Development of a Language-Independent Functional Evaluation
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Pennsylvania Commonwealth System of Higher Education (PCSHE), Temple University, University of Ghana, University of Michigan, University of Michigan System, Vet Hosp Huntington
Haig AJ, Jayarajan S, Maslowski E, Yamakawa KS, Tinney M, Beier KP, Juang D, Chan L, Boggess T, Loar J, Owusu-Ansah B, Kalpakjian C. Development of a language-independent functional evaluation. Arch Phys Med Rehabil 2009;90:2074-80.
Objective: To design, validate, and critique a tool for self-report of physical functioning that is independent of language and literacy.
Design: Software design and 2 prospective trials followed by redesign.
Setting: United States and African university hospitals.
Participants: Outpatient and inpatient competent adults with diverse physical impairments.
Interventions: (1) Software design process leading to a Preliminary Language-Independent Functional Evaluation (Pre-L.I.F.E.); (2) patient surveys using a printed Pre-L.I.F.E. and a computer-animated Pre-L.I.F.E. tested in random order, followed by a questionnaire version of the standard Barthel Index; and (3) software redesign based on objective and qualitative experiences with Pre-L.I.F.E.
Main Outcome Measures: Validation of the general concept that written and spoken language can be eliminated in assessment of function. Development of a refined Language-Independent Functional Evaluation (LIFE.).
Results: A viable Pre-L.I.F.E. software was built based on design parameters of the clinical team. Fifty Americans and 51 Africans demonstrated excellent (Cronbach alpha>0.8 Americans) and good (alpha>.425 Africans) reliability. In general, the relations between Pre-L.I.F.E. and Barthel scores were excellent in the United States (interclass correlation coefficient for stair climbing, .959) but somewhat less good in Africa, with elimination functions very poorly related. The computer-animated Pre-L.I.F.E. was faster and trended to be more reliable than the printed Pre-L.I.F.E. in both the United States and Africa. Redesign meetings corrected statistical and qualitative challenges, resulting in a new tool, the L.I.F.E.
Conclusions: Literacy and language translation can be eliminated from some aspects of functional assessment. The new LIFE., based on solid empirical evidence and design principles, may be a practical solution to assessment of function in the global culture.