Synonyms

FAQ; Functional activities questionnaire; PFAQ

Definition

The Functional Activities Questionnaire (FAQ) is a screening diagnostic tool directed at evaluating independence in activities of daily living (ADL). It was designed to be used in population-based studies (research) on mildly senile dementia and normal aging, although its use has expanded to clinical, acute, and primary care, rehabilitation, assisted living, and home settings.

Description

The FAQ is a commonly used social function scale measuring the current level of performance of ten daily tasks (see Table 1) that may be impaired by dementia, such as handling personal finance, shopping alone, remembering arrangements, using transport, or preparing a meal (Pfeffer et al. 1982). This tool was intended to cover universal skills among older people (McDowell 2006) and supposed to be independent of socioeconomic status, educational level, and intelligence of patients (Pfeffer et al. 1981). Some overlap with activities, and descriptions of the Lawton Instrumental Activities of Daily Living scale were accepted (Lawton IADL scale) (Lawton and Brody 1969).

Table 1 Summary of the FAQ scale
Full size table

The FAQ instrument was evaluated by Pfeffer and colleagues (Pfeffer et al. 1981) in the context of a study of 195 adults between the ages of 61 and 91, living in a stable retirement community of 22,000 people. The study exclusion criteria were severe senile dementia of the Alzheimer type or dementia of other known causes. All the participants completed a standardized medical history questionnaire, three cognitive tests, and a self-reported depression symptom scale developed by the Center for Epidemiologic Studies Depression Scale (Weissman et al. 1977). Each participant was examined by both a nurse with extensive training in neurology and an experienced neurologist (Pfeffer et al. 1982).

In this initial evaluation, the total reliability for all the FAQ items was higher than 0.80, its correlation with their estimates on the Lawton IADL scale scored 0.72 (Pfeffer et al. 1982), and the inter-rater reliability between the reviewing and examining neurologist was excellent (r = 0.97).

The FAQ instrument is not self-administered, but it requires an informant. The instrument must be answered by a relative who knows and has observed the person (named patient in the instrument), such as a spouse or child, a caregiver, or a friend. For each of the ten activities in the questionnaire, the informant must classify the performance of the patient as dependent (score 3), requiring assistance (score 2), having difficulty but doing it by him/herself (score 1), or doing by her/himself (score 0). Two additional choices are added for activities not normally performed by the person. In these cases, the informant must specify if the person is capable of undertaking the activity if required (score 1), or if she/he would have difficulties or would be unable to perform it (score 0). In contrast to other IADL instruments, FAQ scale levels are defined mostly in terms of social function rather than physical capacities (McDowell 2006). The total score is the simple sum of the individual item scores, ranging from zero to 30, and the higher the score, the higher the level of inability to perform the described tasks. The completion of the questionnaire takes around 10 min.

FAQ has shown to be a consistently accurate instrument. In further studies, the Pfeffer FAQ has shown to be good, even better than the Lawton IADL scale, to discriminate between demented and non-demented older people, and between mildly demented and non-demented (Juva et al. 1997; Teng et al. 2010). Furthermore, the instrument has shown to be useful in the assessment of patients with cognitive deterioration at the initial stages (Rios et al. 2001).

In a systematic review and meta-analysis, IADL scales in general (PFAQ, Dementia Scale, and Lawton IADL scale) showed to be reasonably accurate to screen dementia, especially among subjects with more advanced deterioration levels (Castilla-Rilo et al. 2007). A review by the US Preventive Services Task Force (U.S. Preventive Services Task Force 2005) concluded that the FAQ instrument can detect dementia with a sensitivity and specificity similar to those of the mini-mental state examination (MMSE), although this assesses functional limitations rather than cognitive impairment (dementia) which PFAQ does.

A Chilean study validated a combination of the MMSE and FAQ as a screening test with good sensitivity and specificity for the diagnosis of dementia. Sensitivity for the MMSE was 93.6% (95% CI 70.6–99.7%), and specificity was 46.1% (95% CI 34.7–57.8%) for a cutoff point of 21/22. The FAQ instrument mainly added specificity to the screening (70.7%; 95% CI 58.9–80.3%), with a sensitivity of 89.2% (95% CI 70.6–99.7%). The combined use of both instruments resulted in a sensitivity of 94.4% (95% CI 58.9–80.3%) and a specificity of 83.3% (95% CI 72.3–90.7%) for the diagnosis of dementia (Quiroga et al. 2004).

The FAQ is appropriate and has provided consistent results across different professions and settings: research; clinical settings, acute and primary care; rehabilitation; and also at home., Its sensitivity and specificity has shown to be adequate in the diagnosis of different forms of dementia and monitoring changes across the time . Some authors, however, have pointed out that this instrument includes activities that are inappropriate outside the type of sociocultural social setting in which it was developed (Mathuranath et al. 2005). A cultural adaptation and validity study of the instrument should be performed if it to be applied in sociocultural settings different to that (i.e., Western industrialized countries). Otherwise, the validity of the instrument could be affected.

Summarizing, the FAQ is an accurate and reliable instrument to screen the independent performance of daily tasks among older adults. Like other functional instruments, the FAQ offers the advantages of adaptability of various types of settings and patients, acceptability by subjects, easy administration, and in some cases cross-cultural portability (U.S. Preventive Services Task Force 2005). The instrument is widely used in assessing the functional status in studies of dementia with a good validity, apparently superior to those obtained by the Lawton IADL scale (McDowell 2006).

It can discriminate among different functional levels of individuals; predict neurological exam ratings and mental status scores, as well as detect functional changes over time (Weintraub et al. 2009). One of the limitations of the instrument is that the questionnaire must be answered by a caregiver or a lay informant and some persons (patients) do not have one.

Cross-References