Purpose
The EFAP assesses functional ambulation in terms of assistance and time under 5 different environmental variables.
Link to Instrument
Acronym
EFAP, mEFAP
Primary Image
Emory Ambulation Profile; Modified Functional Ambulation Profile
Expertise, Instruction and Mentorship
Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
Upcoming Stroke Course
May 9–10
Live and Online
Offered by Academy, Shirley Ryan AbilityLab
Populations
Key Descriptions
- Emory Functional Ambulation Profile (Wolf et al, 1999): A timed measure of walking under 5 environmental challenges.
- Continuous timed score.
- Time each subtask and multiply that time by the appropriate factor according to the level of assistive device used during the task:
1) No assistance x 1
2) AFO x 2
3) Single point cane x 3
4) Hemi-walker or quad cane x 4
5) AFO + single point cane x 5
6) AFO + hemi-walker or AFO + quad cane x 6
The totals for each of the 5 subtasks are then summed. - The Modified Emory Functional Ambulation Profile (Baer and Wolf, 2001) allows for manual assistance to be provided and is recorded separately from the timed data in accordance with an ordinal scale.
Number of Items
5
Equipment Required
- Stop watch
- Chair with arm rests and 46cm seat height
- Brick
- Hard surface flooring at least 7 meters
- Carpet: 7 meter long x 2 meter wide
- 40 gallon rubber trash can
- 4 steps with hand railing
Time to Administer
20 minutes
Required Training
No TrainingInstrument Reviewers
Initially reviewed by Connie Fiems, MPT, NCS in 11/2012.
Body Part
Lower ExtremityICF Domain
ActivityMeasurement Domain
MotorConsiderations
Only tested on stroke populations. Lack norms for subject age as well as minimal mEFAP values associated with successful household and community ambulation. Lack of normality found in scores possibly due to range in severity of impairments and gait dysfunction. The Modified EFAP contains structured procedures for recording manual assistance separately however it does not account for this in scoring as it was found that the time to complete the task was sufficient to demonstrate improvement. No findings on effect size or MCID.
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Stroke
back to PopulationsStandard Error of Measurement (SEM)
Modified Emory Functional Ambulation Profile:
Subacute Stroke: (Liaw et al 2006; n=40; mean age = 57.45 (10.98) years; mean time post stroke = 33 days (range 20-52 days))
|
Floor |
.23sec |
|
Carpet |
.09sec |
|
Up & Go |
.77sec |
|
Obstacles |
.95sec |
|
Stairs |
1.14sec |
|
Total |
2.60sec |
Modified Functional Ambulation Profile
Subacute Stroke (Baer et al 2001; n = 26; mean age 54.5 (12.7) years; mean time post stroke 32.2 (13.7) days.)
- SEM 3.19 calculated from: square root 1-ICC(.998) x Initial SD(71.5)
Minimal Detectable Change (MDC)
Modified Functional Ambulation Profile:
Subacute Stroke: (Liaw et al 2006)
- 7.18 (calculated from: 1.96 x SEM(2.60) x square root of 2)
Modified Functional Ambulation Profile:
Subacute Stroke: (Baer et al 2001)
- 8.81 (calculated from: 1.96 x SEM(3.19) x square root of 2)
Test/Retest Reliability
Modified Emory Functional Ambulation Profile:
Chronic Stroke: (Liaw et al 2006; n= 20; > 1yr post stroke; mean age 55yrs)
- Excellent for subtask and total scores with all ICCs> 0.97 and lower limits of 95% CI > 0.93
Modified Emory Functional Ambulation Profile:
Subacute Stroke: (Baer et al 2001)
- Excellent for subtasks with all ICC’s > 0.985 and total ICC = 0.99
Interrater/Intrarater Reliability
Emory Functional Ambulation Profile:
Chronic Stroke: (Wolf et al, 1999; n = 56; mean age 56 (12.8) years; of those, 28 subjects with stroke; mean time post stroke 13.59 (12.3) months)
- Excellent interrater reliability in subjects with strokes ICC=.99
Modified Functional Ambulation Profile:
Subacute Stroke: (Baer et al 2001)
- Excellent interrater reliability in subjects with stroke: all subtasks ICC > .985 and total ICC = .99
Criterion Validity (Predictive/Concurrent)
|
Concurrent Validity: Emory Functional Ambulation Profile: Chronic Stroke: (Wolf et al, 1999)
Modified Emory Functional Ambulation Profile: Sub-acute Stroke: (Baer et al 2001)
Predictive validity: Modified Emory Functional Ambulation Profile:
Subacute Stroke: (Liaw et al 2006)
|
Construct Validity
Convergent:
Modified Emory Functional Ambulation Profile:
Subacute Stroke: (Liaw et al 2006)
- Excellent correlation with 10 Meter walk test (r= .88, 95% CI .78, .94 at admission and r= .93, 95% CI .87, .96 at discharge)
- Excellent correlation with the Rivermead Mobility Index (Spearman’s r=-0.67, 95% CI -0.81, -0.45 at admission and r= -0.81, 95% CI -0.90, -0.67 at discharge)
Bibliography
Baer, H. R. and Wolf, S. L. (2001). "Modified emory functional ambulation profile: an outcome measure for the rehabilitation of poststroke gait dysfunction." Stroke 32(4): 973-979. Find it on PubMed
Liaw, L. J., Hsieh, C. L., et al. (2006). "Psychometric properties of the modified Emory Functional Ambulation Profile in stroke patients." Clin Rehabil 20(5): 429-437. Find it on PubMed
Wolf, S. L., Catlin, P. A., et al. (1999). "Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile." Phys Ther 79(12): 1122-1133. Find it on PubMed