Rationale for new R-ACFI Mobility Questions The following gives the rationale for modifying the current ACFI Mobility question. Relevant Assessment Tools Review The NSAF collects information about walking and transfers: For walking the person is: rated on a 3-point scale (Without help -except for walking stick or similar; With some help from a person or with the use of a walker or crutches etc.; Completely unable to walk). If there is difficulty, it then asks: who assists, and is the assistance episodic. For transfers the person is: rated on a 4-point scale of (Independent; Minor Help -verbal or physical; Major help or two people, physical, can sit; Unable- no sitting balance); If there is difficulty, it then asks: who assists, and will assistance be needed. Further comments on the physical domain are collected (not mandatory, with prompts) - why does the person need assistance, what is the underlying problem, what activities can they do themselves and what do they have difficulty with, is the person likely to benefit from reablement, in what area, referral to allied health/aids and equipment? The supplementary functional tools are OARS-ADL, Barthel Index of ADL, and KICA-ADL. These supplementary tools primarily record assessment outcomes – they do not explain the reason why the care is needed. The NSAF items do not give a rationale for the ADL assessment outcome, which is both clinically important and would also strengthen the objectivity of the assessment. The interRAI mobility items cover two mobility items in the ADL self-performance section: Walking (how the person walks between locations on same floor indoors) Locomotion (how the person moves between locations on same floor). These two items rate the person on a detailed seven-point scale: Independent Set up help only Supervision-oversight Limited assistance - guiding with no weight bearing Extensive assistance - weight bearing assistance for less than 50 per cent of subtasks Maximal assistance - weight bearing assistance for more than 50 per cent of subtasks or more than two helpers Total dependence - full performance by others.
Rationale for new R-ACFI Mobility Questions The following gives the rationale for modifying the current ACFI Mobility question. Relevant Assessment Tools Review The NSAF collects information about walking and transfers: For walking the person is: rated on a 3-point scale (Without help -except for walking stick or similar; With some help from a person or with the use of a walker or crutches etc.; Completely unable to walk). If there is difficulty, it then asks: who assists, and is the assistance episodic. For transfers the person is: rated on a 4-point scale of (Independent; Minor Help -verbal or physical; Major help or two people, physical, can sit; Unable- no sitting balance); If there is difficulty, it then asks: who assists, and will assistance be needed. Further comments on the physical domain are collected (not mandatory, with prompts) - why does the person need assistance, what is the underlying problem, what activities can they do themselves and what do they have difficulty with, is the person likely to benefit from reablement, in what area, referral to allied health/aids and equipment? The supplementary functional tools are OARS-ADL, Barthel Index of ADL, and KICA-ADL. These supplementary tools primarily record assessment outcomes – they do not explain the reason why the care is needed. The NSAF items do not give a rationale for the ADL assessment outcome, which is both clinically important and would also strengthen the objectivity of the assessment. The interRAI mobility items cover two mobility items in the ADL self-performance section: Walking (how the person walks between locations on same floor indoors) Locomotion (how the person moves between locations on same floor). These two items rate the person on a detailed seven-point scale: Independent Set up help only Supervision-oversight Limited assistance - guiding with no weight bearing Extensive assistance - weight bearing assistance for less than 50 per cent of subtasks Maximal assistance - weight bearing assistance for more than 50 per cent of subtasks or more than two helpers Total dependence - full performance by others.
acfi_review_report_part_3_appendices.docx