Functional & Activities Questionnaire
Functional Activities Questionnaire (FAQ) Instructions
This questionnaire surveys your views about how your injury or condition affects how you are functioning with everyday activities, also known as activities of daily living (ADL). These include basic physical activities, household activities, and personal hygiene activities. This information will help you and your doctor know how you feel and how well you are able to perform your daily routine at this time. Please answer every question as best you can, based upon how you have been feeling and functioning over the past few weeks. If you are not sure, choose the answer that you think is correct. Tap on the number from 0 to 10 along the line to show how much your injury or condition has affected you (from 0-having no difficulty at all, to 10-having the most severe difficulty or worst problem you can imagine). Tap on the amount of time along the line to show how long you are able to do an activity before it starts to bother you and you have to stop, switch positions or take a rest. You must answer ALL questions as best you can.
FAQ Discussion
According to the US Department of Health and Human Services, activities of daily living (ADL) “are the basic tasks of everyday life, such as eating, bathing, dressing and toileting”. Research has found that the ability to perform ADL is a result of a complex interaction between the neurocognitive, neuropsychological and musculoskeletal systems that determine how a medical condition and functional limitations affect actual performance. Some ADL includes basic tasks that are potentially observable in an office setting, such as sitting, standing, and dressing. Pronounced gait difficulty can readily be observed using a simple walking task in an office setting, but ability to carry out important daily functions such as walking distances, negotiating stairs or going shopping is best assessed through self-reports. Additionally, many activities such as bathing and toileting would almost never be directly assessed outside of an institutional setting. In practice, the extent of ADL impairment is often determined by self-reported surveys or questionnaires. The literature shows that these are reliable and self-reported assessments of functional ability are also significantly associated with objective measures of health and performance based measures of function. The National Institute of Health (NIH) has endorsed “patient reported outcome (PRO) measurement tools that use recent advances in information technology, psychometrics, and qualitative, cognitive, and health survey research to measure PROs such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality-of-life across a variety of chronic diseases.” Self-reported ADL surveys, such as the FAQ, provide information required by a clinician to assess a wide range of ADL that is essential to a patient’s daily routine. Primary goals of a treatment program include improving the quality of life by reducing difficulty with ADL and maintaining independence. These survey results will be used to institute appropriate medical treatment and to monitor progress.
There are numerous ADL questionnaires available and there are a variety published by the NIH and the NYS Workers’ Compensation Board. However, many of these are limited by focus on a specific condition (such as the low back or dementia), focus on a specific subset of patients (such as the geriatric population), lack of adequate quantitative measurement of ADL impairment and/or a failure to assess a wide range of ADL. The FAQ is a 28 question self-reported survey that provides both quantitative and qualitative data regarding a patient’s level of function, independence and ability to perform many ADL. According to the US Bureau of Labor Statistics, Occupational Requirements Survey, in 2018 workers spent an average of 3.18 hours sitting and 4.35 hours standing or walking during a work day. Accordingly the activities of sitting, standing and/or walking are weighted in this FAQ and account for 30% of the total FAQ score. There are a total of 23 quantitative questions that are scored from 0, no difficulty or limitation to 10, severe difficulty or limitation and total scores range from 0 to 230. Higher scores are indicative of higher levels of difficulty with ADL and decreased levels of function. There are also a total of 5 qualitative questions that provide further information about ADL and ability to function independently.
Interpretation
Total score
- 0-45 minimal or mild functional impairment
- 46-92 mild/moderate functional impairment
- 93-138 moderate functional impairment
- 139-184 moderate/severe functional impairment
- 185-230 severe functional impairment
The results of this FAQ are useful in assessing the patient’s perception of pain, loss of function and affect on ADLs. The results will be maintained in the patient’s chart and will serve as marker to measure response to the treatments that the patient is receiving and will help determine if the treatment plan is working or alternative treatments are required.
Sincerely,
Aric Hausknecht, MD
Stacey Jaff, MD
Jason Maas, PA