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RehabMeasures Instrument

Functional Ambulation Category

Last Updated

Purpose

The FAC assesses functional ambulation in patients undergoing physical therapy.

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Instrument Details

Acronym FAC

Area of Assessment

Functional Mobility
Gait

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Multiple Sclerosis
  • Stroke Recovery

Key Descriptions

  • Clinician-completed tick box of 5 broad categories of walking ability.
  • Ranges from independent walking outside to non-functional walking.
  • Patients can be rated on the following categories:
    0) Patient cannot walk, or needs help from 2 or more persons
    1) Patients needs firm continuous support from 1 person who helps carrying weight and with balance
    2) Patient needs continuous or intermittent support of one person to help with balance and coordination
    3) Patient requires verbal supervision or stand-by help from one person without physical contact
    4) Patient can walk independently on level ground, but requires help on stairs, slopes or uneven surfaces
    5) Patient can walk independently anywhere

Number of Items

1

Time to Administer

1 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated with references from the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

ICF Domain

Activity

Measurement Domain

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 for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

R

UR

UR

 

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

UR

R

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

NR

LS

LS

NR

 

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)

StrokEDGE

No

No

No

Not reported

TBI EDGE

No

Yes

No

Not reported

Considerations

Tested primarily in stroke population:

(Kollen et al, 2006): FAC scores depend on the timing of comfortable walking speed measurements after stroke

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Stroke

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Cut-Off Scores

Acute Stroke: (Mehrholz et al, 2007; n = 55; mean age = 62.8 (10.2) years; average time since stroke= 30.6 (15.5) days (assessed 30 to 60 days after stroke); German sample)

  • A cutoff of > 4 was more sensitive (100%) than specific (78%) in predicting community ambulation at 6 months

Normative Data

Acute Stoke: (Kollen et al, 2006; n = 73; mean age = 64.8 (10.5) years; mean days from CVA to assessment 8.2 (2.8) days; mean Mini-Mental State Examination score = 26.7 (2.3) points; FAC Scores 3-5 used in analysis)

Functional Ambulation Categories (FAC) Scores

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Value at the following week after stroke:

 

 

 

 

 

 

 

 

 

 

 

 

FAC Score

Measurement

4

5

6

7

8

9

10

12

14

16

18

20

26

3

Walking speed (m/s)

0.45

0.43

0.37

0.45

0.33

0.39

0.38

0.35

0.33

0.29

0.30

0.30

0.19

4

Walking speed (m/s)

0.73

0.90

0.80

0.63

0.65

0.64

0.58

0.57

0.50

0.50

0.49

0.48

0.48

5

Walking speed (m/s)

1.08

0.92

1.04

1.04

1.06

1.02

1.11

1.07

1.06

1.04

1.00

1.02

0.92

 

 

Acute Stroke: (Mehrholz et al, 2007)

FAC Normative Data:

 

 

 

 

 

Measure

Scale

basline

2-weeks

4-weeks

6-months

FAC

0 - 5

0.44 (0.69)

1.22 (1.32)

1.98 (1.50)

2.79 (2.12)

RMI

0 - 14

2.51 (1.62)

4.04 (2.88)

5.76 (3.93)

7.38 (5.01)

6MWT

meters

15.9 (34.3)

50.9 (81.1)

83.9 (107.8)

112.3 (143.9)

Walking velocity

(m/s)

0.07 (0.14)

0.19 (0.28

0.33 (0.46)

0.38 (0.51)

Step length

meters

0.09 (0.13)

0.18 (0.19)

0.27 (0.20)

0.28 (0.26)

mean (SD)

 

 

 

 

 

Test/Retest Reliability

Acute Stroke: (Mehrholz et al, 2007)

  • Excellent test-retest reliability (Kappa = 0.950)

Interrater/Intrarater Reliability

Acute Stroke: (Mehrholz et al, 2007)

  • Excellent interrater reliability (Kappa = 0.905)

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Mehrholz et al, 2007):

  • Adequate predictive validity (highest area under the curve=0.89) for predicting community ambulation 6 months after study end
  • Excellent concurrent validity with RMI, 6MWT, walking velocity and step length as noted in table below.

Values are Spearman p all with (p< .001)

 

 

 

 

Parameter

FAC Scores at Baseline

FAC Scores After 2 Weeks

FAC Scores After 4 Weeks

FAC Scores at 6-Month Follow-Up

RMI

0.686

0.787

0.825

0.893

6MWT

0.949

0.937

0.931

0.906

Walking velocity

0.952

0.939

0.902

0.901

Step length

0.952

0.932

0.896

0.877

Construct Validity

Acute stroke: (Kollen et al, 2006):

  • Between and within subject regression coefficient of 0.113 between walking speeds and FAC scores for subjects physically independent with gait.

Floor/Ceiling Effects

Stroke: (Salter et al, 2008, overall review of measure)

  • Large ceiling effects have been reported

Responsiveness

Acute Stroke: (Mehrholz et al, 2007)

 

FAC scores changed significantly between:

  • Frst 2 weeks (SRM = 1.016, Wilcoxon z = -8.691, Bonferroni-adjusted P < 0.001),
  • Second 2 study weeks (SRM = 0.842, z = -7.900, Bonferroni-adjusted P < 0.001
  • Week 4 and 6 months after study (SRM = 0.699, z = - 6.368, Bonferroni-adjusted P < 0.001

 

Stroke: (Salter et al, 2008)

  • Decreased responsiveness between lower levels of functioning

(Kollen et al, 2006)

  • Responsiveness ratios= 4.36-17.70

Mixed Populations

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Criterion Validity (Predictive/Concurrent)

Stroke and Multiple Sclerosis: (Holden et al, 1984; n=61(n=24 with MS, mean age= 39(9.8) years, n=37 with hemiparesis, mean age=51(17) years):

  • Excellent relationship between FAC with:
    • Velocity (r=0.67)
    • Cadence (r=0.62)
    • Not reporting step or stride time correlations because article does not differentiate involved side and correlation

Bibliography

Collen, F. M., Wade, D. T., et al. (1990). "Mobility after stroke: reliability of measures of impairment and disability." Int Disabil Stud 12(1): 6-9. Find it on PubMed

Holden, M. K., Gill, K. M., et al. (1986). "Gait assessment for neurologically impaired patients. Standards for outcome assessment." Phys Ther 66(10): 1530-1539. Find it on PubMed

Kollen, B., Kwakkel, G., et al. (2006). "Time dependency of walking classification in stroke." Phys Ther 86(5): 618-625. Find it on PubMed

Martin, B. and Cameron, M. (1996). "Evaluation of walking speed and functional ambulation categories in geriatric day hospital patients." Clinical rehabilitation 10(1): 44.

Mehrholz, J., Wagner, K., et al. (2007). "Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke." Arch Phys Med Rehabil 88(17908575): 1314-1319. Find it on PubMed

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