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Rehabilitation Measures Database

Frenchay Activities Index

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Purpose

The Frenchay Activities Index (FAI) is a measure of instrumental activities of daily living (IADL) for use with patients recovering from stroke. The FAI assesses a broad range of activities associated with everyday life that patient has participated in within the recent past, broken into 3 domains: domestic chores, leisure/work, and outdoor activities.

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Instrument Details

Acronym FAI

Area of Assessment

Activities of Daily Living
Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Stroke Recovery

Key Descriptions

  • The items included move beyond the scope of ADL scales, which tend to focus on issues related to self care and mobility.
  • Can be separated into 3 domains:
    1) Domestic chores
    2) Leisure/work
    3) Outdoor activities
  • The frequency with which each item or activity is undertaken over the past 3-6 months (depending on the nature of the activity) is assigned a score of 1 – 4 where a score of 1 is indicative of the lowest level of activity.
  • The scale provides a summed score from 15 – 60.
  • A modified 0-3 scoring system introduced by Wade et al. (1985) yields a score of 0 – 45.

Number of Items

15 items

Equipment Required

  • Pencil and form

Time to Administer

5 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS, in 2010; Updated with references for the amputation population by Nick Lefere, SPT and  Matt Morris, SPT in 2011; Updated with references for stroke, geriatric, and amputee populations by Erika Gentry, SPT and Ashley Kanelos, SPT in 11/2012. Updated with references for chronic lower back pain, high utilizers of healthcare, traumatic limb injury, and mild cognitive impairment by Susan Felson, OTS, Christine Leung, OTS, Monica O’Connor, OTS in 3/2016. Updated with references for Stroke, Limb Loss and Amputation and Acquired Brain Injury by Bridget Hahn, OTD, OTR/L, Eleanor Sweeney, OTS; Nicole Kovalevsky, OTS; Matthew Medick, OTS; Hannah Hartz, OTS of Rush University in 8/2019.

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living

Considerations

Frenchay Activities Index translations:

French (p26):

Spanish (p288):

Dutch; translated (Schuling, de Haan, Limburg & Groenier, 1993)

Chinese; translated and validated (Hsueh & Hsieh, 1997)

The FAI can be used as a mailed questionnaire. Carter, Mant, Mant, Wade, and Winner (1997) reported an correlation between mailed questionnaire FAI scores and face-to-face interview scores (r = 0.94).

Can also be used with patients with cognitive impairment, using a proxy respondent. The focus of the FAI is on frequency of activity rather than quality of activity. Proxy agreement was for the FAI (intraclass correlation coefficient (ICC) = 0.85) (Segal & Schall, 1994). Holbrook and Skilbeck (1983) found that information obtained by relatives were interchangeable with information acquired from the patient. Segal and Schall (1994) reported proxy agreement for the three subscales as ranging from (ICC = 0.59 for Leisure/work) to (ICC = 0.77 for Domestic and Outdoors).

 

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

Stroke

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Standard Error of Measurement (SEM)

Stroke:

(Lu et al, 2012; = 52, mean age = 59.4 (11.6) years, minimum 6 months post stroke, Taiwanese sample, Chronic Stroke)

  • SEM = 2.4

 

(Lin et al, 2012; = 127, mean age = 55.27 (11.23) years, time post stroke = 16.82 (16.05) months, Taiwanese sample)

  • Standard Error of Measurement of individual items:

Item

Item Difficulty (Standard Error)

The domain of domestic chores

 

Preparing meals

0.08

Washing dishes

0.08

Washing clothes

0.08

Dusting/vacuum cleaning

0.07

Cleaning (heavy housework)

0.08

Local shopping

0.17

The domain of work/leisure

 

Social activities

0.07

Walking outside >15 min

0.08

Hobby/sport

0.07

Car/bus travel

0.07

Outings

0.08

Gardening

0.09

Household/car maintenance

0.10

Reading books

0.08

Employment

0.23

Minimal Detectable Change (MDC)

Stroke:

(Lu et al, 2012, Chronic Stroke)

  • MDC value = 6.7 (14.9%)

Cut-Off Scores

Stroke: (Monteiro et al. 2016; n= 161; mean age= 57.3 (17.0) years; Interval of time from stroke (days) median (IQ) 6 (4–12); Brazilian sample).

  • FAI score ranges:   0 (inactive) to 45 (very active)and can be classified as: 0 –15 = inactive; 16–30 = moderately active, and 31–45 = very active12. The cutoff ≥ 18 was used as a predictor of mild disability after stroke.

Normative Data

Stroke:

(Schepers et al, 2006; n = 163; mean age = 56 (11) years; 6 to 12 months post stroke, Chronic Stroke)

 

6 months post stroke

 

 

12 months post stroke

 

 

Measure (scale range) 

Mean (SD)

Sample range

IQR

Mean (SD)

Sample range

IQR

FAI (0–45)

18.0 (8.5)

0–36

12–25

20.9 (8.7)

2–42

15–28

BI (0–20)

18.7 (1.6)

13–20

18–20

18.9 (1.5)

14–20

18–20

FIM total (18–126)

111.7 (8.3)

81 124

107–118

112.2 (8.3)

83–125

109–11

FIM motor (13–91)

80.3 (6.4)

58–91

77–85

80.9 (7.0)

57–91

77–86

FIM cognitive (5–35)

31.4 (3.6)

18–35

29–34

31.2 (3.2)

16–35

30–34

FAI, Frenchay Activities Index
BI, Barthel Index
FIM, Functional Independence Measure

 

 

 

 

 

 

Test/Retest Reliability

Stroke:

(Lu et al, 2012)

  • Excellent test-retest reliability (ICC = 0.89)

(Liu & Wang, 2011; n = 109)

  • Excellent test-retest reliability (ICC = 0.991)

(Green et al, 2001; n = 22; Mean Age = 71.6 (6.8) years; Mean Time since stroke onset = 15 months; Median Time between assessments = 7 days, Chronic Stroke)

Test-rest agreement

 

 

FAI Domain:

% agreement

Kappa

main meals

100

1.00

washing up

77

0.75

washing clothes

86

0.82

light housework

86

0.84

heavy housework

82

0.25

local shopping

73

0.55

social outing

77

0.81

walking outside >15 m

68

0.53

hobby

64

0.50

drive car/travel on bus

82

0.77

outings car rides

77

0.82

gardening

82

0.74

household /car maintenance

96

0.69

read books

73

0.73

paid work

100

*

*= kappa value uncertain

 

 

Interrater/Intrarater Reliability

Stroke:

(Monteiro et al., 2016)

  • Adequate inter-rater reliability: k=.66

(Piercy et al, 2000; n = 59; 35 = stroke survivors, 24 = caregivers; 15.2 days between assessments; mean age = 71.1 (14.8) years; stroke onset 6 to 12 months, Chronic Stroke)

  • Excellent inter-rater reliability (r = 0.93; FAI total)
  • Excellent item level inter-rater reliability (Kappa range = 0.64-0.80; 9/15 items)

(Post & de Witte, 2003; n = 45; mean age = 55.6 (10.9) years; 3 to 9 days between assessments, Chronic Stroke)

  • Excellent interrater reliability (ICC = 0.90; FAI total)
  • Adequate to excellent interrater reliability (Kappa range = 0.41 - 0.90; at item level)

(Wendel et al, 2013; n=31; mean age=75 (range 54-94); >18 months post stroke (mean =27 months), Swedish population, Swedish version)

Distribution of FAI agreement of two raters

 

FAI Domain

Weighted kappa

Main meals

0.976

Washing up

0.908

Washing clothes

1.000

Light housework

0.956

Heavy housework

0.844

Local shopping

0.819

Social outings

0.975

Walking outdoors (>15 mins)

1.000

Pursing active interest in hobby

0.930

Outings/car rides

0.851

Gardening

0.939

Household and/or car maintenance

0.923

Reading books

0.873

Gainful work

1.000

Internal Consistency

Stroke:

(Lin et al, 2012, Stroke)

  • Excellent internal consistency for whole test (r 0.99)
  • Cronbach’s alpha = 0.81 for domestic chores domain
  • Cronbach’s alpha = 0.73 for work/leisure domain

(Tse et al., 2013; n=35 )

  • Excellent internal consistency when scored by patients (Cronbach's alpha = 0.85)
  • Excellent internal consistency when scored by proxies (Chronbach's alpha = 0.83)

Stroke & General Population:

(Schuling et al, 1993; stroke sample = 185; mean age = 76 (10.4) years; mean time since stroke onset = 26 weeks, Stroke and General Population)

  • Excellent internal consistency
    • (Cronbach's alpha = 0.83 - controls/normal)
    • (Cronbach's alpha = 0.87 - post-stroke)
  • Adequate internal consistency
    • (Cronbach's alpha = 0.78 - pre-stroke retrospective reports)

Criterion Validity (Predictive/Concurrent)

Stroke:

(Wade et al, 1985; Schuling et al, 1993; Cup et al, 2003; Wu et al, 2011; n = 70; mean age = 55.5 (12.1) years; mean time post stroke = 19.9 (12.5) months, Stroke)

  • Excellent concurrent validity with the Barthel Index (r = 0.66; disability scores)
  • Excellent concurrent validity with the Barthel (r = 0.79)
  • Excellent concurrent validity with the Euroqol (r = 0.65)
  • Excellent concurrent validity with the Rankin (r = -0.80)
  • Adequate concurrent validity with the Stoke Adapted Sickness Impact Profile-30 (r = -0.43)
  • Excellent concurrent validity with the Modified Nottingham Extended ADL scale (= 0.80)
  • Adequate concurrent validity with the Stroke Impact Scale Total (r = 0.50)

(Sarker et al, 2012)

  • Excellent concurrent validitiy with Barthel Index (r = 0.80)
  • Excellent concurrent validity with Nottingham Extended ADL scale (r = 0.90)

(Monteiro et al., 2016)

  • Excellent independent predictive validity of the NIHSS score: OR = 0.93 per 1 point increase

 

Construct Validity

Stroke:

(Schuling et al, 1993; Tooth et al, 2003)

  • Poor discriminant validity with the Emotional and Alertness Scales of Sickness Impact Profile (r = -0.15, Emotional and r = -0.14, Alertness)

  • Excellent convergent validity with the Sickness Impact Profile-Home Management (r = -0.73)

  • Excellent convergent validity with the Sickness Impact Profile-Body Care (r = -0.70)

  • Excellent convergent validity with the Sickness Impact Profile- Mobility (r = -0.68)

  • Excellent convergent validity with FIM Motor subscale (r = 0.63)

  • Adequate convergent validity with the Sickness Impact Profile-Ambulation (r = -0.56)

  • Adequate convergent validity with the Sickness Impact Profile-Recreation/pastimes (r = -0.47)

  • Adequate convergent validity with the Sickness Impact Profile-Communication (r = -0.42)

  • Adequate convergent validity with the Sickness Impact Profile-Eating (r = -0.42)

  • Adequate convergent validity with the Sickness Impact Profile-Rest/Sleep (r = -0.42)

  • Adequate convergent validity with the Sickness Impact Profile- Social Interaction (r = -0.39)

(Sarker et al, 2012; = 238, Mean Age (SD) = 68.6 (14.2) years, Time Post Stroke = 3 months, n = 23 with severe deficits (NIHSS score > 13))

  • Poor ICC= 0.27 (CI: -0.09 to 0.60) with Barthel Index
  • ICC= 0.75 (CI: 0.06 to 0.91) with Nottingham Extended ADL scale

(Monteiro et al., 2016)

  • Poor discriminant validity with stroke severity (determined by NIHSS score) (r = -0.226)

Content Validity

Stroke:

(Schuling et al, 1993; Tooth et al, 2003)

  • Poor discriminant validity with the Emotional and Alertness Scales of Sickness Impact Profile (r = -0.15, Emotional and r = -0.14, Alertness)

  • Excellent convergent validity with the Sickness Impact Profile-Home Management (r = -0.73)

  • Excellent convergent validity with the Sickness Impact Profile-Body Care (r = -0.70)

  • Excellent convergent validity with the Sickness Impact Profile- Mobility (r = -0.68)

  • Excellent convergent validity with FIM Motor subscale (r = 0.63)

  • Adequate convergent validity with the Sickness Impact Profile-Ambulation (r = -0.56)

  • Adequate convergent validity with the Sickness Impact Profile-Recreation/pastimes (r = -0.47)

  • Adequate convergent validity with the Sickness Impact Profile-Communication (r = -0.42)

  • Adequate convergent validity with the Sickness Impact Profile-Eating (r = -0.42)

  • Adequate convergent validity with the Sickness Impact Profile-Rest/Sleep (r = -0.42)

  • Adequate convergent validity with the Sickness Impact Profile- Social Interaction (r = -0.39)

Floor/Ceiling Effects

Stroke:

(Pedersen et al, 1997; n = 437; mean age = 73.6 (10) years; assessed 6 months post-stroke, Chronic Stroke)

  • FAI and Barthel Index (BI) are complementary measures that both assess Activities of Daily Life (ADL)
  • Each measure assesses different aspects of ability, the BI assesses movement and motor power functioning, the FAI assessed progressively more difficult aspects of ADL
  • FAI floor effects were observed at approximately 57.5 points (FAI mean = 30.0 (11.6) points)

(Sarker et al, 2012, Stroke)

  • Significantly large floor effect (19%)

Responsiveness

Stroke:

(Schepers et al, 2006; Wade et al, 1985, Stroke)

  • FAI (coupled with Stroke Adapted Sickness Impact Profile) detected the most patient change and had moderate effect sizes (d = 0.59) for chronic stroke patients between 6 and 12 months post stroke)

  • FAI was also noted to change in the expected direction from pre-stroke, 6 months, and 12 months post-stroke

(Sarker et al, 2012; = 238, Mean Age (SD) = 68.6 (14.2) years, Time Post Stroke = 3 months, n = 23 with severe deficits (NIHSS score > 13))

  • ICC= 0.27 (CI: -0.09 to 0.60) with Barthel Index
  • ICC= 0.75 (CI: 0.06 to 0.91) with Nottingham Extended ADL scale

Older Adults and Geriatric Care

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Minimal Detectable Change (MDC)

Elderly:

(Imam & Miller, 2012; = 66, mean age = 79.03 (8.50) years, Chinese/Canadian sample, Elderly)

  • MDC value = 8.64

Test/Retest Reliability

Elderly:

(McPhail et al, 2009; = 40, mean age = 79 (7.3) years, Australian sample)

  • Excellent test-retest reliability (ICC = 0.94 with CI 0.89 - 1.00)

 

(Imam & Miller, 2012)

  • Excellent test-retest reliability (ICC = 0.86)

Criterion Validity (Predictive/Concurrent)

Elderly:

(Imam & Miller, 2012, Elderly)

  • Adequate concurrent validity with Reintegration into Normal Living index (= 0.61)
  • Adequate concurrent validity with Activities-specific Balance Confidence scale (= 0.55)
  • Adequate concurrent validity with Timed Up & Go test (= -0.68)

Limb Loss and Amputation

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Normative Data

Amputation: (Bhangu, Devlin, & Pauley, 2009; n = 31, Mean Age at First Amputation = 63.4 years, Mean Age at Second Amputation = 68.7 years)

  • Mean (SD): 15.3

Test/Retest Reliability

Lower Limb Amputation

(Miller et al, 2004, n = 84, mean age = 56.5 (13) years, Lower Limb Amputation)

  • Excellent test-retest reliability (ICC = 0.79)

Internal Consistency

Lower Limb Amputation:

(Miller et al, 2001; n = 435; mean age = 62.0 (15.7) years, Lower Limb Amputation)

·&苍产蝉辫;Excellent internal consistency, (Cronbach’s alpha = 0.87 post amputation)

 

Traumatic Limb Injury:

(Chern et al, 2014; three months post injury, n=342, mean age=43.7(18.5) years; 6 months post injury, n=1010, mean age=45.3(18.6) years; 12 months post injury, n=987, mean age=45.7(18.5); Traumatic Limb Injury, Taiwanese population, Chinese Version)

  • Excellent internal consistency for three time points (Chronbach's alpha = 0.91 post injury)

Criterion Validity (Predictive/Concurrent)

Traumatic Limb Injury:

(Chern et al, 2014, Traumatic Limb Injury, Chinese Version)

  • Adequate predictive validity at 3, 6, and 12 months with WHOQOL-BREF domains:
    • at 3 months with WHOQOL-BREF - Physical domain (r = .39)
    • at 3 months with WHOQOL-BREF - Psychology domain (r = .38)
    • at 3 months with WHOQOL-BREF - Environment domain (r = .39)
    • at 6 months with WHOQOL-BREF - Physical domain (r = .41)
    • at 6 months with WHOQOL-BREF - Environment domain (r = .31)
    • at 6 months with WHOQOL-BREF - Physical domain (r = .50)
    • at 12 months with WHOQOL-BREF - Psychology domain (r = .37)
    • at 12 months with WHOQOL-BREF - Social Relations domain (r = .35)
    • at 12 months with WHOQOL-BREF - Environment domain (r = .37)

Floor/Ceiling Effects

Traumatic Limb Injury:

(Chern et al, 2014, Traumatic Limb Injury, Chinese Version)

  • Adequate Ceiling Effect at 3 months (0.3%)
  • Adequate Ceiling Effect at 6 months (3.5%)
  • Adequate Ceiling Effect at 12 months (2.5%)
  • Adequate Floor Effect at 3 months (7.3%)
  • Adequate Floor Effect at 6 months (4.3%)
  • Adequate Floor Effect at 12 months (2.4%)

Non-Specific Patient Population

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Normative Data

Age Band (yrs)

n

Median (IQR) (yrs)

Range (yrs)

Male

 

 

 

16-24

24

23.5 (17.5 to 30.3)

10.0 to 37.0

25-34

28

28.5 (26.0 to 33.0)

8.0 to 39.0

35-44

33

27.0 (24.0 to 34.0)

3.0 to 40.0

45-54

34

27.0 (23.0 to 30.3)

16.0 to 42.0

55-64

45

28.0 (24.0 to 33.5)

0.0 to 40.0

65-74

41

24.0 (19.0 to 28.0)

0.0 to 39.0

75-84

44

23.0 (12.3 to 30.0)

1.0 to 38.0

85+

32

15.0 (4.3 to 26.0)

0.0 to 39.0

All ages

281

26.0 (19.0 to 31.0)

0.0 to 42.0

Female

 

 

 


16-24

38

23.0 (20.0 to 28.3)

10.0 to 35.0

25-34

39

32.0 (30.0 to 35.0)

24.0 to 40.0

35-44

42

32.0 (29.0 to 34.0)

17.0 to 40.0

45-54

41

33.0 (30.0 to 37.5)

17.0 to 41.0

55-64

48

31.5 (28.0 to 34.0)

14.0 to 39.0

65-74

47

30.0 (24.0 to 33.0)

7.0 to 39.0

75-84

32

29.0 (21.3 to 32.0)

2.0 to 38.0

85+

34

14.0 (3.0 to 24.8)

0.0 to 35.0

All ages

321

30.0 (24.0 to 33.0)

0.0 to 41.0

Test/Retest Reliability

General Population

(Turnbull et al, 2000, General Population)

Excellent test-retest reliability (r = 0.96)

Floor/Ceiling Effects

Venous Leg Ulcers:

(Walters et al, 1999; n = 233, median age = 75 (range = 67-82) years, Venous Leg Ulcers)

Adequate floor effect (2.1%)

Brain Injury

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Standard Error of Measurement (SEM)

Traumatic Brain Injury (Van Baalen, 2006; n = 22; Mean (SD) Age = 34.6 (11.1) years; Mean (SD) Length Of Stay= 38 (33) days)

  • SEM = 2.64

Minimal Detectable Change (MDC)

Traumatic Brain Injury: (Van Baalen, 2006)

  • MDC = 7.31

Minimally Clinically Important Difference (MCID)

Acquired Brain Injury: (Brands, 2014; n = 148; Mean Age (SD) [Range] = 56 (12.3) [19-84] years; Mean Time Since Injury = 15.1 (9.6) weeks;Infarction 98 (66.2), SAH 10 (6.8), ICH 9 (6.1), Diffuse vascular lesions 2 (1.4) , TBI 14 (9.5), Anoxic encephalopathy 3 (2.0), Tumor benign 5 (3.4), Meningitis/encephalitis 1 (0.7), Other 6 (4.1)

  • MCID= unstandardized regression coefficient= 0.50; β, standardized regression coefficient= 49; CI, 95 % confidence interval=0.36 to 0.63; (P<.001); R2, coefficient of determination=26.5

Normative Data

Traumatic Brain Injury: (Van Baalen, 2006)

  • Observed Range: 16- 33
  • Mean (SD) = 24.85 (5.9)
  • % of Agreement: 14
  • Square Weighted Kappa = 0.89

Test/Retest Reliability

Traumatic Brain Injury: (Van Baalen, 2006)

  • Excellent test- retest reliability: (ICC = .87)

Bibliography

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Blomgren, C., Samuelsson, H., Blomstrand, C., Jern, C., Jood, K., & Claesson, L. (2019). Long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors—Impact of cognitive dysfunction, emotional problems and fatigue. PLoS ONE, 14(5) doi:10.1371/journal.pone.0216822

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Lin, K. C., Chen, H. F., et al. (2012). "Multidimensional Rasch validation of the Frenchay Activities Index in stroke patients receiving rehabilitation." J Rehabil Med 44(1): 58-64.

Liu, R., & Wang, N. (2011). Reliability studies on the frenchay activities index applications in chinese healthy subjects and stroke patients. Chinese Journal of Rehabilitation Medicine, 26(4), 323-328+336. doi:10.3969/j.issn.1001-1242.2011.04.006

Lu, W. S., Chen, C. C., et al. (2012). "Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke." Arch Phys Med Rehabil 93(6): 1097-1100.

McPhail, S., Lane, P., et al. (2009). "Telephone reliability of the Frenchay Activity Index and EQ-5D amongst older adults." Health Qual Life Outcomes 7: 48.

Miller, W. C., Deathe, A. B., et al. (2004). "Measurement properties of the Frenchay Activities Index among individuals with a lower limb amputation." Clinical Rehabilitation 18(4): 414-422.

Miller, W. C., Deathe, A. B., et al. (2001). "The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation." Arch Phys Med Rehabil 82(9): 1238-1244.

Monteiro, M., Maso, I., Campos, S., I., A., Barreto-Neto, N., Oliviera- Filho, J., & Pinto, B., E. (2017). Validation of the Frenchay activity index on stroke victims. Arquivos de Neuro-Psiquiatria, 75(3), 167-171. https://dx.doi.org/10.1590/0004-282x20170014

Pedersen, P. M., Jorgensen, H. S., et al. (1997). "Comprehensive assessment of activities of daily living in stroke. The Copenhagen Stroke Study." Arch Phys Med Rehabil 78(2): 161-165.

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