How Physical Function Is Assessed for Osteoarthritis

Healthcare providers and researchers use several questionnaires that have been established as reliable tools for assessing the function of osteoarthritis patients. Not only do the assessments provide practitioners with information about a patient's current level of function, but the assessments can also be compared for the purpose of identifying functional decline or improvement.

Assessment Tools

Popular assessments used to determine functional ability in osteoarthritis patients include the following.

• The Lequesne Algofunctional Index: The Lequesne Index is a 10-question survey given to patients with osteoarthritis of the knee. It has five questions pertaining to pain or discomfort, one question dealing with maximum distance walked, and four questions about activities of daily living. The total questionnaire is scored on a zero to 24 scale. Lower scores indicate there is less functional impairment.
• The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): The WOMAC osteoarthritis index is composed of 24 items in three subscales that evaluate pain (five questions), physical function (17 questions), and stiffness (two questions).
• Katz Index of Independence in Activities of Daily Living: Bathing, dressing, toileting, transferring, continence, and feeding are assessed in the Katz Index of Independence in Activities of Daily Living. One point is given for each activity that can be performed independently, while no points are given if help is needed. The score ranges from zero to 6, with 6 being highest and indicative of independence. A zero score reflects a patient that is very dependent.
• Instrumental Activities of Daily Living: The Instrumental Activities of Daily Living survey assesses the functional capabilities of older patients. The survey is based on eight criteria: use of a phone book to dial, answer, or find someone's phone number; traveling in a car or using public transportation; shopping for food or clothes; preparing meals; doing laundry; doing housework; using medications properly; and managing money. Patients are given either a score of 0 or 1 for each category. A low score indicates the patient is more dependent, whereas a high score indicates more independence.
• The Arthritis Impact Measurement Scale (AIMS): The Arthritis Impact Measurement Scale measures physical, social, and emotional well-being along nine dimensions: dexterity, mobility, pain, physical, social, and household activities, activities of daily living, depression, and anxiety.

Performance-Based Tests

Along with the surveys that are used to determine a patient's functional status, there are also some performance-based tests that are used to assess physical function. The performance tests may be more effective, in some cases, in predicting future disability than surveys. Some of the performance tests include:

• grip strength
• pinch strength
• manual dexterity
• timed walk
• standing from chair
• balance
• speed and mobility
• gait assessment

The Importance of Functional Assessment

It's very important for a patient to get his or her initial symptoms assessed so an accurate diagnosis can be formulated. It's important to begin appropriate treatment as soon as possible, but it doesn't stop there. Healthcare providers and patients must track how physical function is affected by osteoarthritis. What is the patient having problems with, and what solutions may be available? Functional assessment is just as important as diagnosis and treatment. It's a part of living with arthritis.