Functional Screening Tools

Meri Goehring, PT, PhD Geriatric Clinical Specialist

Introduction
Experience Why I became a physical therapist Clinical practice Education Where and when Research

 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

Introduction
An unexamined life is not worth living. Socrates

 Life is a Mad, Sublime Dance

Morris Graves, Artist (1910-2001)

Functional assessment
Provides an objective measure of relevant patient abilities Provides an insight into the functional abilities Provides ability to measure change

Screening tools: Quiz

What is the purpose of a screen?
A. To rule out or differentiate specific system involvement? B. To establish a baseline to examine the effectiveness of interventions? C. To determine the need to document changes in status? D. To progress the patient from one intervention to the next?

Geriatric Screens
A geriatric screening assessment process
Can assess specific domains Can be cost-effective Can be limited; therefore, different instruments may be needed for different problems Should have validity and/or reliability

Domains of aging***
Physical Mental Social Environmental Financial Spiritual These 6 domains influence the day-to day existence of the aging individual and can provide a measure of their health and well being.

Screening tools
There are not many screening tools that include all of the domains We will be looking at many different tools We will be splitting up into small groups to practice 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

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

Performance Versus Self-Report Measures of the Physical Domain***

Disadvantages of performance based screenings of 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 performance in real life Potential injuries

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.

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.

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.

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;

Reliability
Inter-rater reliability
This measure tests how well different observers score the same test. If a test is reliable then the score should not be affected by who the observer is.

Intra-rater reliability
This measure is similar to the inter-rater reliability but differs in the sense that it is the same observer applying the test at two different points in time.

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 the concepts it was designed to measure.

Validity
Criterion validity
This type of validity refers to how well the measure relates to a particular standard criteria.
Concurrent criterion validity: This is the degree to which a particular measure relates to a criterion at the same point in time. Predictive criterion validity: This form of validity is a measure of how well a test will predict a future criterion.

Responsiveness validity
This measure refers to how well a test measures clinically important change.

Groups
Take time to form groups.

Geriatric Functional Rating Scale

Pages 2 and 3 Designed to measure the level of the patient s physical and mental disability in relation to his or 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 rehabilitation center.

Geriatric Functional Rating Scale

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

Geriatric Functional Rating Scale***

A score above 40 indicates that the patient is able to remain in their own home, functioning independently. A score between 20 and 40 indicates that the patient needs some help with ADL s but does not require a nursing home setting. A score below 20 indicates that the patient requires nursing home placement or hospitalization.

Geriatric Functional Rating Scale

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

COOP Measures of Functional Status

Pages 4 and 5 Actually called the Dartmouth COOP Three of the charts focus on function, two focus 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

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

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

Life Satisfaction Index

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: Almost none is given 1, a little and a lot are given 0 Question 3: Satisfied is given 1 point, reasonably satisfied and not satisfied are given 0 points

Life Satisfaction Index

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

Geriatric Depression Scale

Page 8 A 30 question survey designed to screen for depression in elderly patients. The survey is easy to administer. Can be self-administered or administered by another person Takes 5 minutes

Geriatric Depression Scale

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

Geriatric Depression Scale

Scoring
The cutoff for the scale is as follows;
Normal: 0-9 Mild depressive: 10-19 Severe depressive: 20-30

Geriatric Depression Scale

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

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

A little of the time = 1 Some of the time = 2 A good part of the time = 3 Most of the time = 4

Zung Self-Rating depression Scale

Scoring
Questions 2,5,6,11,12,14,16,17,18,10
A little of the time = 4 Some of the time = 3 A good part of the time = 2 Most of the time = 1

Zung Self-Rating depression Scale

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 to equal 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

Zung Self-Rating depression Scale

Good test-retest reliability High (good) content validity

Functional Status Index

Page 10 (page 11 is blank) Designed to be used to determine level of function in three dimensions; level of assistance, 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

Functional Status Index

Scoring
Higher scores indicate the individual requires more assistance, experiences pain and has difficulty with the tasks

Reliability
Good internal consistency, good test-retest reliability

Validity
Good convergent validity

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

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

Timed Up and Go
Page 15 Fallers- 21.5 seconds Non-fallers 11.3 seconds No reliability measures Validity appears good

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

Berg Balance Scale

Pages 20-23 Designed as a balance measure Task performance, cannot be selfadministered Takes 15-20 minutes Scored as it is administered 0 indicates inability, 4 is independence, points are added up for total score

Berg Balance Scale

The higher the score, the more independent the individual is in keeping their balance without assistance Fall risk Reliability
Good internal consistency, excellent inter-rater and intra-rater reliability

Validity
Good content validity

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

Physical Performance Test

Task performance exam, cannot be selfadministered Takes about 10 minutes Scored while administered Reliability
Good inter-rater reliability,

Validity
Good construct and concurrent validity

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. Tools for Primary Care Research 1987 Folsetin MF, Folstein SE, McHugh PR. Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinicians. Journal of Psychiatric Research 1975; 12: 189-198 Koyano W, Shibata H. Development of a Measure of Subjective Well-Being in Japan: Construct Validity and Reliability of the Life Satisfaction Index K. Facts and Research in Gerontology 1994; 181-187 Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and Validation of a Geriatric Depression Screening Scale: A Preliminary Report. Journal of Psychiatric Research 1983; 17(1): 37-49 Zung WK. A Self-Rating Depression Scale. Archives of General Psychiatry 1965; 12:63-70 Jette AM. The Functional Status Index: Reliability and Validity of a Self-Report Functional Disability Measure. Journal of Rheumatology 1987; 14:15-19 Hospital extra. The Tinetti Performance-Oriented Mobility Assessment Tool. (includes abstract) Abbruzzese LD; American Journal of Nursing, 1998 Dec; 98 (12): 16J-L Balance and ankle range of motion in community-dwelling women aged 64 to 87 years: a correlational study. (includes abstract) Mecagni C; Physical Therapy, Oct2000; 80 (10): 1004-11 Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada 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 Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences [J Gerontol A Biol Sci Med Sci], 1995 Jan; Vol. 50A (1), pp. M28-34;

Questions?
Contact information
Meri Goehring, PT, PhD Northern Illinois University College of Health and Human Sciences School of Allied Health and Communicative Disorders Physical Therapy Program, 209 Wirtz Hall DeKalb, IL 60115 mgoehring@niu.edu 815-753-6245