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RehabMeasures Instrument

Functional Assessment of Multiple Sclerosis

Last Updated

Purpose

The FAMS is utilized in persons with MS to capture information regarding quality of life.

Link to Instrument

Instrument Details

Acronym FAMS

Area of Assessment

Cognition
Pain
Quality of Life
Sleep
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Multiple Sclerosis

Key Descriptions

  • Instrument consists of 59 items (44 of which are scored) in six quality of life domains:
    1) Mobility
    2) Symptoms
    3) Emotional well-being
    4) General contentment (7 items)
    5) Thinking/Fatigue (9 items)
    6) Family/Social well-being (7 items)
  • Additional Concerns subscale of 15 items consists of items that fall outside the six domains but may provide further clinical value.
  • Persons completing the tool answer items on a 5-point Likert scale with “0” meaning “not at all” to “4” meaning “very much”.
  • Embedded within the FAMS is a 28-item cancer quality of life questionnaire.
  • FAMS Total score (range = 0 – 176) is derived by adding:
    1) Mobility (r = 0 – 28)
    2) Symptoms (r = 0 – 28)
    3) Emotional well-being (r = 0 – 28)
    4) General contentment (r = 0 – 28)
    5) Thinking and fatigue (r = 0 – 36)
    6) Family/social wellbeing (r = 0 – 28)

    Additional Concerns (r = 0 – 56) are not included in the total FAMS score.

    Higher scores indicate better quality of life.
  • For guidelines on handling missing data and scoring option, refer to the FAMS Administration and Scoring Guidelines found online at ww.facit.org.

Number of Items

59

Equipment Required

  • Instructions and score sheets found at: http:www.facit.org/FACITOrg/Questionnaires

Time to Administer

20 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Amy M. Yorke, PT, NCS and the Rehabilitation Measures Team in 2011.

ICF Domain

Body Structure
Body Function
Activity

Measurement Domain

Emotion
General Health
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

MS EDGE

NR

R

R

R

R

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

R

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)

MS EDGE

No

Yes

Yes

No

Considerations

Original validation of the scale did not demonstrate a diverse population based on race, gender and educational status.

Increased weight on the psychosocial consequences of the disease.

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

Multiple Sclerosis

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Normative Data

Multiple Sclerosis:

(Cella et al., 1996; n = 377 for a mail survey cohort and n = 56 for a clinical cohort) 

Scores published during development of test:

  • Survey Sample (n = 377) (mean (SD))
    • Mobility 13.9 (7.6) 
    • Symptoms 19.7 (5.9)
    • Emotional Well-Being 17.9 (6.8)
    • General Contentment 16.0 (6.8)
    • Thinking/Fatigue 20.6 (8.4)
    • Family/Social Well-Being 19.4 (5.9)
    • FAMS total 107.5 (32)
  • Clinical Sample (n = 56)
    • Mobility 13.7 (6.5)
    • Symptoms 20.0 (5.9)
    • Emotional Well-Being 19.6 (5.5) 
    • General Contentment 16.5 (6.8) 
    • Thinking/Fatigue 20.3 (7.9) 
    • Family/Social Well-Being 20.6 (5.8)
    • FAMS total 110.6 (27.4)

Test/Retest Reliability

Multiple Sclerosis:

(Cella et el., 1996)

  • Adequate to excellent reliability with subscales (ICC = 0.81 - 0.91)

Internal Consistency

Multiple Sclerosis:

(Cella et al., 1996)

  • Excellent consistency with the subscales (alpha = 0.82 - 0.96) 

 

(Riazi et al., 2003; n = 121;includes patients with MS undergoing rehabilitation (n = 57) and steroid treatment (n = 64); the health measures were completed before and after treatment)

  • Adequate consistency with FAMS Mobility scale (alpha = 0.78)
  • Excellent consistency with FAMS Emotional scale (alpha = 0.9)

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Cella et al., 1996)

  • Excellent association of SF-36 Physical Component Scale (PCS) and FAMS Mobility scale (r = 0.62 – 0.78)
  • Adequate to excellent association of SF-36 Mental Component Scale (MCS) and FAMS Emotional Scale (r = 0.59 – 0.62) 

 

(Riazi et al., 2003)

  • Excellent correlation of FAMS Mobility with MSIS-29 physical (r = 0.71) and SF-36 PCS (r = 0.65)
  • Excellent correlation of FAMS Emotional with MSIS-29 psychological (r = 0.70) and SF-36 MCS (r = 0.75) 

 

(Modrego et al., 2001; = 36; mean age = 38.1 (17-66); patients all from the northeastern region of Spain diagnosed with probable or clinically definite MS; majority were women (66.6%) and had relapsing-remitting forms (83.3%)) 

  • Excellent correlation of FAMS items with Incapacity Status Scale and Environmental Scale with mobility (r = 0.90), symptoms (r = 0.90), and emotional well-being (r = 0.76)
  • Adequate correlation of FAMS items with general contentment, thinking and fatigue, family/social well-being, and additional concerns (r is equal to or less than 0.40)

Construct Validity

Multiple Sclerosis:

(Cella et al., 1996)

  • Patients that have progressive disease have lower QOL than patients that have relapsing remitting (p < 0.001)
  • FAMS Mobility score means are significantly different in patients with EDSS scores equal to or less than 6.0 as compared to those that are > 6.0 (p < 0.001)

Floor/Ceiling Effects

Multiple Sclerosis:

(Riazi et al., 2003)

  • Excellent lack of ceiling effect in the FAMS Mobility when tested in 121 patients with MS (0%)
  • Adequate lack of ceiling effect in the FAMS Emotional when tested in 121 patients with MS (2.5%) 
  • Adequate lack of floor effect in the FAMS Mobility and FAMS Emotional when tested in 121 patients with MS) 

 

(Nicholl et al., 2001; n = 96; questionnaires were either sent by post or completed at interview with patients )

  • FAMS did not show a floor effect on physical functioning in contrast to MSQOL-54

Responsiveness

Multiple Sclerosis:

(Cella et al., 1996)

  • Large change of effect size of FAMS total = 1.06
    • Large change of effect size for mobility (1.24), symptoms (0.73), emotional well-being (0.79), general contentment (0.78), thinking/fatigue (0.87)
    • Moderate change in effect size for family/social well-being (0.56)

 

(Riazi et al., 2003)

  • Moderate change in effect size for FAMS Mobility and Emotional (0.64 and 0.45, respectively)

Bibliography

Benito-Leon, J., Morales, J. M., et al. (2003). "A review about the impact of multiple sclerosis on health-related quality of life." Disabil Rehabil 25(23): 1291-1303. Find it on PubMed

Cella, D. F., Dineen, K., et al. (1996). "Validation of the functional assessment of multiple sclerosis quality of life instrument." Neurology 47(1): 129-139. Find it on PubMed

Modrego, P. J., Pina, M. A., et al. (2001). "The interrelations between disability and quality of life in patients with multiple sclerosis in the area of Bajo Aragon, Spain: a geographically based survey." Neurorehabil Neural Repair 15(11527281): 69-73. Find it on PubMed

Nicholl, C. R., Lincoln, N. B., et al. (2001). "Assessing quality of life in people with multiple sclerosis." Disabil Rehabil 23(14): 597-603. Find it on PubMed

Riazi, A., Hobart, J. C., et al. (2003). "Evidence-based measurement in multiple sclerosis: the psychometric properties of the physical and psychological dimensions of three quality of life rating scales." Mult Scler 9(4): 411-419. Find it on PubMed

Webster, K., Cella, D., et al. (2003). "The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation." Health Qual Life Outcomes 1(14678568): 79. Find it on PubMed

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