Functional Limitations Profile Research Articles

Development and Initial Validation of a Questionnaire for Measuring Fear-Avoidance Associated with Pain: The Fear-Avoidance of Pain Scale

Objectives: A scale to measure fear-avoidance in chronic musculoskeletal pain has been developed and its internal consistency, reliability, sensitivity to treatment change and concurrent validity was investigated.Methods: The Fear-Avoidance of Pain Scale [FAPS] was administered to 62 subjects at three time points: prior to entering a cognitive behavioral pain management program [pre-treatment], at completion of the program [post-treatment] and at a three month follow-up [follow-up]. Along with the FAPS, five other questionnaires were administered at each time point. These were; Visual Analog Scale, Zung Depression Scale, Pain-Related Self Statements [PRSS-Cat], Multidimensional Pain Inventory [MPI] and Functional Limitations Profile [FLP]. Changes in these measures due to the treatment were investigated as well as the relationship between measures.Results: The FAPS showed good internal consistency and reliability. There was a significant reduction in FAPS score from pre-treatment to post-treatment. At fol...

Evaluation of the effectiveness of a chronic pain management programme

Thirty-two chronic pain patients classified as dysfunc~onal (N=15); interpersonally distressed (N=9); or adaptive copers (N=8) on the West Haven-Yale Multidimensional Pain Inventory were evaluated before and aftera 3.5 week outpatient multimodal chronic pain management programme. Five patients also participated in a post-treatment focus group in which they gave accounts of their experiences of the programme. The three groups, which were demographically similar, did not differ in their response to the programme. There was an overall significant reduction (p<01) in mean depression scores on the Beck Depression Inventory and a near significant reduction (p<08) in mean scores on the functional limitations subscale of the Functional Limitations Profile when pre- and post-treatment scores were compared. There was no significant reduction in McGill Pain Questionnaire scores. A thematic content analysis of the focus group transcript showed that patients experienced ~he programme as improving their mood. their cap...

The Functional Limitations Profile may be a valid, reliable and sensitive measure of disability in multiple sclerosis.

This pilot study was designed to evaluate the usefulness of the Functional Limitations Profile (FLP), a validated interval measure of self-report of disability, in studies of multiple sclerosis (MS). It is compared with the standard measure of disability in MS, the Kurtzke Expanded Disability Status Scale (EDSS), and the Illness Severity Score (ISS), which is an interval score derived from the EDSS. Inherent problems of all measures are discussed. On two occasions separated by 6 months, 50 MS patients were assessed prospectively by a neurologist and a psychologist, using the above measures. Validity was reflected in correlation and in agreement between measures. The FLP Physical dimension correlated significantly with the EDSS for both visits (at visit 1: r = 0.77; at visit 2: r = 0.77). Agreement between the interval measures, FLP and ISS, was satisfactory (mean difference +0.18, SD 6.8). The reliability of FLP was assessed by comparing FLP Physical dimension scores in the 30 patients who had not changed clinically between visits (EDSS change < 1.0, ISS change < 3.8). For this unchanged group the mean difference was +0.56 (SD 6.2); the 95% confidence interval (CI) was -2.87 to +1.75. For sensitivity of the FLP the 20 MS patients who had clinically changed between visits were assessed (EDSS =/> 1.0, ISS =/> 3.8). For this changed group the mean difference was -8.0 (SD 9.21); 95% CI was -12.3 to -3.69. The FLP Physical dimension in this pilot study seems to be a valid, reliable and sensitive measure of MS disability. If confirmed by larger studies it would be useful in prospective clinical studies of treatments for MS.

Multi-dimensional measurement of need and outcome in physical disability

Collaboration between health and social services is important when assessing the needs of clients and evaluating outcomes resulting from planned interventions. This article looks at the reality of interprofessional collaboration in developing services for people with physical disabilities. It focuses on the use of formal measurement tools such as the Functional Limitations Profile and discusses the way in which such tools can be used. The possible mismatch between clients' own perception of need and that of professionals is highlighted. Furthermore, the use of qualitative research complements understanding, because it allows for contextual understanding of the FLP scores.

Impairment, disability and handicap in chronic respiratory illness

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. 92 patients suffering from COAD were interviewed in order to assess impairment, disability and handicap. Measures included spirometric tests of lung function; the Fletcher breathlessness grading scale, the oxygen cost diagram and a visual analogue scale of dyspnoea; the Functional Limitations Profile (FLP); and the shortened 12 item General Health Questionnaire (GHQ-12), supplemented by the 7-item GHQ sub-scales of anxiety and severe depression. Low correlations were found between lung function and disability (-0.38, P <0.001), accounting for only 14% of the variance, and high correlations were found to exist between measures of dyspnoea and disability (-0.90, P <0.001). Major areas of disability and handicap included; household management, ambulation, sleep and rest, recreation and pastimes and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper goes on to discuss both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families and for a complementary social perspective and approach to COAD and its treatment.

Services for disabled people; what criteria should we use to assess disability?*

The measure of disability used in the UK National Survey (NS) of disabled persons in 1969, based almost exclusively on self-care activities, was compared with the Functional Limitation Profile (FLP), a much broader measure of disability, on 748 disabled people in Lambeth. Two hundred and nine respondents were classified as severely/very severely disabled on the FLP compared with only 40 on the NS measure. Of the 209, 126 had either no disability or only minor disability on the NS instrument. These 126 persons were not significantly different to those persons with appreciable-to-very severe disability on the NS measure in their use of health and social services and in certain severe restrictions in ambulation, mobility and household management. We conclude that the NS measure fails to identify many disabled people who might need services. The NS measure is the DHSS recommended guide for Local Authority surveys to estimate need for services for the disabled. We recommend that the DHSS continue the evaluation and development of measures of disability.