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LEARNING OBJECTIVES
Discuss the concepts of health, function, activity, participation, disability, impairment, activity limitations, and participation restrictions.
Define function and discuss the purposes and components of the examination of function.
Select activities and roles appropriate to an individual’s particular characteristics and condition to guide examination of function.
Compare and contrast characteristics of various tests of function, including performance measures and self-report measures.
Identify factors to consider in the selection of instruments for testing function.
Compare and contrast various scoring methods used in instruments to measure function.
Discuss the issues of reliability, validity, and responsiveness as they relate to the measurement of function.
Using the case study example, apply clinical decision making skills in evaluating data from the examination of function.
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A clinician needs to consider the purposes of obtaining the measurement in deciding which measure of function to use. For example, is the measure to describe a specific activity limitation or describe an individual’s overall level of function? Will the measure be used to measure an individual’s current status or to assess the outcomes of an episode of care? Will the measure be used to determine the destination at discharge, to obtain reimbursement, to meet regulatory requirements, or some combination of these reasons? As function may incorporate performance at the level of body systems, the person, and society, or a combination of these, the clinician should be cognizant of the ability of the measure to capture the applicable information.
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The ultimate objective of any rehabilitation program is to return the individual to a lifestyle that is as close to their previous level of function as possible or, alternatively, to maximize the current potential for function and maintain it. For an otherwise healthy person with a fractured arm, this may be a reasonably simple process: improving range of motion, strength, and impairments in body function will generally correlate with the reestablishment of skills related to the performance of activities, such as dressing and feeding. However, considering the person with a stroke, the task is much more complex because the problems are much more extensive, complicated, and interwoven. The two cases, however, are broadly similar. In both instances, the therapist begins by describing the problem in functional terms obtained from the history, performing a review of body systems and detailed examination using selected tests and measures, evaluating the data, establishing a diagnosis and prognosis, implementing interventions to reduce or to eliminate the problems identified, and documenting the progress toward the desired functional outcome.1
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Every individual values the ability to live independently. The construct of function encompasses all those tasks, activities, and roles that identify a person as an independent adult or as a child progressing toward adult independence. These activities require the integration of both cognitive and affective abilities with motor skills. Functional activity is a patient-referenced concept and is dependent on what the individual self-identifies ...