BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet Test: Functional Autonomy Measurement System (SMAF) Year: 1984; revised 1993, 2003 Domain: Biological, Psychological Assessment Tool Category: Physical Functioning/ADLs Variations/Translations: Iso-SMAF; eSMAF; Originally developed in Canadian French; translations available in seven languages including English. Setting: Clinical Method of Delivery: In-person interview Description: The SMAF was developed according to the World Health Organization classification of disabilities. The SMAF measures functional ability based on clinical judgement following an interview with the client that can be supplemented by other sources of observation such as proxies, simulation, or actual observation tasks. The SMAF is comprised of a 29-item scale, which measures functional ability in 5 areas: activities of daily living (ADL) [7 items], mobility [6 items], communication [3 items], mental functions [5 items] and instrumental activities of daily living (IADL) [8 items]. The SMAF can also be used to assess if the available physical and social resources for a person with a disability are adequate (Hebert, Guilbault, Desrosiers, & Dubuc, 2001). 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). Time to Administer: Variable, depending on time required for observation. Availability: Contact Dr. R. Hebert for permission to use. Software: N/A Website: N/A Quantitative/Qualitative: Quantitative Validity (Quantitative): As the SMAF is based on a recognized conceptual framework and the selection of items was based on World Health Organization classification of disabilities, it has high content validity. When compared with the PLAISIR 84 (Planification informatisée des soins infirmiers requis) instrument – used to measure required nursing care time – a high correlation coefficient (0.88), indicating good concurrent validity, was noted (Hebert et al., 2001). When the SMAF was compared with the CTMSP (Classification par type en milieux de soins prolongés), a measure of nursing care time, the correlation coefficient was reported to be 0.92. Correlations between the SMAF and the Functional Independence Measure and between the SMAF and the Barthel Index were found to be high (r = 0.94 and r = 0.92, respectively). The SMAF was found to be capable of distinguishing between clients/patients with different needs (p < 0.01), indicating its high discriminant construct validity (Hebert et al., 2001). Reliability (Quantitative): Test-retest reliability for the original test was high, with an estimated intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval: 0.90 to 0.97). Interrater reliability was also found to be high, with an ICC of 0.96 (95% confidence interval: 0.93 to 0.98) (Hebert et al., 2001). Interrater reliability for the social functioning subscale, added to the 2003 version of the tool, was found to have an ICC of 0.83 (Pinsonnault et al., 2003). References: 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. 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. Comments: The 1993 revised version of the SMAF appears to currently be the most widely used version of the tool.