Functional Autonomy Measurement System (SMAF)

Hébert‚ 1984‚ revised 1993‚ 2001

A. ACTIVITIES OF DAILY LIVING (ADL)

· Feeds self independently

· With difficulty

· Feeds self but needs stimulation or supervision OR food must be prepared or cut or puréed first

· Needs some help to eat OR dishes must be presented one after another

· Must be fed totally by another person OR has a naso-gastric tube or a gastrostomy

naso-gastric‚ tube gastrostomy

2. WASHING

· Washes self independently (including getting in or out of the bathtub or shower)

· With difficulty

· Washes self but needs cueing‚ OR needs supervision‚ OR needs preparation‚ OR needs help for the complete weekly bath‚ only (including washing feet and hair)

· Needs help for the daily wash but participates actively

· Must be washed by another person

3. DRESSING (all seasons)

· Dresses self independently

· With difficulty

· Dresses self but needs cueing‚ OR needs supervision‚ OR clothing must be readied and presented‚ OR needs help for finishing touches (buttons‚ laces)

· Needs help dressing

· Must be dressed by another person

support hose/stocking

4. GROOMING

(brushes teeth or combs hair or shaves or trims finger or toenails or puts on make-up)

· Grooms self independently

· With difficulty

· Grooms self but needs cueing or supervision

· Needs help for grooming

· Must be groomed by another person

5. URINARY FUNCTION

· Normal voiding

· Occasional incontinence‚ OR dribbling‚ OR needs frequent cueing to avoid incontinence

· Frequent urinary incontinence

· Complete urinary incontinence‚ OR wears a diaper or an indwelling catheter or a urinary condom

diaper‚ indwelling catheter‚ urinary condom

day incontinence‚ night incontinence

6. BOWEL FUNCTION

· Normal bowel function

· Occasional incontinence‚ OR needs cleansing enema occasionally

· Frequent incontinence‚ OR needs cleansing enema regularly

· Always incontinent‚ OR wears a diaper or an ostomy

diaper‚ ostomy

day incontinence‚ night incontinence

7. TOILETTING

· Toilets self (including getting on/off toilet‚ wiping self and managing clothing)

· With difficulty

· Needs supervision for toileting‚ OR uses commode‚ bedpan or urinal

· Needs help to go to the toilet‚ OR use commode‚ bedpan or urinal

· Does not use toilet‚ commode‚ bedpan or urinal

commode‚ bedpan‚ urinal

B. MOBILITY

1. TRANSFERS (bed to chair or wheelchair and to stand‚ and vice-versa)

· Gets in and out of bed or chair alone

· With difficulty

· Gets in and out of bed/chair alone but needs cueing‚ supervision or guidance
specify: ______________________________________

· Needs help to get in and out of bed/chair
specify: ______________________________________

· Bedridden (must be lifted in and out of bed)

particular positioning:

lift‚ transfer board

2. WALKING INSIDE (including in the building and going to the elevator)

· Walks independently (with or without cane‚ prosthesis‚ orthosis or walker)

· With difficulty

· Walks independently but needs guidance‚ cueing or supervision in certain circumstances OR unsafe gait

· Needs help of another person to walk

· Does not walk

cane‚ tripod‚ quadripod‚ walker

*Distance of at least 10 meters

3. DONNING PROSTHESIS OR ORTHOSIS

· Does not wear prosthesis or orthosis

· Dons prosthesis or orthosis independently

· With difficulty

· Donning of prosthesis of orthosis needs checking‚ OR needs partial help

· Prosthesis or orthosis must be put on by another person Type of prosthesis or orthosis:

4. PROPELLING A WHEELCHAIR (W/C) INSIDE

· Does not need a wheelchair

· Propels wheelchair independently

· With difficulty

· Needs to have wheelchair pushed

· Unable to use wheelchair (must be transported on stretcher)

standard wheelchair

wheelchair with unilateral axis

motorized wheelchair

three wheeled scooter

four wheeled scooter

5. NEGOTIATING STAIRS

· Goes up and down stairs independently

· With difficulty

· Requires cueing‚ supervision or guidance to negotiate stairs OR does not safely negotiate stairs

· Needs help to go up and down stairs

· Does not negotiate stairs

6. MOVING AROUND OUTSIDE

· Walks independently (with or without cane‚ prosthesis‚ orthosis or walker)

· With difficulty

· Uses a wheelchair or scooter independently
W/C with difficulty
OR walks independently but needs guidance‚ cueing‚ or supervision in certain circumstances‚ OR unsafe gait1

· Needs help of another person to walk1‚ OR to use W/C

· Cannot move around outside (must be transported on a stretcher)

1 Distance of at least 20 meters

C. COMMUNICATION

1. VISION

· Sees adequately with or without corrective lenses

· Visual problems but sees enough to do ADLs

· Only sees outlines of objects and needs guidance in ADLs

· Blind

corrective lenses‚ magnifying glass

2. HEARING

· Hears adequately with or without hearing aid

· Hears if spoken to in a loud voice‚ OR needs hearing aid put in by another person

· Only hears shouting or certain words‚ OR reads lips‚ OR understands gestures

· Completely deaf and unable to understand what is said to him/her

hearing aid

3. SPEAKING

· Speaks normally

· Has a speech/language problem but able to express him/herself

· Has a major speech/language problem but able to express basic needs
OR answer simple questions (yes‚ no)
OR uses sign language

· Does not communicate technical aid:
computer
communication board

D. MENTAL FUNCTIONS

1. MEMORY

· Normal memory

· Minor recent memory deficit (names‚ appointments‚ etc.) but remembers important facts

· Serious memory lapses (shut off stove‚ medications‚ putting things away‚ eating‚ visitors)

· Almost total memory loss or amnesia

2. ORIENTATION

· Oriented to time‚ place and persons

· Sometimes disoriented to time‚ place and persons

· Only oriented for immediate events (i.e.‚ time of day) and in the usual living environment and with familiar persons

· Complete disorientation

3. COMPREHENSION

· Understands instructions and requests

· Slow to understand instructions and requests

· Partial understanding even after repeated instructions OR is incapable of learning

· Does not understand what goes on around him/her

4. JUDGMENT

· Evaluates situations and makes sound decisions

· Evaluates situations but needs help in making sound decisions

· Poorly evaluates situations and only makes sound decisions with strong suggestions

· Does not evaluate situations and dependent on others for decision making

5. BEHAVIOUR

· Appropriate behaviour

· Minor behavioural problems (whimpering‚ emotional lability‚ stubbornness‚ apathy) requiring occasional supervision or a reminder or stimulation

· Major behavioural problems requiring more intensive supervision (aggressive towards self or others‚ disturbs others‚ wanders‚ screams out constantly)

· Dangerous‚ requires restraint OR harmful to others or self-destructive OR tries to run away

E. INSTRUMENTAL ACTIVITIES OF DAILY LIVING

1. HOUSEKEEPING

· Does housekeeping alone (including daily housework and occasional big jobs)

· With difficulty

· Does housekeeping but needs supervision or cueing to ensure cleanliness (including washing the dishes) OR needs help for big jobs (floors‚ windows‚ painting‚ lawn‚ clearing the snow‚ etc.)

· Needs help for daily housework

· Does not do housework

2. MEAL PREPARATION

· Prepares own meals independently

· With difficulty

· Prepares meals but needs cueing to maintain adequate nutrition

· Only prepares light meals OR heats up pre-prepared meals (including handling the plates)

· Does not prepare mea

3. SHOPPING

· Plans and does shopping independently (food‚ clothes)

· With difficulty

· Plans and shops independently but needs delivery service

· Needs help to plan or shop

· Does not shops

4. LAUNDRY

· Does all laundry independently

· With difficulty

· Does laundry but needs cueing or supervision to maintain standards of cleanliness

· Needs help to do laundry

· Does not do laundry

5. TELEPHONE

· Uses telephone independently (including use of directory)

· With difficulty

· Answers telephone but only dials a few memorized numbers or emergency numbers

· Communicates by telephone but does not dial numbers or lift the receiver off the hook

· Does not use the telephone

6. TRANSPORTATION

· Able to use transportation alone (car‚ adapted vehicle‚ taxi‚ bus‚ etc.)

· With difficulty

· Must be accompanied to use transportation OR uses paratransit independently

· Uses car or paratransit only if accompanied and has help getting in and out of the vehicle

· Must be transported on a stretcher

7. MEDICATION USE

· Takes medication according to prescription OR does not need medication

· With difficulty

· Needs weekly supervision (including supervision by telephone) to ensure compliance to prescription OR uses a medication dispenser aid (prepared by someone else)

· Takes medication if prepared daily

· Must be given each dosage of medications (as prescribed) medication dispenser aid

8. BUDGETING

· Manages budget independently (including banking)

· With difficulty

· Needs help for certain major transactions

· Needs help for some regular transactions (cashing checks‚ paying bills) but uses pocket money wisely

· Does not manage budget

Scoring/Interpretation: For each item‚ the disability is scored on a 5-level scale: 0 (independent)‚ -0.5 (with difficulty)‚ -1 (needs supervision)‚ -2 (needs help)‚ -3 (dependent) (Hebert et al.‚ 2001).

This instrument can be found at: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf

Hébert‚ R.‚ Carrier‚ R.‚ & Buodeau‚ A. (1984). Le système de mesure de l’autonomie fonctionnelle: description d’un instrument de mesure des handicaps. In W. Van Eimeren‚ R. Engelbrecht‚ & C.D. Fiagle (Eds.)‚ Third International Conference on System Science in Health Care (pp.241-244). Berlin: Springer-Verlag.

Hébert‚ R.‚ Carrier‚ R.‚ & Bilodeau‚ A. (1988). The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age and Ageing‚ 17(5)‚ 293-302.

Desrosiers‚ J.‚ Bravo‚ G.‚ Hébert‚ R.‚ & Dubuc‚ N.‚ A. (1995). Reliability of the Revised Functional Autonomy Measurement System (SMAF) for Epidemiological Research‚ Age and Ageing‚ 24:402-406

Hébert‚ R.‚ Guilbault‚ J.‚ Desrosiers‚ J.‚ & Dubuc‚ N. (2001). The functional autonomy measurement system (SMAF): A clinical-based instrument for measuring disabilities and handicaps in older people. Geriatrics Today: Journal of Canadian Geriatric Society‚ Sept. 2001‚ 1-7.

Pinsonnault‚ E.‚ Desrosiers‚ J.‚ Dubuc‚ N.‚ Kalfat‚ H.‚ Colvez‚ A.‚ & Delli-Colli‚ N. (2003). Functional autonomy measurement system: development of a social subscale. Archives of Gerontology and Geriatrics‚ 37‚ 223-233.

McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS

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Related terms:

Requst a

Scale