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Rehab Measures: Emory Ambulation Profile; Modified Functional Ambulation Profile

Link to instrument

 

Title of Assessment

Emory Ambulation Profile; Modified Functional Ambulation Profile 

Acronym

EFAP, mEFAP

Instrument Reviewer(s)

Initially reviewed by Connie Fiems, MPT, NCS in 11/2012.

Summary Date

2/1/2013 

Purpose

To assess functional ambulation in terms of assistance and time under 5 different environmental variables.

Description

Emory Functional Ambulation Profile (Wolf et al, 1999)

  • A timed measure of walking under 5 environmental challenges.
  • Continuous timed score
  • Time each subtask and multiply that time by the appropriate factor according to the level of assistive device used during the task.
    • No assistance x 1
    • AFO x 2
    • Single point cane x 3
    • Hemi-walker or quad cane x 4
    • AFO + single point cane x 5
    • AFO + hemi-walker or AFO + quad cane x 6.
    • The totals for each of the 5 subtasks are then summed.

Modified Emory Functional Ambulation Profile (Baer and Wolf, 2001)

  • Allows for manual assistance to be provided and is recorded separately from the timed data in accordance with an ordinal scale.

Area of Assessment

 

Body Part

 

ICF Domain

Activity 

Domain

 

Assessment Type

 

Length of Test

06 to 30 Minutes 

Time to Administer

20 minutes

Number of Items

5 items 

Equipment Required

  • Stop watch
  • Chair with arm rests and 46cm seat height
  • Measuring tape
  • Brick
  • Hard surface flooring at least 7 meters
  • Carpet: 7 meter long x 2 meter wide
  • 40 gallon rubber trash can
  • 4 Steps with hand railings

Training Required

None necessary

Type of training required

No Training 

Cost

Free 

Actual Cost

Cost of equipment

Age Range

 

Administration Mode

 

Diagnosis

Stroke 

Populations Tested

  • Stroke

Standard Error of Measurement (SEM)

Modified Emory Functional Ambulation Profile:

Subacute Stroke: (Liaw et al 2006; n=40; mean age = 57.45 (10.98) years; mean time post stroke = 33 days (range 20-52 days))

Floor

.23sec

Carpet

.09sec

Up & Go

.77sec

Obstacles

.95sec

Stairs

1.14sec

Total

2.60sec

Modified Functional Ambulation Profile

Subacute Stroke (Baer et al 2001; n = 26; mean age 54.5 (12.7) years; mean time post stroke 32.2 (13.7) days.)

  • SEM 3.19 calculated from: square root 1-ICC(.998) x Initial SD(71.5)

Minimal Detectable Change (MDC)

Modified Functional Ambulation Profile:

Subacute Stroke: (Liaw et al 2006)

  • 7.18 (calculated from: 1.96 x SEM(2.60) x square root of 2)

Modified Functional Ambulation Profile:

Subacute Stroke: (Baer et al 2001)

  • 8.81 (calculated from: 1.96 x SEM(3.19) x square root of 2)

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Not Established

Test-retest Reliability

Modified Emory Functional Ambulation Profile:

Chronic Stroke: (Liaw et al 2006; n= 20; > 1yr post stroke; mean age 55yrs)

  • Excellent for subtask and total scores with all ICCs> 0.97 and lower limits of 95% CI > 0.93

Modified Emory Functional Ambulation Profile:

Subacute Stroke: (Baer et al 2001)

  • Excellent for subtasks with all ICC’s > 0.985 and total ICC = 0.99

Interrater/Intrarater Reliability

Emory Functional Ambulation Profile:

Chronic Stroke: (Wolf et al, 1999; n = 56; mean age 56 (12.8) years; of those, 28 subjects with stroke; mean time post stroke 13.59 (12.3) months)

  • Excellent interrater reliability in subjects with strokes ICC=.99

Modified Functional Ambulation Profile:

Subacute Stroke: (Baer et al 2001)

  • Excellent interrater reliability in subjects with stroke: all subtasks ICC > .985 and total ICC = .99

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

 

Emory Functional Ambulation Profile:

Chronic Stroke: (Wolf et al, 1999)

  • Excellent correlations with 10 Meter Walk test (r=-.71 to -.78)
  • Excellent correlations with Berg Balance Scale (r=-.59 to - .60)
  • Adequate correlation with Functional Reach Test (r=-.30 to - .36)

Modified Emory Functional Ambulation Profile:

Sub-acute Stroke: (Baer et al 2001)

  • Excellent correlations with Berg balance test (r= -.74 on initial scores) and (r= -.70 on final scores)
  • Excellent correlation with the FAMm (r= -.69 on initial scores) and (r=-.78 on final scores)

Predictive validity:

Modified Emory Functional Ambulation Profile:

Subacute Stroke: (Liaw et al 2006)

  • Adequate predictive validity to the Barthel Index (r=-0.52, 95% CI-0.72, -0.25
  • Excellent predictive validity to the Rivermead Index scores at discharge (r= -0.78, 95% CI -0.88, -0.62)

Construct Validity (Convergent/Discriminant)

Convergent:

Modified Emory Functional Ambulation Profile:

Subacute Stroke: (Liaw et al 2006)

  • Excellent correlation with 10 Meter walk test (r= .88, 95% CI .78, .94 at admission and r= .93, 95% CI .87, .96 at discharge)
  • Excellent correlation with the Rivermead Mobility Index (Spearman’s r=-0.67, 95% CI -0.81, -0.45 at admission and r= -0.81, 95% CI -0.90, -0.67 at discharge)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Modified Emory Functional Ambulation Profile:

Subacute Stroke: (Liaw et al 2006)

  • Standardized response mean 1.1 with the change in mEFAP significant (paired t=6.8; p<0.001)

Modified Emory Functional Ambulation Profile:

Subacute Stroke: (Baer et al 2001)

  • Decreased timed scores in sub-acute stroke mean 16.03 + 4.68

Professional Association Recommendations

Considerations

  • Only tested on stroke populations.
  • Lack norms for subject age as well as minimal mEFAP values associated with successful household and community ambulation.
  • Lack of normality found in scores possibly due to range in severity of impairments and gait dysfunction.
  • The Modified EFAP contains structured procedures for recording manual assistance separately however it does not account for this in scoring as it was found that the time to complete the task was sufficient to demonstrate improvement.
  • No findings on effect size or MCID.
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Bibliography

Baer, H. R. and Wolf, S. L. (2001). "Modified emory functional ambulation profile: an outcome measure for the rehabilitation of poststroke gait dysfunction." Stroke 32(4): 973-979. Find it on PubMed

Liaw, L. J., Hsieh, C. L., et al. (2006). "Psychometric properties of the modified Emory Functional Ambulation Profile in stroke patients." Clin Rehabil 20(5): 429-437. Find it on PubMed

Wolf, S. L., Catlin, P. A., et al. (1999). "Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile." Phys Ther 79(12): 1122-1133. Find it on PubMed

Year published

 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 2/1/2013 12:59 PM  by Jason Raad 
Last modified at 12/4/2013 5:48 PM  by Jason Raad