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RehabMeasures Instrument

Foot and Ankle Ability Measures

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Purpose

The FAAM was developed to provide a universal measure of change in physical functioning of patients with leg, ankle, and foot musculoskeletal disorders. Creating such a universal self-report measure would improve researchers’ and clinicians’ ability to compare effectiveness of relevant treatments as well as provide a tool with which to gather information about the pathology and impairments caused by lower extremity disorders. The study aimed to create a measure with items that would evaluate overall physical performance of patients with a wide variety of foot, ankle, and leg disorders. Once the FAAM was created, researchers also aimed to collect evidence for the validity, reliability, and responsiveness of the instrument to ensure clinically meaningful interpretation of results relating to impairments in normal functioning due to ankle and foot disorders.

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Instrument Details

Acronym FAAM

Area of Assessment

Activities of Daily Living
Functional Mobility
Gait
Life Participation
Occupational Performance

Assessment Type

Patient Reported Outcomes

Cost

Free

Diagnosis/Conditions

  • Brain Injury

Key Descriptions

  • The FAAM is a self-report measure that assesses physical function of individuals with lower leg, foot, and ankle musculoskeletal disorders.
  • This instrument includes 2 subscales:
    1) Activities of Daily Living (ADLs) subscale of 21 items
    2) Sports subscale of 8 items.
  • For each subscale patients are asked to answer each question with a single response that most clearly describes their condition within the past week.
  • Answers for both scales are based on a Likert scale (4-0) of:
    4) “no difficulty”
    3) “slight difficulty”
    2) “moderate difficulty”
    1) “extreme difficulty”
    0) “unable to do”
  • If an activity in question is limited by something other than their foot or ankle, the patient is asked to record N/A.
  • In addition to this, each subscale asks the patient to rate separately their current level of function during their usual activities of daily living and during their sports related activities from 0 to 100 with 100 being the patient’s prior level of function and 0 being unable to perform their usual daily activities.
  • The FAAM also asks the patient to note their current level of function as “normal”, “nearly normal”, “abnormal”, and “severely abnormal”.
  • When scoring the FAAM, there should be two scores, one for each subscale.
  • In order to score the ADL subscale and the Sports subscale, 20/21 items and 7/8 items must be completed, respectively.
  • For all other responses, there is a one-point interval between each category.
  • Questions for which “N/A” is indicated are not counted.
  • To calculate the score for either subscale, the total number of points are added, divided by the total number of possible points (84 for the ADL subscale and 32 for the Sports subscale), and then multiplied by 100.
  • Therefore, a higher score reflects a higher level of physical function.
  • The MDC and MCID for the ADL subscale and Sports subscale are 5.7 and 8 points and 12.3 and 9 points, respectively.

Number of Items

ADL: 21
Sports: 8

Equipment Required

  • Questionnaire & Pencil

Time to Administer

Less than 10 minutes

Required Training

No Training

Age Ranges

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Corinne Bohling, SPT; Christie Clem, SPT; Nicole Davis, SPT; Jeremy Evans, SPT; Kelly Hewitt, SPT; Christopher Hope, SPT; Genevieve Monroe, SPT; Sarah Morrison, SPT; Elizabeth Nixon, SPT; Lindsey Viltrakis, SPT.

Body Part

Lower Extremity

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Motor

Professional Association Recommendation

Recommendations for use based on acuity level of the patient.

  • The study findings can be generalized to patients undergoing outpatient physical therapy treatment for musculoskeletal disorders of the foot, ankle, or leg over a 4-week time period.

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

  • All participants in this study were receiving physical therapy treatment in an outpatient clinic setting.

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

  • The authors suggest that the FAAM be used as a self-reported evaluative instrument to provide a comprehensive assessment of the physical function of patients who have musculoskeletal disorders of the foot, ankle, or leg.

Considerations

Further study regarding validity of using the FAAM score for other settings (aside from outpatient ortho) or over a different time frame (> or < 4 weeks). Should also investigate the reliability and responsiveness across different functional levels.

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Musculoskeletal Conditions

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Standard Error of Measurement (SEM)

Various Foot/Ankle Musculoskeletal Disorders (Martine, 2005)

  • ADL Subscale: SEM= 2.1
  • Sports Subscale: SEM= 4.5

Minimal Detectable Change (MDC)

Various Foot/Ankle Musculoskeletal Disorders (Martine, 2005)

  • ADL Subscale: MDC (95%)= 5.7
  • Sports Subscale: MDC (95%)= 12.3

Minimally Clinically Important Difference (MCID)

Various Foot/Ankle Musculoskeletal Disorders (Martine, 2005)

  • ADL subscale: MCID= 8% points
  • Sports subscale: MCID= 9% points.

Test/Retest Reliability

Various Foot/Ankle Musculoskeletal Disorders (Martine, 2005)

  • ADL Subscale: Excellent (ICC=0.89)
  • Sports Subscale: Excellent (ICC= 0.87)

Internal Consistency

Various Foot/Ankle Musculoskeletal Disorders (Martine, 2005)

  • Group Expected to Change:
    • ADL: Excellent (Cronbach's Alpha= 0.98)
  • Group Expected to Remain the Same:
    • ADL: Excellent (Cronbach's Alpha= 0.96)
  • Combined Groups:
    • Sports: Excellent (Cronbach's Alpha= 0.98)

Criterion Validity (Predictive/Concurrent)

Various Foot/Ankle Musculoskeletal Disorders (Martine, 2005)

 

Correlation coefficients between the ADL and sports subscales to concurrent measures of physical and emotional function.

 

Physical Function Subscale

  • ADL: Excellent (r= 0.84); Sports: Adequate (r= 0.78)

 

Physical Component Summary Score:

  • ADL Excellent (r= 0.84); Sports: Excellent (r= 0.80)

 

Mental Health Subscale

  • ADL: Poor (r= 0.18); Sports: Poor (r= 0.11)
 
Mental Component Summary Score
  • ADL: Poor  (r=0.05); Sports: Poor (r-0.02)

Construct Validity

Convergent Analysis

  • SF-36 Physical Function: ADL Excellent (r= .84); Sports Adequate (r= .78)
  • Physical Component Summary: ADL Excellent  (r= .84); Sports Excellent (r= .80)

 

Divergent Analysis

  • SF-36 Mental Health Subscale: ADL Poor (r=.18 ADL); Sports Poor (r= .11)
  • Mental Health Component Summary: ADL Poor (r= .05); Sports Poor (r-= .05)

Content Validity

At initial item reduction, a list of potential items relating to symptoms, signs, and limitations in physical function associated with lower extremity musculoskeletal disorders were created from a literature review and input from physical therapists who treat patients with lower extremity pathologies. This list was mailed to members of the APTA Ankle Special Interest group and respondents rated items from -2 (not important) to +2 (important). Any items at or above a mean score of 1 (important) were included on the initial FAAM. It was also noted by clinicians that a separate ADL and Sports subscale was needed. An exploratory factor analysis was completed on this initial FAAM and items that did not fit a one-factor model were removed from the instrument. Item characteristic curves were also created for each item for the initial FAAM and those that did not have appropriate characteristic curves were also eliminated.

Floor/Ceiling Effects

AOFAS clinical rating system and FFI are commonly reported in the literature and were used as comparison for item content. Both were discussed as instruments possibly lacking in adequate assessment of higher level functions (such as sports), causing a ceiling effect.

Responsiveness

Individual patient self-perception of change was the measurement for responsiveness and was done at the end of four weeks of physical therapy.

  • 73.3% of participants in the group expected to change reported “much improved” while 25.6% reported “improved” and all were placed in the improved group. 14.6% reported “slightly improved”, 3% were “unchanged” and 1.2% reported “slightly worse” and were placed in the group that did not improve.
  • The average change on the sports subscale was 17.2 and 0.0 for the group expected to change and not change, respectively. Average change in the ADL subscale score was 17.1 and -0.2 in those same respective groups.

Bibliography

Martin, R.L., Irrgang, J.J., Burdett, R.G., Conti, S.F., Van Swearingen, J.M. Evidence of validity for the foot and ankle ability measure (FAAM). Foot & Ankle International. 2005; 26(11): 968-83.

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