Validating The Use Of The Functional Autonomy Measurement System (SMAF) For Routine Assessment Of Activities Of Daily Living Within The Australian Hospital Setting

Introduction: Function is routinely assessed by occupational therapists. Methods used to assess functional decline and ability include self-reported questionnaires, performance-based assessments and informant-based questionnaires. Inconsistency in approach to measuring function is common within occupational therapy. Objective: The aim of this study was to introduce a single, standardised measure of function across an area health service and evaluate the validity of the tool. Method: Patients seen by occupational therapists between March and December 2013 across the physical services of an area health service in Melbourne were included in this cross-sectional study. The Functional Autonomy Measurement System (SMAF) was administered on admission to all patients; scoring methodology modifications were necessary to differentiate resource need from resources already in place in the home. Internal consistency reliability was tested and factor analysis was used to determine whether items load onto their hypothesised SMAF subscales. Results: N = 5082 adults (52% male, average age 66 years) participated. On admission, the mean total score was –16 (SD = 14.5) suggestive of large occupational therapy needs in the population assessed. The greatest limitations in functional autonomy were noted in the subtest of instrumental activities of daily living, while the least were noted in the subtest of communication. Factor analysis suggested variables loaded onto five factors (not the hypothesised six subtests). A revised version of the SMAF is suggested by these results. Conclusion: As function is acknowledged to be the most frequently assessed outcome in occupational therapy, its accurate measurement and assessment is essential to our profession.