Questionnaire-Mobility; Activities-specific Balance Confidence Scale. Known groups: The FAI has been found to distinguish strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity in male patients only and can discriminate between patients in a pre-stroke versus a reference group, and patients’ pre-stroke and post-stroke levels of activity.
Does the tool detect change in patients?	One study reported an “obvious” floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also “ceiling effect.” for individuals examined at 6 months post-stroke. Out of two studies examined, one reported that the FAI had a moderate ability to detect change (in patients 6-12 months post-stroke) and one reported that the FAI changed in the expected direction from pre-stroke to 6 months post-stroke, to 1 year post-stroke.
Acceptability	The FAI is short, simple, and encourages participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. of significant others or family members. It is suitable for use with proxy respondents.
Feasibility	The FAI is simple to administer and requires no training or special equipment. It has been used for longitudinal assessment.
How to obtain the tool?	A copy of the original FAI provided in Holbrook, M., Skilbeck, C. E. (1983). An activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. index for use with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. patients. Age and Ageing, 12(2), 166-170.

Psychometric Properties

Overview

For the purposes of this review, we conducted a literature search to identify all relevant publications on the psychometric properties of the FAI. In general, the FAI has good overall reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
, however it has considerable variability in the strength of agreement at the level of individual scale item scores (reported both for test-retest and inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
). Further, there is little evidence regarding the responsivenessThe ability of an instrument to detect clinically important change over time.
of the FAI.

Floor/Ceiling Effects

Schuling et al. (1993) examined the psychometric properties of the FAI in a group of patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and a control group of individuals from the general population aged 65 or older. No ceiling effects were reported in this study.

Similarly, Wade et al. (1985) examined the psychometric properties of the FAI using data from 976 patients with acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. No ceiling effects were reported.

Pederson et al. (1997) examined the FAI in 437 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and reported an “obvious” floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also "ceiling effect."
at 6 months post-stroke.

Walters, Morrell and Dixon (1999) examined the psychometric properties of four generic instruments in 233 patients with venous leg ulcers. The FAI demonstrated an adequate floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also "ceiling effect."
of 2.1%. No ceiling effectA ceiling effect occurs when test items aren't challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes - the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also "floor effect." was observed.

Reliability

Internal consistency:

Schuling et al. (1993) examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the FAI retrospectively in a group of patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and a control group of individuals from the general population aged 65 or older. They looked at the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the FAI pre-stroke, 6 months post-stroke and in control patients. An excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. was reported for the total score of the FAI in the control group (alpha = 0.83) and in patients post-stroke (alpha = 0.87). An adequate alpha coefficient was reported for patients pre-stroke (alpha = 0.78). When subscales were examined individually, the Domestic subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
had excellent alpha coefficients (alpha = 0.82 for control and pre-stroke; 0.88 for post-stroke). The Leisure/work subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
had poor internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. in all groups (control, alpha = 0.63; pre-stroke, alpha = 0.58; post-stroke, alpha = 0.61). The Outdoors subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
also had poor internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. in all groups (control, alpha = 0.67; pre-stroke, alpha = 0.55; post-stroke, alpha = 0.66). However, when item 14 (reading books) was deleted, alpha coefficients were adequate for control and post-stroke groups (alpha = 0.72, alpha = 0.73, respectively) and remained poor in the pre-stroke group (alpha = 0.66).

Tooth et al. (2003) examined the agreement between patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and their proxies using a modified version of the FAI (13 items). At 6 months post-stroke, the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the 13 FAI items was excellent when scored by patients (alpha = 0.85) and when scored by proxies (alpha = 0.83). The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of each subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
examined separately varied widely. Coefficient alphas for the Domestic, Leisure, and Outdoor subscales completed by patients ranged from poor to excellent (0.83, 0.38, 0.66, respectively), as did completion by proxies (0.83, 0.59, 0.57, respectively).

Miller et al. (2004) compared the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of the FAI to a modified version, the FAI-18. The internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the FAI was excellent (alpha = 0.81).

Test-retest:

Wade et al. (1985) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the FAI and reported that the overall agreement of individual items was variable. Heavy housework, local shopping, walking outside and social outings failed to reach statistical significance, while other items demonstrated excellent agreement (r = 0.80).

Green, Forster, and Young (2001) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the Barthel Index (Mahoney & Barthel, 1965), the Rivermead Mobility Index (Nouri & Lincoln, 1987), the Nottingham Extended ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living Scale (Whiting & Lincoln, 1980), and the FAI in 22 patients > 1 year post-stroke, tested twice at an interval of 1 week. Kappa coefficients for the FAI ranged from poor (kappa = 0.25 for heavy housework) to excellent (kappa = 1.00 for preparing main meals). The results of this study indicate that basic measures of activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living (as measured by the Barthel Index and Rivermead Mobility Index) may be more reliable than the measures used to assess IADL.

Turnbull, Kersten, Habib, McLellan, Mullee, and George (2000) assessed the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of the FAI to establish age and sex norms in people age 16 years and over. A postal questionnaire survey was sent to 1,280 people. Then 57 respondents completed a re-test questionnaire. Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the postal version of the FAI was excellent, with a correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
of r = 0.96.

Miller et al. (2004) examined the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of the FAI in 84 individuals with lower limb amputation. Individuals completed the FAI twice, within two weeks. The ICC for the FAI was excellent (ICC = 0.79), demonstrating the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the FAI.

Inter-rater:

Piercy, Carter, Mant, and Wade (2000) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the FAI in 35 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and 24 individuals who were the main caregivers for patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Two raters evaluated each person, 15 days apart on average. Kappa statistics showed an excellent level of agreement for 3/15 items (kappas ranging from 0.77-0.80). An adequate level of agreement was found for 10/15 items (kappas ranging from 0.42-0.73). The other 2 items showed poor agreement (social outings, 0.27; pursuing active interest in hobby, 0.35). Three items showed significant differences between the two raters (light housework, outing/car rides, household and/or car maintenance). Spearman’s correlation for FAI totals of rater B verses rater A was excellent (r = 0.93). The results of this study confirm the reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of the FAI when administered by interview.

Post and de Witte (2003) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the Dutch version of the FAI in 45 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI was administered twice, with 3-5 days in between evaluations. The total inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the FAI was excellent (ICC = 0.90). At item level, kappa coefficients ranged from adequate to excellent (kappa = 0.41-0.90).

Validity

Content:

Wade et al. (1985) examined data from 976 patients with acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. A factor analysis was conducted to demonstrate levels of communality among the FAI’s items. Correlations ranged from 0.44-0.77, suggesting the presence of a single underlying construct in that each item contributes to each of the three identified factors (Domestic; Leisure/work; Outdoors) to some extent.

Pedersen, Jorgensen, Nakayama, Raaschou, and Olsen (1997) examined whether the FAI was a good supplementary assessment to the Barthel Index (Mahoney & Barthel, 1965) for measuring higher order ADL functions in 437 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI was found to be a heterogeneous scale comprised of 3 factors, two of which may represent increased item difficulties, and the third related to activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
away from the home. Items from the Barthel Index and the FAI, when analyzed together, appeared on different, orthogonal factors, suggesting that the FAI supplements the Barthel Index with minimal content overlap.

Sveen et al. (1999) examined data from 65 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. to observe how motor and cognitive impairments relate to physical activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living. In this study, the 3-factor structure of the FAI was confirmed. These three subscales include Domestic chores, Outdoor activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and Hobbies.

Criterion:

Concurrent:
Carter et al. (1997) examined the agreement between postal and interview-administered versions of the FAI, and assessed the criterion validityExamines the extent to which a measure provides results that are consistent with a gold standard . It is typically divided into concurrent validity and predictive validity .
of the postal version, using the interviewer method as the gold standardA measurement that is widely accepted as being the best available to measure a construct.
. An excellent Spearman’s correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
of r = 0.94 was found between mailed questionnaire FAI scores and face-to-face interview FAI scores. Individual differences on scores ranged widely between FAI responses by post and responses by interview 10 days later. At the level of individual items, kappas ranged from poor (kappa = 0.35 for travel outings/car rides) to excellent (kappa = 1.00 for gainful work). The postal version was found to be a satisfactory alternative to interview administration, however, due to poor agreement in scores for individual patients, the two approaches should not be used sequentially to monitor individual patient.

Cup, Scholte op Reimer, Thijssen, and van Kuyk-Minis (2003) administered a number of different standardized measures to 26 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI had excellent correlations with the Barthel Index (Mahoney & Barthel, 1965) (r = 0.79), the Euroqol (r = 0.65) (EuroQol Group, 1990), and the Rankin Scale (r = -0.80) (de Haan, Limburg, Bossuyt, van der Meulen, & Aaronson, 1995). The FAI an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Adapted Sickness Impact Profile-30 (van Straten, de Haan, Limburg, Schuling, Bossuyt, & van den Bos, 1997) (r = -0.43).
Note: Some correlations are negative because a high score on the FAI indicates a high level of functioning, where as a high score on the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Adapted Sickness Impact Profile-30 and the Rankin Scale indicates less desirable health outcomes.

Segal and Schall (1994) examined the proxy agreement between 38 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and their caregivers. Using Spearman’s rho, the FAI and the Functional Independence Measure (Keith et al., 1987) were found to have an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(r = 0.80).

Hsueh, Lee, and Hsieh (2001) examined the psychometric properties of the Barthel Index (Mahoney & Barthel, 1965) in 121 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI was compared to the Barthel Index at 180 days after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and was found to have an adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the Barthel Index scores obtained at 14, 30, and 90 days after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. (Pearson’s r = 0.59).

Walters et al. (1999) examined the psychometric properties of four generic instruments: Short-Form Health Survey (SF-36) (Ware & Sherbourne, 1992); EuroQol (EuroQol Group, 1990); McGill Short Form Pain Questionnaire (Melzack, 1975) and the FAI in 233 patients with venous leg ulcers. Correlations were calculated using Pearson Product Moment Correlations. The FAI had an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the SF-36 subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of Physical Functioning (r = 0.72). Poor correlations between FAI and the SF-36 subscales of Role Limitations-Physical (r = 0.25), Role Limitations-Emotional (r = 0.11), Pain (r = 0.28), General Health Perceptions (r = 0.30), and Mental Health (r = 0.26) were observed. Adequate correlations were found between the FAI and the SF-36 subscales of Social Functioning (r = 0.35), and Vitality (r = 0.45). The FAI had a moderate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the EuroQol Derived Single Index (r = 0.54), and a poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases - for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases - for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the McGill Pain Questionnaire Sensory (r = -0.12) and Affective (r = -0.13) subscales. Note: Some correlations are negative because a high score on the FAI indicates a high level of functioning, where as a high score on other measures indicates less desirable health outcomes.

Miller et al. (2004) examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
of the FAI in 84 individuals with lower limb amputation. As predicted, the FAI correlated adequately with the Two-minute walk test (r = 0.53), the Timed Up and Go test (Podsiadlo & Richardson, 1991) (r = -0.49), the Prosthetic Evaluation Questionnaire-Mobility Scale (Legro, Reiber, Smith, del Aguila, Larsen, & Boone, 1998) (r = 0.39), and the Activities-specific Balance Confidence Scale (Powell & Myers, 1995) (r = 0.51).
Note: Some correlations are negative because a high score on the FAI indicates a high level of functioning, whereas a high score on the Timed Up and Go test indicates less desirable health outcomes.

Construct:

Convergent/Discriminant:
Schuling et al. (1993) examined the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the FAI in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., and in a group of unselected participants aged 65 or older. Functional status of the patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. was measured at 26 weeks. Correlations between the FAI and the Sickness Impact Profile (Bergner, Bobbitt, Carter, & Gilson, 1981) subscales of Home management, Body care and movement, Mobility and Ambulation ranged from adequate to excellent (r = -0.56 to -0.73). The FAI also had an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the disability scores of the Barthel Index (Wade & Collin, 1988) (r = 0.66). These results provide evidence for the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the FAI. Further, the discriminant validityMeasures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.
of the FAI is supported by the poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
found between FAI scores and Emotional Behavior and Alertness Behavior scales of the Sickness Impact Profile (r = -0.15 and -0.14).
Note: Some correlations are negative because a high score on the FAI indicates a high level of functioning, where as a high score on the Sickness Impact Profile indicates less desirable health outcomes.

Sveen et al. (1999) examined data from 65 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and found that Domestic chores and Outdoor activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(factors found in this study to make up the FAI) correlated adequately with Barthel Index (Mahoney & Barthel, 1965) scores (r = 0.58 and r = 0.50). Domestic chores was the factor most strongly related to arm motor function of the Barthel Index, and Outdoor activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
was most strongly related to visuospatial ability. Hobbies, the third factor found in this study, did not correlate with Barthel Index scores (r = 0.11).

Tooth et al. (2003) examined the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the FAI in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and their proxies using a modified version of the index (13 items). The total patient FAI score was found to correlate significantly with the Motor subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Functional Independence Measure (Keith, Granger, Hamilton, & Sherwin, 1987) (r = 0.63) but not with the Cognitive subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Functional Independence Measure (r = 0.09).

Known groups:
Holbrook and Skilbeck (1983) divided patients by strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. severity into ‘mild’ and ‘severe’ based on Rankin grade at the time of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. They reported that the FAI distinguished severity of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. (by Rankin groupings) in male patients, who showed significantly poorer Domestic chores scores and Outdoor activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
scores at follow up. However, strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. severity did not influence one-year follow-up for females.

Schuling et al. (1993) reported that the FAI was able to discriminate between patients in the pre-stroke group and patients in the reference group. The FAI was also discriminative of patients’ pre-stroke and post-stroke levels of activity.

Responsiveness

Schepers, Ketelaar, Visser-Meily, Dekker, and Lindeman (2006) compared the responsivenessThe ability of an instrument to detect clinically important change over time.
of frequently used functional health status measures in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The FAI and the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Adapted Sickness Impact Profile detected the most changes and had moderate effect sizes for patients in the chronic phase (between 6 and 12 months post-stroke) of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation.

Wade et al. (1985) reported that FAI scores changed in the expected direction from pre-stroke to 6 months post-stroke to 1 year post-stroke.

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See the measure

How to obtain the FAI:

For a copy of the FAI with the scoring system by Wade et al. (1985), please click here.

A copy of the measure with the original scoring system is also provided in Holbrook, M., Skilbeck, C. E. (1983). An activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
index for use with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. patients. Age and Ageing, 12(2), 166-170.