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RehabMeasures Instrument

Activity Measure for Post Acute Care

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Purpose

The AM-PAC assesses activity limitations based on World Health Organization’s International Classification of Functioning, Disability and Health (ICF).

The Computer Adaptive Test (CAT) version of the AM-PAC selects items designed to match a patient’s functional abilities, reducing the total number of items on the assessment while increasing the measure's validity.

Conversion tables to CMS G-codes are available for all AM-PAC scales.

 

AM-PAC Activity Domains:

Applied Cognitive

Personal & Instrumental/Daily Activity

Movement & Physical/Basic Mobility

Communication

Grooming and Hygiene

Bend/Stand/Carry

Print Information

Feeding and Meal Prep

Ambulation

New Learning

Dressing

Transfers

Social

Instrumental

WC Skills

Link to Instrument

Instrument Details

Acronym AM-PAC

Area of Assessment

Activities of Daily Living
Cognition
Functional Mobility

Assessment Type

Patient Reported Outcomes

Administration Mode

Computer

Cost

Free

Cost Description

AM-PAC is free for academic research use; there is a charge for clinical/commercial use.

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Cancer Rehabilitation
  • Parkinson's Disease + Neurologic Rehabilitation
  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • AM-PAC can be a patient- or clinician-reported measure.
  • In each domain, AM-PAC scores have a mean of 50 and a standard deviation of 10.
  • AM-PAC Activity Domains:
    1) Applied Cognitive
    2) Personal & Instrumental/Daily Activity
    3) Movement & Physical/Basic Mobility
    4) Communication
    5) Grooming and Hygiene
    6) Bend/Stand/Carry
    7) Print Information
    8) Feeding and Meal Prep
    9) Ambulation
    10) New Learning
    11) Dressing
    12) Transfers
    13) Social
    14) Instrumental
    15) Wheelchair Skills

Number of Items

5-8 per domain.
Inpatient short: 6 per domain.
Outpatient short: 15-18 per domain.

Equipment Required

  • Computer adaptive test
  • Paper and Pencil for in-patient and out-patient short forms

Time to Administer

Varies depending on AM-PAC version used; As a Computer Adaptive Test (CAT), the time to administer will slightly vary between patients. 

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad and the Rehabilitation Measures Team; Updated by Tammie Keller Johnson PT, DPT, NCS and the TBI EDGE task force of the neurology section of the APTA in September 2012; Updated in 2019 by Bridget Hahn, OTD, OTR/L, Erin Thrasher, OTS, Carley Rowe, OTS, Carissa Studer, OTS and Mackenzie Traub, OTS. Reviewed in June 2020 by Rachel Bond, BA.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Cognition
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
 
For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

LS

LS

NR

NR

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

No

Yes

Not reported

Considerations

  • Can be administered with either a paper and pencil or computer-based version.
  • Accurate scoring can be obtained from either the setting-specific short form versions or Computer Adaptive Testing forms. 
  • Recent work using patient-reported outcomes suggests that a short-form version of the Activity Measure for Post-Acute Care (AM-PAC) may be more sensitive than the FIM in assessing functional gains and losses once a patient returns to the community (Coster et al., 2006). 
  • Haley et al, 2006, reported that fewer items (33%) and less time (44%) is required to complete the AM-PAC-CAT than the AM-PAC-66 (short form). 

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Mixed Populations

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Standard Error of Measurement (SEM)

AM-PAC Computer Adaptive Test (CAT): (Jette et al., 2007; n = 1815 retrospective study; patients diagnosed with spine, lower-extremity, and upper-extremity impairments)

Average Standard Error of Estimate by Ability Score:

 

 

 

 

Scale

Score Range

 

 

 

 

10-29

30-49

50-69

70-90

Basic Mobility; Mean S.E. 

4.45

2.16

1.99

3.19

95% C.I.

+/- 8.72

+/- 4.23

+/- 3.90

+/- 6.25

Daily Activity; Mean S.E.

2.60

1.98

5.32

N/A

95% C.I.

+/- 5.10

+/- 3.88

+/- 10.43

N/A

C.I. = Confidence Interval

S.E. = Standard Error of Measurement

 

 

 

 

AM-PAC Inpatient Mobility Short Form: (Hoyer et al., 2017; n=118; mean age = 56.6) 

  • Standard Error of Measurement (SEM)= 1.6

Minimal Detectable Change (MDC)

AM-PAC Computer Adaptive Test (CAT): (Jette et al., 2007)

  • Basic Mobility: MDC = 4.28
  • Daily Activity: MDC = 3.70
  • Applied Cognitive: MDC90 = 5.55

AM-PAC Inpatient Mobility Short Form: (Hoyer et al., 2017)

  • MDC95% CI= 4.5.

 

Cut-Off Scores

AM-PAC Inpatient Mobility Short Form: (Hoyer et al., 2017; n=118; mean age = 56.6) 

  • 4-point ordinal scale, with a raw score range from 6-24
  • A score of 1 indicates that the participant was unable to perform the task and a score of 4 indicates the participant was independent in completing the task
  • A higher score indicates fewer limitations in functional performance

Medically Complex: (Jette et al., 2014)

  • Basic Mobility: 42.9
  • Daily Activity: 39.4

Normative Data

Patients with Hip Fracture: (Latham et al., 2008; n = 108; patients aged 65 or older; assessed within 17 days of surgical repair of a unilateral hip fracture; International Sample)

AM-PAC and Related Measure Norms:

 

 

AM-PAC Physical Mobility

mean (SD)

median (range)

    Baseline

48.0 (10.0)

51.9 (19.2–62.7)

    Week 12

59.7 (8.2)

60.2 (29.0–82.5)

AM-PAC Personal Care

mean (SD)

median (range)

    Baseline

49.2 (8.0)

48.5 (22.0–68.0)

    Week 12

57.0 (8.8)

58.2 (35.0–68.1)

PFP-10

mean (SD)

median (range)

    Baseline

10.4 (9.9)

6.8 (0–45.2)

    Week 12

24.5 (18.4)

21.3 (0–78.1)

SPPB

mean (SD)

median (range)

    Baseline

4.7 (2.8)

5.0 (0–12.0)

    Week 12

7.9 (2.6)

8.0 (0–12.0)

Gait speed (m/s)

mean (SD)

median (range)

    Baseline

0.50 (0.28)

0.45 (0.01–1.33)

    Week 12

0.77 (0.35)

0.76 (0.003–1.83)

6MWT (m)

mean (SD)

median (range)

    Baseline

121.0 (103.0)

109.6 (0–408.1)

    Week 12

251.0 (155.5)

259.0 (0–651.9)

SF-36 PF

mean (SD)

median (range)

    Baseline

23.0 (21.8)

15.0 (0–90.0)

    Week 12

57.5 (25.5)

57.5 (0–100)

 

Orthopedic outpatient: Individuals with spine, lower-extremtiy and upper extremity impairments: (Jette et al, 2007; n = 1815 seen in outpatient clinics)

Domain

n

Admission

Mean (SD)

Discharge

Mean (SD)

Total

1703

63.26 (9.19)

68.71 (8.41)

Spine

666

63.57 (7.78)

68.40 (8.59)

EU

462

68.42 (8.24)

71.20 (7.74)

LE

575

58.75 (9.16)

67.07 (8.26

Medically Complex: (Jette et al., 2014)

First Visit “6-Clicks” Patient Scores 

Daily activity

39.9 (39.2, 39.4)

Basic mobility

43.8  (43.7, 44.0)

Patients discharged to home

Daily activity

44.9 (44.8, 45.0)

Basic mobility

50.7 (50.6, 50.9)

Patients discharged to institution

Daily activity

34.9 (34.8, 35.0)

Basic mobility

38.5 (38.4, 38.6)

Test/Retest Reliability

Postacute Care Patients: (Andres et al., 2003; n = 25; mean age = 65.0 (range = 23-87) years; Impairments, Neurologic = 32%, Orthopdedic = 32%, Medically complex = 36%; mean time between assessments = 2.7 to 3.5 (range 1 to 7) days)

Test-retest Reliability:

 

 

 

 

Strength

ICC

95% CI

Personal and instrumental

Excellent

0.96

0.92–0.98

Movement and physical

Excellent

0.97

0.92–0.98

Applied cognition

Excellent

0.91

0.70–0.96

CI = Confidence Interval

 

 

 

 AM-PAC Inpatient Mobility Short Form: (Hoyer et al., 2017; n=118; mean age = 56.6) 

  •  Excellent: ICC= 0.91-0.96

Interrater/Intrarater Reliability

Postacute Care Patients: (Andres et al., 2003; proxy = primary physical, occupational therapist or family member)

Interrater Reliability:

 

 

 

 

Strength

ICC

95% CI

Personal and instrumental

Excellent

0.90

0.73–0.94

Movement and physical

Excellent

0.86

0.68–0.96

Applied cognition

Adequate

0.68

0.55–0.89

CI = Confidence Interval

 

 

 

Internal Consistency

AM-PAC Inpatient Mobility Short Form: (Hoyer et al., 2017; n=118; mean age = 56.6) 

  • Excellent: Cronbach’s alpha= 0.94-0.96

Medically Complex: (McDonough et al., 2016, convenience sample of n=235 patients in outpatient setting)

  • Good: Cronbach’s alpha= > 0.80 in the score range from 17~56, and more limited performance for scores beyond 56. The IRT-based internal consistency reliability: 0.86, which is comparable to that of the full item bank (0.89). 

Criterion Validity (Predictive/Concurrent)

Patients with Hip Fracture: (Latham et al., 2008)

Adequate to Excellent convergent validity (see below)

Performance-Based and Self-Report Function Measure Correlations* at Week 12

 

 

 

 

 

 

AM-PAC Physical Mobility

AM-PAC Personal Care

SF-36 PF

PFP-10

SPPB Total

AM-PAC Physical Mobility

1

0.71

0.84

0.64

0.65

AM-PAC Personal Care

 

1

0.68

0.63

0.55

SF-36 PF

 

 

1

0.69

0.67

PFP-10

 

 

 

1

0.73

SPPB Total

 

 

 

 

1

Gait Speed Value

 

 

 

 

 

6MWT

 

 

 

 

 

r < .31 = Poor

r .31 to .59 = Adequate

r > .6 = Excellent

 

 

 

 

 

SF-36 PF = Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale

PFP-10 = Physical Functional Performance Test

SPPB = Short Physical Performance Batter

6MWT = Six-Minute Walk Test

*Spearman Correlations

 

 

 

 

 

Medically Complex: (Jette et al., 2014, n=84,466, Mean Age=69, SD=15.6).

  • Sensitivity, Specificity, and Predictive Values for Various Basic Mobility and Daily Activity Scores

Sensitivity, Specificity, and Predictive Values for Various Basic Mobility

Basic Mobility Score, scale (raw)

Sensitivity

Specificity

Positive Predictive Value

Negative Predictive Value

25.0 (6.5)

0.03

0.98

0.56

0.50

 

27.5 (7.5)

0.04

0.97

0.58

0.50

 

29.6 (8.5)

0.09

0.94

0.61

0.51

 

31.4 (9.5)

0.11

0.93

0.61

0.51

 

33.1 (10.5)

0.16

0.90

0.62

0.52

 

34.6 (11.5)

0.23

0.87

0.64

0.53

 

36.0 (12.5)

0.30

0.84

0.65

0.54

 

37.4 (13.5)

0.34

0.82

0.65

0.55

 

38.8 (14.5)

0.39

0.80

0.65

0.57

 

40.1 (15.5)

0.44

0.77

0.66

0.58

 

41.5 (16.5)

0.51

0.73

0.66

0.58

 

42.9 (17.5)

0.62

0.67

0.65

0.64

 

44.5 (18.5)

0.80

0.54

0.63

0.73

 

46.6 (19.5)

0.85

0.49

0.63

0.77

 

49.0 (20.5)

0.90

0.42

0.61

0.81

 

51.8 (21.5)

0.93

0.37

0.60

0.84

 

55.1 (22.5)

0.96

0.29

0.58

0.89

 

59.0 (23.5)

0.98

0.21

0.56

0.93

 

Sensitivity, Specificity, and Predictive Values for Various Daily Activity 

Daily Activity Score, scale (raw)

Sensitivity

Specificity

Positive Predictive Value

Negative Predictive Value

18.6 (6.5)

0.02

0.98

0.52

0.50

21.5 (7.5)

0.03

0.97

0.52

0.50

24.1 (8.5)

0.04

0.96

0.53

0.50

26.3 (9.5)

0.05

0.95

0.54

0.50

28.2 (10.5)

0.07

0.94

0.55

0..50

29.8 (11.5)

0.10

0.93

0.56

0.51

31.3 (12.5)

0.14

0.90

0.57

0.51

32.7 (13.5)

0.19

0.86

0.58

0.52

34.0 (14.5)

0.27

0.81

0.59

0.53

35.3 (15.5)

0.39

0.73

0.59

0.54

36.6 (16.5)

0.53

0.66

0.61

0.58

38.0 (17.5)

0.64

0.60

0.61

0.62

39.4 (18.5)

0.77

0.49

0.60

0.68

41.1 (19.5)

0.88

0.37

0.58

0.75

43.2 (20.5)

0.93

0.30

0.57

0.82

45.7 (21.5)

0.97

0.23

0.56

0.88

49.1 (22.5)

0.98

0.19

0.55

0.92

52.8 (23.5)

0.99

0.16

0.54

0.93

Construct Validity

AM-PAC Computer Adaptive Test (CAT): (Jette et al., 2007)

  • Significant differences in basic mobility were observed in the subject’s acuity level and surgical status.

AM-PAC Difference Scores for Basic Mobility and Daily Activity: 

 

 

 

 

 

 

Scale

Acuity

 

 

Postsurgical Treatment

 

 

Basic Mobility

< 35 days

> 35 days

Difference

Yes

No

Difference

Admission

63.45 (9.39)

62.85 (9.63)

0.60

59.00 (10.14)

64.69 (8.37)

-5.70*

Discharge

70.11 (8.17)

68.14 (8.30)

1.97*

66.73 (7.79)

69.34 (8.52)

-2.61*

Increase

6.62 (8.60)

5.22 (7.94)

1.40*

7.85 (8.62)

4.65 (7.57)

3.20*

Daily Activity

< 35 days

> 35 days

Difference

Yes

No

Difference

Admission

56.31 (8.28)

56.18 (8.43)

0.13

54.32 (8.19)

57.88 (7.67)

-3.56*

Discharge

61.85 (5.96)

60.12 (7.06)

1.73*

60.70 (6.67)

60.95 (6.50)

-0.25

Increase

5.53 (7.60)

3.89 (6.95)

1.64*

6.38 (8.10)

3.07 (6.24)

3.31*

*p < 0.05

 

 

 

 

 

 

Content Validity

The AM-PAC was developed using the World Health Organization’s International Classification of Functioning, Disability and Health (ICF).

Face Validity

Items for the original prototype of the AM-PAC were created based on the ICF activities domain. Items relevant to individuals in post-acute care setting were chosen. The items were reviewed by 10 experts and feedback was provided by individuals with disabilities. (Haley et al., 2004)

Many items were selected from existing legacy measures.

Floor/Ceiling Effects

Rehabilitation Patients: (Coster et al., 2006; n = 516; mean age = 68.3 (14.97) years; data collected at 1, 6, and 12 months after discharge)

  • Excellent: No floor effects were observed across 3 assessments
  • Adequte: Physical and Movement Activity scales demonstrated low ceiling effects (less than 1% at 12 months)
  • Adequate: Personal Care and Instrumental scales had higher ceiling effects (16% at 12 months)
  • Poor: Applied Cognitive scale demonstrated the largest ceiling effects (27% at 1 month; 44% at 12 months)

Medically Complex: (McDonough et al., 2016, n=235)

  • Fair
    • Percent with highest score (ceiling) of the Applied Cognition Scale by impairment group.

 Short Form (15 items)

 

Subjects n

Short Form (15 items)

 

 

Mean score (SD)

Floor n(%)

Ceiling n( %)

Outpatient

235

 

0

65(27.7)

Neurological

97

47.2(10.1)

0

14(14.4)

Medically complex

39

51(9.2)

0

12(30.8)

Orthopedic

99

55.1(8.3)

0

39(39.4)

Full Item Bank (44 items)

 

 

Subjects n

Full Item Bank (44 items)

 

 

Mean Score (SD)

Floor n(%)

Ceiling n(%)

Outpatient

235

 

0

62(26.4)

Neurological

97

47.5(10.2)

0

12(12.4)

Medically complex

39

52.6(10.1)

0

12(30.8)

Orthopedic

99

56.9(8.8)

0

38(38.4)

Responsiveness

Rehabilitation Patients: (Coster et al., 2006)

  • Standard Response Means between 3 diagnostic groups (neurological, orthopedic, complex medical) ranged between -0.02 and 0.10 (small)
  • Mean positive changes ranged from 8.35 to 13.23 points from 1 to 6 months
  • Mean positive changes ranged from 4.64 and 7.56 points from 6 to 12 months

 

Orthopedic outpatient: Individuals with spine, lower-extremtiy and upper extremity impairments (Jette et al., 2007; n = 1815 seen in outpatient clinics)

Domain

n

Difference

Effect Size

SRM

Total

1703

5.45 (7.97)

0.59

0.68

Spine

666

4.83 (7.56)

0.62

0.64

EU

462

2.78 (6.87)

0.34

0.40

LE

575

8.32 (8.35)

0.91

1.00

Stroke

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Standard Error of Measurement (SEM)

Neurologic Cases: (Jette et al., 2015)

  • Basic Mobility: SEM=3.16 (n=102)
  • Daily Activity: SEM= 3.46 (n=105)

Minimal Detectable Change (MDC)

Neurologic Cases: (Jette et al., 2015)

  • Basic Mobility: MDC90% CI=7.36 (n=102)
  • Daily Activity: MDC90% CI=8.06 (n=105)

 

Neurologic Cases: (Jette et al., 2014; Mean Age=69, SD=15.6; n=10,085).

  • Basic Mobility: MDC90%CI =4.72
  • Daily Activity: MDC90%CI = 5.49

Test/Retest Reliability

Neurologic Cases: (Jette et al., 2015)

  • Basic Mobility
    • Excellent: ICC= 0.97 (n=102)
  • Daily Activity
    • Excellent: ICC= 0.96 (n=105)

Interrater/Intrarater Reliability

Neurologic Cases:(Jette et al., 2015)

  • Basic Mobility (n=102)
    • Excellent interrater reliability: ICC: r=.921, CI=0.830, 0.965
  • Daily Activity (n=105)
    • Excellent interrater reliability:  ICC= r=.907, CI=.801, 0.958

Internal Consistency

Neurologic Cases:(Jette et al, 2014)

  • Excellent:
    • Bed Mobility:  Cronbach’s alpha=.957
    • Daily Activity: Cronbach’s alpha=.911

Neurologic Cases: (Robinson-Smith, Harmer, Sheeran, & Bellino Vallo, 2016; n=10)

  • Excellent:
    • Bed Mobility: Cronbach’s alpha= .947
    • Daily Activity: Cronbach’s alpha= .967

Floor/Ceiling Effects

Neurologic Cases: (Sandel et al, 2013; n=222)

Floor Effect:

  • Poor

 

Domains at Baseline

No, n (%)

Yes, n (%)

Basic Mobility (n = 222)

214 (96.40)

8 (3.60)

Daily Activity (n = 222)

216 (97.30)

6 (2.70)

Applied Cognitive (n = 222)

222 (100.0)

0 (0.00)

At 6 months

 

 

Basic Mobility (n = 220)

217 (98.64)

3 (1.36)

Daily Activity (n = 220)

219 (99.55)

1 (0.45)

Applied Cognitive (n = 220)

219 (99.55)

1 (0.45)

Ceiling Effect: 

  • Poor 

Baseline

No, n (%)

Yes, n (%)

Basic Mobility (n = 222)

211 (95.05)

11 (4.95)

Daily Activity (n = 222)

196 (88.29)

26 (11.71)

Applied Cognitive (n = 222)

198 (89.19)

24 (10.81)

At 6 months

 

 

Basic Mobility (n = 220)

214 (97.27)

6 (2.73)

Daily Activity (n = 220)

212 (96.34)

8 (3.64)

Applied Cognitive (n = 220)

196 (89.09)

24 (10.91)

Responsiveness

Neurologic Cases: (Jette et al., 2014)

  • Mean absolute differences between the scores for the first visit and last visit were 5.71 (95% CI=5.61, 5.80) for basic mobility and 4.61 (95% CI=4.49, 4.73) for daily activity
  • Standardized Response Means
    • Basic Mobility: 1.06 (95% CI=1.04, 1.08)
    • Daily Activity: 0.95 (95% CI=0.95, 0.97)

Joint Pain and Fractures

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Minimal Detectable Change (MDC)

Hip Fracture: (Latham, 2008; n=108;  mean age= 78.9; mean AMPAC physical mobility at baseline= 48.0; mean AMPAC physical mobility at 12 weeks= 59.7)

Distribution-Based Measures of Responsiveness (Baseline to Week 12)

Assessment

ES (Cohen’s d)

SRM

SE of Mean

MDC90

Percentage Who Exceed MDC90 (Baseline to Week 12) (%)

AM-PAC Physical Mobility

1.28

1.43

1.73

4.02

90.9

AM-PAC Personal Care

0.93

1.22

1.60

3.72

74.0

Minimally Clinically Important Difference (MCID)

Hip Fracture: (Latham, 2008)

  • MCID for mobility= 4.3
  • MCID for daily activity= 3.7

Normative Data

Hip Fracture: (Latham, 2008)

Study Sample Patient Characteristics

Assessment

Mean

Median

Range

AM-PAC Physical Mobility (0-100) Baseline

48.0+10.0

51.9

19.2-62.7

AM-PAC Physical Mobility (0-100) Week 12

59.7+8.2

60.2

29.0-82.5

AM-PAC Personal Care  (0-100) Baseline

49.2+ 8.0

48.5

22.0-68.0

AM-PAC Personal Care  (0-100) Week 12

57.0+8.8

58.2

35.0-68.1

Internal Consistency

Hip Fracture:  (Latham, 2008)

  • Adequate: Cronbach’s Alpha= 0.93

Floor/Ceiling Effects

Hip Fracture:  (Latham, 2008)

  • No subjects reached the floor or the ceiling at either time point for the AM-PAC Personal Care scale or AM-PAC Physical Mobility scale.

Bibliography

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