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The development of a patient-reported functional limitations index
Megan Mathews, Denis Agniel, Marc N Elliott1
1RAND Corporation, 1776 Main St, Santa Monica, CA 90401.
The American Journal of Managed Care
|July 17, 2020
Summary
A new Functional Limitations Index (FLI) effectively measures disability in community-dwelling adults. Mobility limitations most strongly impact self-rated health, guiding better patient care and monitoring.
Area of Science:
- Health Services Research
- Gerontology
- Public Health
Background:
- Assessing functional limitations is crucial for monitoring health and guiding interventions in community-dwelling populations.
- Existing measures may not capture the full spectrum of disability or be easily interpretable by patients and providers.
Purpose of the Study:
- To develop and validate an easy-to-interpret, patient-reported Functional Limitations Index (FLI).
- To assess and monitor the full spectrum of functioning in a community-dwelling population.
Main Methods:
- Utilized a nationally representative observational survey design.
- Employed self-rated health as a criterion to empirically assign weights to 5 National Health Interview Survey items (seeing, hearing, walking, cognition, self-care).
- Developed a respondent-level summary score using a model predicting self-rated health, accounting for nonlinear severity-self-rated health associations with splines.
Main Results:
- Mobility limitations showed the strongest association with self-rated health; sensory limitations had the weakest.
- The association between severity of limitation and self-rated health was nonlinear, with the largest impact observed when moving from no difficulty to some difficulty.
- Nationally, 5% of noninstitutionalized adults were classified as most limited, 8% as somewhat limited, and 87% as least limited.
Conclusions:
- The Functional Limitations Index (FLI) is a valid, easy-to-administer, and interpretable measure of disability.
- Health plans and organizations can use the FLI for quality-of-care monitoring to improve care for individuals with disabilities.
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