Functional Autonomy Measurement System (SMAF)

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).    

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