Brief Validated Functional Status Questionnaires for Activities of Daily Living
Primary Recommendation
The Barthel Index is the most appropriate brief validated functional status questionnaire for assessing activities of daily living, with strong reliability, validity, and ease of application across clinical and epidemiological settings. 1
Evidence-Based Tool Selection
Barthel Index (Recommended)
- Measures 10 basic activities of daily living with quantitative estimation of dependency level 1
- High reliability and validity demonstrated across multiple studies, with strong criterion-related validity and inter-rater reliability (ICC 0.99) 2
- Easy to apply and interpret with immediate adaptation to different cultural environments 1
- Capable of detecting functional changes over time, making it suitable for monitoring rehabilitation progress 1
- Acceptable distribution and high internal consistency (alpha coefficient ≥0.84) with high responsiveness (standardized response mean ≥1.2) 3
Modified Barthel Index (Alternative)
- Five-point rating system provides more granular assessment than the original two-to-four point system 2
- Performance Evaluation Tool based on Modified Barthel Index (PET-MBI) shows strong criterion-related validity (correlation coefficient 0.95) and high inter-rater reliability (ICC 0.99) 2
- Specific predictive items vary by population: feeding, personal hygiene, bladder, and transfers predict outcomes in neurological patients, while personal hygiene, dressing, and bladder predict outcomes in orthopedic patients 4
Functional Status Questionnaire (FSQ)
- Brief, self-administered questionnaire designed for ambulatory patients in primary care settings 5
- Comprehensive assessment covering physical, psychological, social, and role function 5
- Can be completed and computer-scored in minutes producing a one-page report with six summated-rating scale scores and six single-item scores 5
- Reliable subscales with construct validity demonstrated in 1,153 primary care patients 5
Comprehensive Geriatric Assessment Context
When assessing functional status in older adults specifically, the American Geriatrics Society recommends:
- Standardized tools measuring both ADLs and Instrumental Activities of Daily Living (IADLs) for comprehensive functional assessment 6
- Lawton IADL Scale for assessing complex activities necessary for independent community living 6
- Monitoring changes in ADL scores from baseline through hospitalization and discharge for early detection of functional decline 6
Clinical Application Algorithm
Step 1: Select Appropriate Tool
- For inpatient rehabilitation or stroke patients: Use Barthel Index or Modified Barthel Index 1, 2
- For primary care ambulatory patients: Use Functional Status Questionnaire 5
- For comprehensive geriatric assessment: Combine ADL tools with IADL assessment 6
Step 2: Administration
- Barthel Index: Can be administered by direct observation or video evaluation with high reliability 2
- FSQ: Self-administered by patient in clinical waiting area 5
Step 3: Interpretation
- Barthel Index total scores provide quantitative dependency level 1
- Specific item performance predicts discharge outcomes and guides rehabilitation planning 4
- Serial assessments track functional changes over time 6, 1
Important Clinical Considerations
Advantages of Barthel Index
- No problematic application issues in clinical practice 1
- High level of reliability and validity across diverse populations 1, 2
- Standard of comparison for other functional assessment scales 1
Limitations to Recognize
- 5-item Barthel Index (BI-5) shows notable floor effect at admission and limited discriminative ability for patients with severe disability, though it maintains adequate responsiveness 3
- Functional capacity field tests (like 6-minute walk) do not correlate strongly with self-reported ADL performance, requiring both types of assessment 7
Avoid Common Pitfalls
- Do not rely solely on patient self-report without informant input, as this may lead to inaccurate assessment due to variable insight into functional changes 6
- Do not use exercise capacity tests alone as surrogate measures for functional ADL evaluation 7
- Ensure standardized, validated, and reproducible assessments for reliable results 6