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Functional assessments have become an integral part of the comprehensive rehabilitation medicine evaluation. Descriptions of improvements in function have been consistently performed since rehabilitation medicine developed after World War II. Unfortunately, previously utilized methods lacked the consistency required to study rehabilitation outcomes accurately.
Functional assessment measures an individual’s level of function and ability to perform specific tasks on a safe and dependable basis over a defined period. A detailed assessment should include a pertinent clinical history; a neurologic and musculoskeletal evaluation, a physical effort determination, and a comprehensive evaluation of behaviors that might impact physical performance. Assessments must be valid, reliable, and reproducible. They can be self-administered questionnaires or clinician administered.
From a research standpoint, functional assessments provide supporting evidence to develop, improve and attest to different evidence-based treatments. In the clinical setting, these instruments are commonly used to set rehabilitation goals, to develop specific therapeutic interventions and to monitor clinical changes.
In 2014, functional assessments took a different direction when the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) was signed into law seeking to connect findings on the baseline assessment to functional outcomes. This required that Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs) to report and submit standardized patient assessment data, including quality measures and standardized patient assessment data elements. The collection of this information permitted the exchange of information among providers on specific functional domains that included functional status, cognitive function, and mental status among some. The final goal intended to enhanced rehabilitation outcomes through share decision making, care coordination and improved discharge planning.
Relevance To Clinical Practice
The scope of practice in Rehabilitation Medicine is wide and includes an array of conditions such as neurological (stroke, TBI, neurodegenerative), musculoskeletal (joint pain, tendinopathies, ligamentous injuries, balance dysfunction) pain syndromes, medical (deconditioning, cardiopulmonary), rheumatologic (Rheumatoid Arthritis, Osteoarthritis, Connective Tissue Disorders), among others.
Commonly used assessments include:
Activities of daily living (Table 1A) measures the performance of basic functional skills required to care for oneself independently. They measure basic daily activities (eating, grooming, bathing, dressing, continence) mobility (gait, transfers) and cognition. Examples include:
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- Barthel Index
- Functional Independence Measure (FIM)
- Functional Independence Measure for Children (WeeFIM)
- GG Functional Abilities and Goal
- specific Functional Scale
- Canadian Occupational Performance Measure
- Lawton’s Instrumental Activities of Daily Living among others
- WHO International Classification of Functioning, Disability, and Health (ICF)
- International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)
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