Frenchay Activities Index

Last Updated

August 09, 2019

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.

Link to Instrument

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

Stroke

Older Adults and Geriatric Care

Non-Specific Patient Population

Limb Loss and Amputation

Brain Injury

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

Pencil and form

5 minutes

Required Training

No Training

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):
http://www.neuroloxia.com/wp-content/uploads/2009/06/escalas_en_neurologia_marzo.pdf

Spanish (p288):
http://www.societe-francaise-neurovasculaire.fr/wp-content/uploads/2012/10/Rapport_HAS_Evaluation_fonctionnelle_AVC_ref.pdf

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 excellent 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 excellent 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 adequate (ICC = 0.59 for Leisure/work) to excellent (ICC = 0.77 for Domestic and Outdoors).

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Standard Error of Measurement (SEM)

Stroke:

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

SEM = 2.4

(Lin et al, 2012; n = 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 (r = 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; n = 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; n = 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

Minimal Detectable Change (MDC)

Elderly:

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

MDC value = 8.64

Test/Retest Reliability

Elderly:

(McPhail et al, 2009; n = 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 (r = 0.61)
Adequate concurrent validity with Activities-specific Balance Confidence scale (r = 0.55)
Adequate concurrent validity with Timed Up & Go test (r = -0.68)

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)

· 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%)

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%)

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)

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Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Cut-Off Scores

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Construct Validity

Content Validity

Floor/Ceiling Effects

Responsiveness

Minimal Detectable Change (MDC)

Test/Retest Reliability

Criterion Validity (Predictive/Concurrent)

Normative Data

Test/Retest Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Floor/Ceiling Effects

Normative Data

Test/Retest Reliability

Floor/Ceiling Effects

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Normative Data

Test/Retest Reliability

Bibliography

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