RehabMeasures Instrument
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  2. Human Activity Profile

Human Activity Profile

Last Updated

Purpose

94-item activity & 8-item dyspnea measure that assesses activities of patients with COPD and other diagnoses. It measures physical activity and exhibits low- to high-energy requirements ordered based on metabolic equivalents (Fix & Daughton, 1998).

Acronym HAP

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Populations

Pulmonary Diseases
Osteoarthritis
Older Adults and Geriatric Care
Mixed Populations

Key Descriptions

  • Scaling:
    1) 3-point scale assesses activity and 4-point scale assesses dyspnea.
    2) Primary minimum scores: Activity = 94; Dyspnea = 8
    3) Primary maximum scores: Activity = 282; Dyspnea = 32
  • Scoring:
    1) Identify the maximum activity score, or the item number scored with highest MET level the individual still has the ability to perform (Bilek et al., 2008).
    2) The number of activities below the maximum activity score that exhibit activities the respondent has stopped doing is subtracted from the maximum activity score to determine the adjusted activity score (Bilek et al., 2008).
    3) Patients provide scores for activity age, fitness classification, and energy analysis.
  • Administration:
    See Fix, A. J., & Daughton, D. M. (1988). Human Activity Profile Professional Manual. Psychological Assessment Resources, Inc.

Number of Items

102

Equipment Required

  • None

Time to Administer

5-10 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Jayson Zeigler, MS, OTR

ICF Domain

Activity

Considerations

  • The HAP was originally named the Additive Daily Activities Profile Test Quality of Life Scale (Daughton, Fix, Kass, Bell, & Patil, 1982).

  • Kramer et al. (2012) noted a close correlation between the HAP and the Hospital Anxiety and Depression Scale (HADS), so the HAP may be a clinically useful outcome measure for depression and anxiety.

  • Bennell et al. (2004) observed that women typically scored lower than males.

  • The HAP has been used in healthy and diseased populations (Davidson & de Morton, 2007).

  • A change score of 7.8 and 6.8 is required to be 90% confident that change is beyond measurement error for both maximum activity scores and adjusted activity scores (Davidson & de Morton, 2007).

Permission not granted for hyperlink to obtain PDF copy of Human Activity Profile (HAP) form. There is no cost for this outcome measure if requested for research purposes. All requests to obtain the HAP outcome measure form must go to David M. Daughton, MS.

Address:

David M. Daughton, MS

Pulmonary & Critical Care Medicine

University of Nebraska Medical Center

600 S 42nd Street

Omaha, NE 68105-2465

 

Mixed Populations

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Standard Error of Measurement (SEM)

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza, Wegner, Costa, Chiavegato, & Lunardi, 2017; n = 100; mean age 41 (15) years; admitted for fewer than 48 hours for clinical or surgical reasons)

  • SEM for hospitalized patients (n = 100): 1.44

Minimal Detectable Change (MDC)

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • MDC₉₀ for hospitalized patients, 3.34.

  • MDC for MAS and AAS not distinguished.

Normative Data

Normative data established and available for research purposes if request submitted to David M. Daughton. Normative data in HAP manual (Fix & Daughton, 1988).

Classification

HAP score

Low activity

Scores < 53

Moderate activity

Scores 54 - 73

High activity

Scores ≥ 74

 

Heart failure: (Ribeiro-Samora et al., 2016, n = 62, mean age = 47.98 years (range 25-59 years); New York Heart Association functional classes I-III; body mass index <30 kg/m²; resting left ventricular ejection fraction ≤ 45% on transthoracic echocardiography)

  • Maximum activity score mean = 79.76 ± 8.76

  • Adjusted activity score mean = 65.81 ± 17.01

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • All patients HAP test mean score 68.34 ± 12.83, HAP retest 68.45 ± 12.54

  • Clinical conditions HAP test mean score 67.23 ± 13.53, HAP retest 67.37 ± 13.24

  • Surgical conditions HAP test mean score 69.52 ± 12.08, HAP retest 69.60 ± 11.76. Please note these data were collected as mean scores from the sample and contribute to, but not intended as normative data.

Stem Cell Transplantation: (Kramer et al., 2013, n = 27, median age = 47 (range 16 – 69) years; 3 months after transplantation available for all evaluation time points)

  • At baseline, HAP maximum achievable score mean 80.8±9.6, adjusted score 67.3 ± 14.8.

  • Post stem cell transplant (SCT), HAP mean adjusted score 76.3 ± 12.2.

  • One month post SCT, HAP maximum achievable score mean 69.4 ± 19.2, adjusted 49.5 ± 21.7.

  • Three months post SCT, maximum achievable score mean 76.7±14.6, adjusted 58.4 ± 2.3.

Test/Retest Reliability

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • Excellent test-retest reliability (ICC = 0.99)

Internal Consistency

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • Excellent internal consistency, Cronbach’s α = 0.937

 

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Heart failure: (Ribeiro-Samora et al., 2016)

Pain/Physical Function Measures

HAP (MAS) (r)

HAP (AAS) (r)

WOMAC (PAIN)

-0.23

-0.32

VAS: pain rest (cm)

-0.18

-0.19

VAS: pain on movement (cm)

-0.27

-0.39

WOMAC (Self-reported physical function)

-0.23

-0.39

VAS (Self-reported physical function)

-0.27

-0.48

Step test (N) (Observed physical function)

0.34

0.52

TUG test (s) (Observed physical function)

-0.46

-0.59

Walking speed (m/s)

0.44

0.63
  • Excellent correlation associated the HAP with 6 Minute Walk Test distance (r = 0.62).

Concurrent Validity

Stem Cell Transplantation: (Kramer et al., 2013)

  • Poor correlation (r = -0.4, r =-0.5) noted with HAP AAS score and HADS anxiety and depression at baseline, 1 month, and 3 months.

Predictive Validity:

Stem Cell Transplantation: (Kramer et al., 2013)

  • Multivariate regression analyses completed to identify adequate predictors of HAP adjusted scores to include the grip test (at 1 month, R^2 = 0.2, ß = 0.6, p = 0.03) and the 2 Minute Walk Test (at 3 months, R^2 = – 0.2, ß = -0.8, p = 0.04).

 

Construct Validity

Convergent Validity:

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • Adequate construct validity as evidenced by completed Chi-square with classification by IPAQ-6, 3.39 (p = 0.18).

Face Validity

Heart failure: (Ribeiro-Samora et al., 2016)

  • When used with the 6 Minute Walk Test, the HAP is a clinically valid assessment for functional capacity of patients diagnosed with heart failure. However, despite the 6 Minute Walk Test used in conjunction with the HAP test demonstrating a positive correlation, it should not replace the gold standard, cardio-pulmonary exercise test.

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • The HAP questionnaire is appropriate for assessing physical activity level if used as a tool for classification.

Stem Cell Transplantation: (Kramer et al., 2013)

  • The HAP and grip test may serve as a valid substitute marker for strength loss during a stem cell transplant.

Floor/Ceiling Effects

Hospitalized adults admitted clinically and surgically, diagnosed with acute myocardial infarction, chronic obstructive pulmonary disease, and spinal cord injury: (Souza et al., 2017)

  • Excellent floor/ceiling effect as evidenced by 10.0% floor/ceiling effects

 

Osteoarthritis

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Standard Error of Measurement (SEM)

Osteoarthritis and Rheumatoid Arthritis: (Bennell et al, 2008; n = 256; 226 diagnosed with OA and 33 diagnosed with RA)

  • SEM (MAS) = 3.0 and SEM (AAS) = 3.0

Osteoarthritis and Rheumatoid Arthritis: (Bilek et al., 2005; n = 13; mean age = 57.14 ± 11.60; 7 diagnosed with OA and 6 with RA)

  • SEM (MAS) = 36.57 and SEM (AAS) = 29.42

Minimal Detectable Change (MDC)

Osteoarthritis and Rheumatoid Arthritis: (Bennell et al., 2004. Data retrieved from Davidson and Morton, 2006)

  • MDC₉₀ = 7 for both MAS and AAS for 20 people over 50 years with OA knee

Osteoarthritis and Rheumatoid Arthritis: (Calculated using data from Bilek et al., 2005)

  • MDC for maximum activity score: 3.05

  • MDC for adjusted activity score: 5.54

Normative Data

 

Osteoarthritis and Rheumatoid Arthritis: (Bennell et al., 2004)

  • Mean HAP scores:
    • Maximal Activity score = 76.0 ± 8
    • Adjusted activity score = 62.0 ± 13

Osteoarthritis and Rheumatoid Arthritis: (Bilek et al., 2005)

  • Mean HAP scores:
    • Maximal Activity score = 74.64 ± 9.15
    • Adjusted activity score = 67.5 ± 12.26

Test/Retest Reliability

Osteoarthritis and Rheumatoid Arthritis: (Bilek et al., 2005)

  • Excellent for maximum achievable score test-retest reliability (ICC = 0.76)

  • Excellent adjusted score test-retest reliability (ICC = 0.87)

Osteoarthritis and Rheumatoid Arthritis: (Bennell et al., 2004)

  • Excellent for maximum achievable score test-retest reliability (ICC = 0.96)

  • Excellent adjusted score test-retest reliability (ICC = 0.95)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Osteoarthritis and Rheumatoid Arthritis: (Bennell et al., 2004)

  • Weak to Moderate correlations between HAP and commonly used pain and physical function measures (r = 0.15-0.63)

Osteoarthritis and Rheumatoid Arthritis: (Bilek et al., 2005)

  • Excellent to Poor Spearman rho correlations of HAP scores and self-report questionnaires and physical performance tests

Self-report questionnaires

HAP (MAS) (ρ)

HAP (AAS) (ρ)

SF-36 Physical Functioning

0.78

0.80

SF-36 Role Functioning-Physical

0.71

0.73

M-HAQ

-0.49

-0.51

AIMS2 Household Tasks

-0.39

-0.53

AIMS2 Physical Component

-0.49

-0.54
  • Significant Spearman's rho correlation of HAP scores (MAS and AAS scores) with the Timed-Stands Test (MAS = -0.77, AAS = -0.72) and 50-foot Walk Test (MAS = -0.70, AAS = -0.71) physical performance tests

Construct Validity

Discriminant Validity:

Osteoarthritis and Rheumatoid Arthritis: (Hinmam et al., 2002, cross-sectional design, n = 41, with symptomatic knee osteoarthritis and 33 controls matched for age, sex, and body mass)

  • OA knee and no knee problems were similar on MAS score (P > .05) but AAS scores were significantly lower in OA group (P >.01)

Face Validity

Osteoarthritis and Rheumatoid Arthritis: (Bilek et al., 2008)

  • The HAP is a useful tool in estimating fitness level of patients diagnosed with OA and RA, when standard exercise testing is not feasible (Bilek et al., 2008)

Responsiveness

Osteoarthritis and Rheumatoid Arthritis: (Bilek et al., 2005)

  • Moderate response to change demonstrated by HAP as evidenced by effect size, ES = 0.5

  • Following a 12-week exercise program, the HAP demonstrates similar response to change when compared to other questionnaires examining physical function

HAP

ES = 0.5

SF-36 Physical Functioning

ES = 0.5

SF-36 Role Functioning-Physical

ES = 0.7

M-HAQ

ES = 0.5

AIMS2

ES = 0.2-0.7

Older Adults and Geriatric Care

back to Populations

Standard Error of Measurement (SEM)

Community-dwelling older adult women: (Farrell et al., 1996, n = 28; older people with chronic pain)

  • SEM (MAS) = 3.0 It is important to note that this data retrieved from Davidson and Morton (2006).

Minimal Detectable Change (MDC)

Community-dwelling older adult women: (Farrell et al., 1996; retrieved from Davidson & Morton, 2006)

  • MDC₉₀ = 7 (MAS) and MDC₉₀ = 8 (AAS) for 28 older people with chronic pain

Cut-Off Scores

Community-dwelling older adult women: (Bastone et al., 2014)

Classification

Cutoff point HAP

Active

> 74

Physically and mentally healthy

> 74

Housebound

≤ 66

Dependent

≤ 58

Test/Retest Reliability

Community-dwelling older adult women: (Bastone et al., 2014)

  • Excellent for maximum achievable score test-retest reliability (ICC = 0.79)

  • Excellent adjusted score test-retest reliability (ICC = 0.94)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Community-dwelling older adult women: (Bastone et al., 2014)

  • Adequate to Excellent Spearman's rho correlation detected (rho = .47-.75) between HAP MAS and AAS scores and Accelerometer measures to include counts/day, sedentary activity/day, moderate activity/day, steps/day, and energy expenditure/day.

 

Face Validity

Community-dwelling older adult women: (Bastone et al., 2014)

  • The HAP is valid indicator of physical activity levels in older community-dwelling adult women.

Bibliography

American Thoracic Society. (2017). Quality of Life Resource: Human Activity Profile. Retrieved from http://qol.thoracic.org/sections/instruments/fj/pages/adapt.html

A. C., Moreira, B. S., Vieira, R. A., Kirkwood, R. N., Dias, J. M. D., & Dias, R. C. (2014). Validation of the Human Activity Profile questionnaire as a measure of physical activity levels in older community-dwelling women. Journal of Aging and Physical Activity, 22, 348-356. https://doi.org/10.1123/JAPA.2012-0283

Bennell, K. L., Hinman, R. S., Crossley, K. M., Metcalf, B. R., Buchbinder, R., Green, S., & McColl, G. (2004). Is the Human Activity Profile a useful measure in people with knee osteoarthritis. Journal of Rehabilitation Research & Development, 41(4), 621-630.

Bilek, L. D., Venema, D. M., Camp, K. L., Lyden, E. R., & Meza, J. L. (2005). Evaluation of the Human Activity Profile for use with persons with arthritis. Arthritis & Rheumatism (Arthritis Care & Research), 53(5), 756-763. https://doi.org/10.1002/art.21455

Bilek, L. D., Venema, D. M., Willett, G. M., & Lyden E. R. (2008). Use of the Human Activity Profile for estimating fitness in persons with arthritis. Arthritis & Rheumatism (Arthritis Care & Research),59(5), 659-664. https://doi.org/10.1002/art.23572

Daughton, D. M., Fix, A. J., Kass, I., Bell, C. W., & Patil, K. D. (1982). Maximum oxygen consumption and the ADAPT quality-of-life scale. Archives of Physical Medicine and Rehabilitation, 63, 620- 622.

Davidson, M. & de Morton, N. (2007). A systematic review of the Human Activity Profile. Clinical Rehabilitation, 21, 151-162. https://doi.org/10.1177/0269215506069475

Farrell, M. J., Gibson, S. J., & Helme, R. D. (1996). Measuring the activity of older people with chronic pain. Clinical Journal of Pain, 12, 6-12.

Fix, A. J., & Daughton, D. M. (1998). Human Activity Profile Professional Manual. Psychological Assessment Resources, Inc.

Hinman, R. S., Bennell, K. L., & Metcalf, B. R. (2002). Temporal activity of vastus medialis obliquus and vastus lateralis in symptomatic knee osteoarthritis. American Journal of Physical Medicine Rehabilitation, 81, 684-690. https://doi.org/10.1097/01.CCM.0000026919.24522.59

Kramer, M., Heussner, P., Herzberg, P.Y., Andree, H., Hilgendor, I., Leithaeuser, M., Junghanss, C., Freund, M., & Wolff, D. (2013). Validation of the grip test and Human Activity Profile for evaluation of physical performance during the intermediate phase after allogeneic hematopoietic stem cell transplantation. Support Care Cancer, 21, 1121-1129. https://doi.org/10.1007/s00520-012-1634-1

Ribeiora-Samora, G. A., Pereira, D. A. G., Vieira, O. A., Noman de Alencar, M. C., Rodrigues, R. S., Carvalho, M. L. V., Montemezzo, D., & Britto, R. R. (2016). Using the Human Activity Profile to assess functional performance in heart failure. Heart Failure, 36, 180-185. https://doi.org/10.1097/HCR.000000000000162

Souza, D. C., Wegner, F., Costa, L. C. M., Chiavegato, L. D., & Lunardi, A. C. (2017). Measurement properties of the Human Activity Profile questionnaire in hospitalized patients. Brazilian Journal of Physical Therapy, 21(3), 153-158. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537466/

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