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RehabMeasures Instrument

Emory Ambulation Profile; Modified Functional Ambulation Profile

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Purpose

The EFAP assesses functional ambulation in terms of assistance and time under 5 different environmental variables.

Link to Instrument

Acronym EFAP, mEFAP

Cost

Free

Populations

Key Descriptions

  • 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:
    1) No assistance x 1
    2) AFO x 2
    3) Single point cane x 3
    4) Hemi-walker or quad cane x 4
    5) AFO + single point cane x 5
    6) AFO + hemi-walker or AFO + quad cane x 6
    The totals for each of the 5 subtasks are then summed.
  • The 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.

Number of Items

5

Equipment Required

  • Stop watch
  • Chair with arm rests and 46cm seat height
  • 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 railing

Time to Administer

20 minutes

Required Training

No Training

Instrument Reviewers

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

Body Part

Lower Extremity

ICF Domain

Activity

Measurement Domain

Motor

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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Stroke

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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)

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

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:

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)

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.

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.

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.