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Variable: Functional Status (Current to October 2008) Subcategories: Activities of Daily Living, Assessment, Cognitive, Dementia, Disability, Functional Status, Motor Performance, Physical Activity, Quality of Life, Respiratory VARIABLES SUBCATEGORY MEASURES AUTHOR WEBSITE/ JOURNAL/ BOOK/
REFERENCE PERMISSION/ COPYRIGHT/ CORRESPONDENCE
Functional Status Activities of Daily Living
Activities of Daily Living (ADL) Index
K. Sheikh, D. S. Smith, T.W. Meade, E. Goldenberg, E., P. J. Brennan & G. Kinsella
Sheikh, K., Smith, D. S., Meade, T. W., Goldenberg, E., Brennan, P. J., & Kinsella, G. (1979). Repeatability and validity of a modified Activities of Daily Living (ADL) Index in studies of chronic disability. International Rehabilitation Medicine, 1, 51-8. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 199). London: Martin Dunitz.
Functional Status Activities of Daily Living
Arc’s Self-Determination Scale M. L. Wehmeyer & N. Bolding
Wehmeyer, M. L. & Bolding, N. (1999). Self-determination across living and working environments: a matched samples study of adults with mental retardation. Mental Retardation, 37; 353-363
M. L. Wehmeyer 1200 Sunnyside Ave. Haworth Hall, Room 3101 University of Kansas Lawrence, KS 66045-7534 Phone: (785) 864-0723 e-mail: [email protected]
Functional Status Activities of Daily Living
Barthel Index F. I. Mahoney & D. W. Barthel
http://www.strokecenter.org/trials/scales/barthel.pdf
Copyright The Maryland State Medical Society. It may be used freely for non-commercial purposes with the following citation: Mahoney FI, Barthel D. "Functional evaluation: the Barthel Index." Maryland State Med Journal 1965; 14:56-61. Used with permission.
Functional Status Activities of Daily Living
Bayer Activities of Daily Living Scale (B-ADL)
I. Hindmarch H. Lehfeld, P. Jongh & H.
Hindmarch, I., Lehfeld, H., Jongh, P., & Erzigkeit, H. (1998). The
Correspondence: Professor Ian Hindmarch
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Erzigkeit Bayer Activities of Daily Living Scale (B-ADL). Dementia and geriatric Cognitive Disorders 9 (Suppl. 2), 20-6. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 218). London: Martin Dunitz.
HPRU Medical Research Centre University of Surrey Egerton Rd Guildford, GU2 7XP UK. Permission S. Karger AG, Basel
Functional Status Activities of Daily Living
Bristol Activities of Daily Living Scale
R. S. Bucks, D. L.ashworth, G. K. Wilcock & K. Siegfried
http://www.download.bham.ac.uk/bctu/AD2000/AD2000%20protocol.pdf Bucks, R. S., Ashworth, D. L., Wilcock, G. K., & Siegfried, K. (1996). Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale. Age and Ageing, 25, 113-20.
G. K. Wilcock Department of Care of the Elderly Frenchay Hospital Bristol, BS16 1LE UK e-mail: [email protected]
Functional Status Activities of Daily Living
Cleveland Scale for Activities of Daily Living (CSADL)
M. B. Patterson, J. L. Mack, M. M. Neundorfer, R. J. Martin, K. A. Smyth & P. J. Whitehouse
Patterson, M. B., Mack, J. L., Neundorfer, M. M., Martin, R. J., Smyth, K. A., & Whitehouse, P. J. (1992.) Assessment of functional ability in Alzheimer disease: a review and a preliminary report on the Cleveland Scale for Activities of Daily Living. Alzheimer Disease and Associated Disorders, 6, 145-63. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 200). London: Martin Dunitz.
Correspondence: M. B. Patterson Department of Neurology University Hospitals of Cleveland 2074 Abington Road Cleveland, OH 44106
Functional Status Activities of Daily Living
Cognitive Performance Test T. Burns, J. A. Mortomer & P. Merchak
Burns, T., Mortimer, J. A., & Merchak, P. (1994.) Cognitive performance test: a new approach to functional assessment in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 7, 46-54.
Theresa Burns Veterans Affairs Medical Center 1 Veterans Drive Minneapolis, MN 55417
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In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 201). London: Martin Dunitz.
Functional Status Activities of Daily Living
Daily Activities Questionnaire (DAQ)
F. Oakley, T. Sunderland, J. L. Hill, S. L. Phillips, R. Mokahon & J. D. Ebner
Oakley, F., Sunderland, T., Hill, J. L., Phillips, S. L., Mokahon, R., & Ebner, J. D. (1991). The Daily Activities Questionnaire: a functional assessment for people with Alzheimer's disease. Physical and Occupational Therapy in Geriatrics, 10, 67-81. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 194). London: Martin Dunitz.
Frances Oakley Occupational Therapy Service National Institutes of Health Bethesda, MD 20892
Functional Status Activities of Daily Living
Direct Assessment of Activities of Daily Living in Alzheimer's Disease
E. Skurla, J. C. Roger & T. Sunderland
Skurla, E., Roger, J. C., & Sunderland, T. (1988). Direct assessment of activities of daily living in Alzheimer's disease. Journal of the American Geriatrics Society, 36(2), 97-103. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 215). London: Martin Dunitz.
Permission: Skurla, E., Roger, J. C., Sunderland, T.
Functional Status Activities of Daily Living
Direct Assessment of Functional Status (DAFS)
D. A. Loewenstein, E. Amigo, R. Duara, A. Guterman, D. Hurwitz, N. Berkowitz, F. Wilkie, G. Weinberg, B. Black, B. Gittelman & C. Eisdorfer
Loewenstein, D. A., Amigo, E., Duara, R., Guterman, A., Hurwitz, D., Berkowitz, N., Wilkie, F., Weinberg, G., Black, B., Gittelman, B., & Eisdorfer, C. (1989). A new scale for the assessment of functional status in Alzheimer's disease and related disorders. Journal of Gerontology, 44, 114-21. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd
Correspondence: David A. Loewenstein, Wien Center for Alzheimer’s Disease Mount Sinai Medical Center Miami Beach, FL 33140 E-mail: [email protected]
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ed., pp. 197-8). London: Martin Dunitz.
Functional Status Activities of Daily Living
Dressing Performance Scale C. Beck Beck, C. (1988). Measurement of dressing performance in persons with dementia. American Journal of Alzheimer's Care and Related Disorders and Research, 3, 21-5. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 205-6). London: Martin Dunitz.
Permission. Cornelia Beck, RN, PhD Department of Psychiatry and Behavioral Sciences College of Nursing University of Arkansas for Medical Sciences Little Rock, AR 72205 Email: [email protected]
Functional Status Activities of Daily Living
Functional Activities Questionnaire (FAQ)
R. I. Pfeffer, T. T. Kurosaki, C. H. Harrah, J. M. Chance & S. Filos
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H., Chance, J. M., & Filos, S. (1992). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323-9. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 192-3). London: Martin Dunitz.
Correspondence: R. I. Pfeffer Department of Neurology University of California at Irving Medical Center 101 City Drive North Orange, CA 92668
Functional Status Activities of Daily Living
Functional Dementia Scale (FDS)
J. T. Moore, J. A. Bobula, T. B Short & M. Mischel
Moore, J. T., Bobula, J. A., Short, T. B., & Mischel, M. (1983). A Functional Dementia Scale. The Journal of Family Practice, 16, 499-503. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 209). London: Martin Dunitz.
Correspondence: James T. Moore Duke-Watts Family Medicine Program 407 Crutchfield St. Durham, NC 27704-2799
Functional Status Activities of Daily Living
Instrumental Activities of Daily Living Scale (IADL)
M. P. Lawton & E.M. Brody
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179-86. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment
Copyright © The Gerontological Society of America
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scales in old age psychiatry (2nd ed., pp186-7). London: Martin Dunitz.
Functional Status Activities of Daily Living
Interview for Deterioration in Daily Living Activities in Dementia (IDDD)
S. Teunisse & M. M. A. Derix
Teunisse, S., Derix, M. M. A., & van Crevel, H. (1991). Assessing the severity of dementia: patient and caregiver. Archives of Neurology, 48, 274-7. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 188-9). London: Martin Dunitz.
Correspondence: S. Teunisse Psychology Department William Guild Building King's College University of Aberdeen Aberdeen, AB24 2UB UK Copyright 1991 American Medical Association.
Functional Status Activities of Daily Living
Performance Test of Activities of Daily Living (PADL)
J. Kuriansky & B. Gurland
Kuriansky, J., & Gurland, B. (1976). The Performance Test of Activities of Daily Living. International Journal of Aging and Human Development, 7, 343-52. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 210-11). London: Martin Dunitz.
Functional Status Activities of Daily Living
Physical Self - Maintenance Scale (PSMS) and Instrumental Activities of Daily Living (IADL)
M. P Lawton & E. M. Brody
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179-86. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 221). London: Martin Dunitz.
Functional Status Activities of Daily Living
Present Functioning Questionnaire (PFQ) and Functional Rating Scale (FRS)
D. Crockett, H. Tuokko, W. Koch & R. Parks
Crockett, D., Tuokko, H., Koch, W., & Parks, R. (1989). The assessment of everyday functioning using the Present Functioning Questionnaire and the Functional Rating Scale in elderly samples. Clinical Gerontologist, 8, 3-25.
Request permission. Correspondence: Dr. D. J. Crockett Professor Emeritus Suite 104 – 3709 Pender Street Burnaby, BC V5C 2L3 Canada
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In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 202-04). London: Martin Dunitz.
e-mail: [email protected]
Functional Status Activities of Daily Living
Progressive Deterioration Scale (PDS)
R.Dejong, O. W Osterlund & G. W. Roy
Dejong, R., Osterlund, O. W., & Roy, G. W. (1989). Measurement of quality-of-life changes in patients with Alzheimer's Disease. Clinical Therapeutics, 11, 545-554. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 191). London: Martin Dunitz.
Functional Status Activities of Daily Living
Rapid Disability Rating Scale - 2 (RDRS - 2)
M. W Linn & B. S. Linn
Linn, M. W., & Linn, B. S. (1982). The Rapid Disability Rating Scale - 2. Journal of the American Geriatrics Society, 30, 378-82. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 207-8). London: Martin Dunitz.
Permission needed. M. W. Linn Director, Social Science Research Veterans Administration Medical Center 1201 Northwest 16th Street Miami, FL 33125
Functional Status Activities of Daily Living
Refined ADL Assessment Scale (RADL)
R. Tappen Tappen, R. (1994). Development of the refined ADL assessment scale for patients with Alzheimer's and related disorders. Journal of Gerontological Nursing, 20, 36-41. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 216-17). London: Martin Dunitz.
Permission needed. Ruth Tappen, College of Nursing Florida Atlantic University NU 307A at the Boca Campus 777 Glades Road Boca Raton, FL 33431 E-mail: [email protected]
Functional Status Activities of Daily Living
Structured Assessment of Independent Living Skills (SALES)
R. K Mahurin, DeBettignieis & F. J. Pirozzolo
Mahurin, R. K., DeBettignieis & Pirozzolo, F. J. (1991). Structured assessment of independent living skills: preliminary report of a performance measure of functional abilities in dementia. Journal of Gerontology, 46, 58-66.
Correspondence: Roderick Mahurin School of Medicine, Radiology University of Washington, Box 357115
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In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 212-14). London: Martin Dunitz.
Seattle, WA 98104-2499 E-mail: [email protected]
Functional Assessment Aid To Capacity Evaluation (ACE)
E. Etchells, P. Darzins, M. Silberfeld, P. Singer, J. Mckenny, G. Naglie, M. Latz, G. Guyatt, W. Molloy, D. Srang
Etchells, E., Darzins, P., Silberfeld, M., Singer, P. A., Mckenny, J., Naglie, G., Latz, M., Guyatt, G. H., Molloy, W., Srang, D., (1999). Assestment of Patient Capacity to Consent to Treatment. J Gen Intern Med, 14, 27-34
Correspondence: Dr. E. Etchells Sunnybrrok & Women’s College Health Sciences Centre Sunny Campus Room C4-10, 2075 Bayview Avenue Toronto, Ontario, M4N 3M5 Telephone: (416) 480-6100 X5996, Fax (416)480-5951 E-mail: [email protected]
Functional Status Cognitive Wide Range Achievement Test (WRAT) 3 Current version: WRAT 4
S. Jastak & G. S. Wilkinson
http://www3.parinc.com/default.aspx
Copyright 1993 Jastak Associates.
Functional Status Dementia TRIMS (Texas Research Institute of Mental Science) Behavioral Problem Checklist (BPC)
G. Niederehe Niederehe, G. (1988). TRIMS Behavior Problem Checklist (BPC). Psychopharmacology Bulletin, 24, 771-8. In: Burns, A., Lawlor, B., & Craig, S. (Eds.). (2004). Assessment scales in old age psychiatry (2nd ed., pp. 336). London: Martin Dunitz.
Correspondence: George Niederehe Geriatric Resources Research Office Neuro Science Center, Room 7720-9634 National Institute of Mental Health 5600 Fishers Lane Rockville, MD 20857 Phone: 301-443-1369 E-mail: [email protected]
Functional Status Disability National Health Interview Survey on Disability (NHIS-D)
National Center for Health Statistics
www.cdc.gov/nchs/about/major/nhis_dis/nhis_dis.htm
Correspondence: U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for
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Health Statistics 3311 Toledo road Hyattsville, MD 20782 T: 301-458-4000 or 1-866-441-NCHS E-mail: [email protected]
Functional Status Functional Status Functional Performance Inventory (FPI)
N. K. Leidy http://www.atsqol.org/sections/instruments/fj/pages/fpi.html
Nancy K Leidy Center for Health Outcomes Research, MEDTAP International Inc. 7101 Wisconsin Avenue, Suite 600 Bethesda, MD 20814 E-mail: [email protected]
Functional Status Functional Status Functional Status II ® R. E. K. Stein, C. K Reissman & D. J. Jessop
Stein, R. E. K., Reissman, C. K., & Jessop, D. J. (1990). Functional Status II® A Measure of Child Health Status. Medical Care, 28(11), 1041-1055.
Copyright. Stein, Riessman, and Jessop, 1981. Correspondence: Ruth E. K. Stein, MD Department of Pediatrics Albert Einstein College of Medicine Bronx, NY 10461 E-mail: [email protected]
Functional Status Functional Status RAND 36-item Health Survey R. D. Hays, C. D. Sherbourne & R. Mazel
Hays, R.D., Sherbourne, C.D., & Mazel, R.(1993). The RAND 36-item health survey 1.0. RAND corporation, Santa Monica, CA.
RAND Corporation. RAND Distribution Services, P.O. Box 2138, Santa Monica, CA 90407-2138.
Functional Status Functional Status Short Form (SF-12) Health Survey Current version: SF-12v2
J. E. Ware, M. Kosinski & S. D. Keller
Available for order at www.sf-36.org
Copyright 1992 Medical Outcomes Trust
Functional Status Functional Status SF-36 (The Medical Outcomes Study (MOS) 36-item short-form) Health Survey Current version: SF-36v2
J. E. Ware & C. D. Sherbourne
Available for order at www.sf-36.org Available for no payment at: http://www.rand.org/health/surveys
Copyright 1992 Medical Outcomes Trust. Medical Outcomes Study (MOS) instruments are
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/core/index.html free and in the public domain.
Functional Status Functional Status Sickness Impact Profile (SIP) J. Conn, R. A. Bobbitt & M. Bergner
1976 (Revised 1981) http://www.outcomes-trust.org/
Copyright is held by Johns Hopkins University, 1977. All rights reserved. The Medical Outcomes Trust can provide information and permission for use. 275 Wyman Street, Suite 120, Waltham, MA, 02451 T: 781-890-4884 Fax: 781-890-0922 E-mail: [email protected].
Functional Status Motor Performance Psychomotor Vigilance Task (PVT-192)
Designed by CWE, Inc. http: //www.ambulatory-monitoring.com
Functional Status Motor Performance Simpson/ Angus Scale, Modified K. Tracy, L. A. Adler, J. Rotrosen, R. Edson, P. Lavori, & the Veterans Affairs Cooperative Study #394 Study Group
Tracy, K., Adler, L. A., Rotrosen, J., Edson, R., Lavori, P., & the Veterans Affairs Cooperative Study #394 Study Group. (1997). Interrater reliability issues in multicenter trials, part 1: theoretical concepts and operational procedures used in Department of Veterans Affairs Cooperative Study #394. Psychopharmacology Bulletin, 33, 53-57. Swartz, M., Perkins, D. O., Stroup, T. S., McEvoy, J. P., Nieri, J. M. & Haak, D. C. (2003). Assessing Clinical and Functional Outcomes in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial. Schizophrenia Bulletin, 29(1), 33-43.
Functional Status Outcome Measures Abnormal Involuntary Movement Scale (AIMS)
W. Guy Guy, W. ECDEU Assessment Manual for Psychopharmacology: Revised (DHEW publication number ADM 76-338).
Scale is in public domain.
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Lane, R. D., Glazer, W. M., Hansen, T. E., Berman, W. H. & Kramer, S. I. (1985). Assessment of tardive dyskinesia using the Abnormal Involuntary Movement Scale. Journal of Nervous and Mental Diseases, 173(6), 353-7. Munetz, M. R. & Benjamin, S. (1988). How to examine patients using the Abnormal Voluntary Movement Scale. Hospital Community Psychiatry, 39(11), 1172-7.
Functional Status Outcome Measures Adverse Event/Side Effects Form
M. Swartz Swartz, M., Perkins, D. O., Stroup, T. S., McEvoy, J. P., Nieri, J. M. & Haak, D. C. (2003). Assessing Clinical and Functional Outcomes in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial. Schizophrenia Bulletin, 29(1), 33-43.
Functional Status Outcome Measures Barnes Rating Scale for Drug-Induced Akathasia
T. R. E. Barnes Barnes, T. R. E. (1989). A Rating Scale for Drug-Induced Akathasia. British Journal of Psychiatry, 154, 672-676. Sachdev, P. A. (1994). Rating Scale for Acute Drug-Induced Akathisia: Development, Reliability, and Validity. Biological Psychiatry, 35, 263-271. Swartz, M., Perkins, D. O., Stroup, T. S., McEvoy, J. P., Nieri, J. M. & Haak, D. C. (2003). Assessing Clinical and Functional Outcomes in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial. Schizophrenia Bulletin, 29(1), 33-43.
Correspondence: Thomas R. E. Barnes Department of Clinical Psychiatry, Imperial College, Charing Cross Campus, London, UK. T: +44 (0)20 7386 1233 E-mail: [email protected]
Functional Status Physical Activity Activity Counseling Trial (ACT) Physical Activity Recall (Seven-
S. N. Blair, W. L. Haskell, P. Ho, R. S.
Seven-Day Physical Activity Recall Questionnaire [ACT]
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Day Physical Activity Recall) Paffenbarger, K. M. Vranizan, J. W. Farquhar & P. D. Wood
(1984). Blair, N. Cooper Institute for Aerobics Research. St. Jeor ST (ed.) (1997). Obesity assessment: tools, methods, and interpretations (a reference case: the RENO diet-heart study). New York: Chapman & Hall. Pp. 161-210, 744-745, 748-750. Blair, S.N., Haskell, W.L., Ho, P., Paffenbarger, R.S. Jr, Vranizan, K.M., Farquhar, J.W., & Wood, P.D. (1985). Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. American Journal of Epidemiology; 122, 794-804
Functional Status Physical Activity The Aerobics Center Longitudinal Study Physical Activity Questionnaire
H. W. Kohl, S. N. Blair, R. S Paffenbarger, Jr., C. A. Macera & J. J. Kronenfeld
Kohl, H. W., Blair, S. N., Paffenbarger, Jr., R. S., Macera, C. A., & Kronenfeld, J. J. (1988). A mail survey of physical activity habits as related to measured physical fitness. American Journal of Epidemiology, 127, 1228-1239.
Contact: Dr. Steven N. Blair Cooper Institute for Aerobics Research 12330 Preston Road Dallas, TX 75230
Functional Status Physical Activity Baecke Questionnaire of Habitual Physical Activity
J. A. Baecke, J. Burema, & J. E. Frijters
www.ms-se.com Baecke, J.A., Burema, J., & Frijters, J.E. (1982). A short questionnaire for the measurement of habitual physical activity in epidemiological studies. American Journal of Clinical Nutrition, 36, 936-42 (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Functional Status Physical Activity Behavioral Risk Factor Surveillance System
C. J. Caspersen www.ms-se.com Caspersen, C.J., & Merritt, R.K. (1995). Physical activity trends among 26 states, 1986-1990. Medicine & Science in Sports and Exercise, 27, 713-720
Dr. Carl Caspersen Physical Activity and Health Branch Division of Nutrition and Physical Activity National Center for Chronic Disease
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(1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Prevention & Health Promotion Centers for Disease Control and Prevention Atlanta, GA 30314-3724
Functional Status Physical Activity Bouchard Three-day Physical Activity Record
C. Bouchard, A. Tremblay, C. LeBlanc, G. Lortie, R. Savard, & G. Theriault
www.ms-se.com Bouchar, C., Tremblay, A., Leblanc, C., Lortie, G., Savard, R., & Theriault, G. (1983). A method to assess energy expenditure in children and adults. American Journal of Clinical Nutrition, 37, 461-467. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Dr. Claude Bouchard Executive Director of Pennington Biomedical Research Center 6400 Perkins Road Baton Rouge, LA 70808 T: 225) 763-2513
Functional Status Physical Activity Canada Fitness Survey Canadian Fitness and Lifestyle Research Institute
www.ms-se.com Canada Fitness Survey. Fitness and Lifestyle in Canada. Ottawa: Canada Fitness Survey, 1983 (distributed by the Canadian Fitness and Lifestyle Research Institute). (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Canadian Fitness and Lifestyle Research Institute 201-185 Somerset Street West Ottawa, Ontario K2P 0J2 CANADA T: (613) 233-5528
Functional Status Physical Activity Cardia Physical Activity History D. R. Jacobs, Jr., L. P. Hahn, W. L. Haskell, P. Pirie, & S. Sidney
Jacobs, D. R. Jr., Hahn, L. P., Haskell, W. L., Pirie, P., & Sidney, S. (1989). Reliability and validity of a short physical activity history: CARDIA and the Minnesota Heart Health Program. Journal of Cardiopulmonary Rehabilitation, 9, 448-459.
Dr. David R. Jacobs, JR. Division of Epidemiology & Community Health University of Minnesota 1300 S. Second Street, Suite 300 Minneapolis, MN 55454-1015 T: (612) 624-4196 E-mail: [email protected]
Functional Status Physical Activity Collection of Physical Activity Questionnaires
A. M. Kriska, & C. J. Caspersen
Kriska, A. M., & Caspersen, C. J. (1997). Introduction to a collection of physical activity questionnaires.
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Medicine & Science in Sports and Exercise, 29(6) Supplement, S5-S9.
Functional Status Physical Activity Framingham Physical Activity Index
W. B. Kannel & P. Sorlie
www.acsm-msse.orgKannel, W. B. & Sorlie, P. (1979). Some health benefits of physical activity: The Framingham Heart Study. Archives of Internal Medicine, 139, 857-861. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. William B. Kannel Boston University Framingham Heart Study 73 Mt. Wayte Ave Framingham, MA 01702-5803 T: 508-935-3442 e-mail: [email protected]
Functional Status Physical Activity Godin Leisure-Time Exercise Questionnaire
G. Godin & R. J. Shepard
www.acsm-msse.orgGodin, G. & Shepard, R. J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sports Science, 10, 141-146. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. G. Godin Ecole des Sciences Infirmieres Universite Laval Ste-Foy Quebec, Canada E-Mail: [email protected] or Dr. Roy. J. Shepard University of Toronto Faculty of Physical Education and Health 55 Harbord St. Toronto, ON M5S 2W6 Canada
Functional Status Physical Activity Health Insurance Plan of New York (HIP) Activity Questionnaire
S. Shapiro, E. Weinblatt, C. W. Frank & R. V. Sager
www.ms-se.com Shapiro, S., Weinblatt, E., Frank, C. W., & Sager, R. V. (1965). The H.I.P. study of incidence and prognosis of coronary heart disease. Journal of Chronic Disease, 18, 527-558. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
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Functional Status Physical Activity Historical Leisure Activity Questionnaire
A. M. Kriska, W. C. Knowler, R. E LaPorte, et al.
www.ms-se.com Kriska, A. M., Knowler, W. C., LaPorte, R. E., et al. (1990). Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care, 13, 401-411. Kriska, A. M., Sandler, J. A., Cauley, R E., LaPorte, R. E., Hom, D. L. & Pambianco, G. (1988). The assessment of historical physical activity and its relation to adult bone parameters. American Journal of Epidemiology, 127, 1053-1063. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. Andrea M. Kriska University of Pittsburgh Department of Epidemiology 505B Parran Hall/GSPH 130 DeSoto Street Pittsburgh, PA 15261 e-mail: [email protected]
Functional Status Physical Activity Lifelong Physical Activity Questionnaire
J. Wilbur, E. O'Conner & K. Holm
Modified from: Saltin, B. & Grimby, G. (1968). Physiological analysis of middle-aged and former athletes. Circulation, 38, 1104-1113.
Wilbur, J., Holm, K., & Dan, A. (1993). A quantitative survey to measure energy expenditure in midlife women. Journal of Nursing Measurement, 1(1), 29-40. Wilbur, J., Miller, A., Montgomery, A. & Chandler, P. (1998). Physical activity patterns of midlife women. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27(4), 383-392. Wilbur, J., Miller, A., Dan, A., & Holm, K. (1989). Measuring physical activities in midlife women. Public Health Nursing,
Correspondence: JoEllen Wilbur, PhD, RN, FAAN Rush University College of Nursing 600 South Paulina Street Chicago, IL 60612 e-mail: [email protected] T: 312-942-8947
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6(3), 120-128.
Dan, A., Wilbur, J., Hedricks, C., O'Connor, E., & Holm, K. (1990). Lifelong physical activity in midlife and older women. Psychology of Women Quarterly, 14, 537-542. Wilbur, J., Miller, A., Chandler, P, McDevitt, J. (2003). Determinants of physical activity and adherence to a 24-week home-base walking program in African American and Caucasian women. Research in Nursing and Health, 26(3), 213-224.
Functional Status Physical Activity Lipid Research Clinics Questionnaire
B. E. Ainsworth, D. R. Jacobs, Jr., & A. S. Leon
www.ms-se.com Ainsworth, B. E., Jacobs, Jr., D. R., & Leon, A. S. (1993). Validity and reliability of self-reported physical activity status: the Lipid Research Clinics Questionnaire. Medicine & Science in Sports and Exercise, 25, 92-98. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. Barbara E. Ainsworth Department of Exercise & Wellness Arizona Sate University - Polytechnic Campus 7350 E. Unity Drive Mesa, AZ 85212 e-mail: [email protected]
Functional Status Physical Activity Minnesota Leisure-Time Physical Activity Questionnaire
H. L. Taylor, D. R Jacobs, Jr., B Shucker, J. Knudsen, A. S. Leon & G. DeBacker
www.ms-se.comPacket of questionnaires and related information sent out for a small fee. Taylor, H. L., Jacobs, Jr., D. R., Shucker, B., Knudsen, J., Leon, A. S., & DeBacker, G. (1978). A questionnaire for the assessment of leisure-time physical activities. Journal of Chronic Diseases, 31, 741-755. (1997). A Collection of Physical Activity Questionnaires. Medicine
Correspondence: Dr. David R. Jacobs, Jr. Division of Epidemiology University of Minnesota 1300 South 2nd Street, Suite 300 Minneapolis, MN 55454-1015. T: 612-624-4196 email: [email protected]
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& Science in Sports and Exercise, 29(6) Supplement.
Functional Status Physical Activity Modifiable Activity Questionnaire
A. M. Kriska www.ms-se.com Kriska, A. M. & Bennett, P. H. (1992). An epidemiological perspective of the relationship between physical activity and NIDDM: from activity assessment to intervention. Diabetes Metabolism Review, 8, 355-372. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. Andrea M. Kriska University of Pittsburgh Department of Epidemiology 505B Parran Hall/GSPH 130 DeSoto Street Pittsburgh, PA 15261 e-mail: [email protected]
Functional Status Physical Activity Modifiable Activity Questionnaire for Adolescents
D. J. Aaron & A. M. Kriska
www.ms-se.com Aaron, D. J. & Kriska, A. M., Dearwater, S. R., Cauley, J. A., Metz, K. F. & LaPorte, R. E. (1995). Reproducibility and validity of an epidemiologic questionnaire to assess past-year physical activity in adolescents. American Journal of Epidemiology, 142, 191-201. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. Deborah J. Aaron & Dr. Andrea M. Kriska University of Pittsburgh Department of Epidemiology 505B Parran Hall/GSPH 130 DeSoto Street Pittsburgh, PA 15261 e-mail: [email protected]
Functional Status Physical Activity Modified Baecke Questionnaire for Older Adults
L. E. Voorrips, A. C. J. Ravelli, P. C. A. Dongelmans, P. Deurenberg & W. A Van Staveren
www.ms-se.com Voorrips, L. E., Ravelli, A. C. J., Dongelmans, P. C. A., Deurenberg, P., & Van Staveren, W. A. (1991). A physical activity questionnaire for the elderly. Medicine & Science in Sports and Exercise, 23, 974-979. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: L. E. Voorrips Department of Human Nutrition Wageningen Agricultural University P.O. Box 8129 6700 EV Wageningen Wageningen, The Netherlands
Functional Status Physical Activity The MONICA Optional Study of Physical Activity (MOSPA)
www.ms-se.com (1997). A Collection of Physical
Correspondence: Dr. Deborah Arriaza
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Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Jones Physical Activity and Health Branch Division of Nutrition & Physical Activity National Center for Chronic Disease Prevention & Health Promotion Centers for Disease Control & Prevention 4770 Buford Highway, Mailstop K-46 Atlanta, GA 30341-3724
Functional Status Physical Activity National Children and Youth Fitness Study I & II
J. G. Ross www.ms-se.com Ross, J. G., & Gilbert, G. G. (1985). The National Children and Youth Fitness Study: a summary of findings. Journal of Physical Education, Recreation and Dance, 56(1), 43-90. Special insert. Ross, J. G., & Pate, R. R. (1987). The National Children and Youth Fitness Study II: a summary of findings. Journal of Physical Education, Recreation and Dance, 58(10), 49-96. Special insert. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Mr. James G. Ross Vice President Macro International, Inc. 11785 Beltsville Dr. Calverton, MD 20705
Functional Status Physical Activity National Health and Nutrition Examination Survey I, II, and III
National Center for Health Statistics
www.ms-se.com National Center for Health Statistics. (1973). Plan and operation of the Health and Nutrition Examination Survey, United States 1971-1973. Rockville, MD: National Center for Health Statistics. National Center for Health Statistics. McDowell, A. A., Engel, J. T., Massey, J. T., & Mauer, K.
Correspondence: Division of Health Examination Statistics National Center for Health Statistics Centers for Disease Control and Prevention 6525 Belcrest Rd., Room 1000 Hyattsville, MD 20782
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(1982). Plan and operation of the Second Health and Nutrition Examination Survey, 1976-1980. Washington, DC: US Government Printing Office. National Center for Health Statistics. (1994). Plan and operation of the Third National Health Examination Survey, 1988-94. Vital Health Statistics, 1(32). (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Functional Status Physical Activity National Health Interview Survey
National Center for Health Statistics
http://wonder.cdc.gov/wonder/sci_data/surveys/nhis/type_txt/nhis2005/NHIS2005.asp National Health Interview Survey. 1991. National Center for Health Statistics. Vital Health Statistics, 10(185). (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Division of Health Interview Statistics National Center for Health Statistics Centers for Disease Control and Prevention 3311 Toledo Road Hyattsville, MD 20782
Functional Status Physical Activity Paffenbarger Physical Activity Questionnaire
R. S. Paffenbarger, A. L. Wing & R. T. Hyde
http://www.hhp.umd.edu/KNES/courses/knes260/documents/KNES260winter2004Paffenbarger.pdf#search=%22Paffenbarger%20Physical%20Activity%20Questionnaire%22 Paffenbarger, R. S., Wing, A. L., & Hyde, R. T. (1978). Physical activity as an index of heart attack risk in college alumni. American Journal of Epidemiology, 108, 161-175. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
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Functional Status Physical Activity Physical Activity Questionnaire M. A. Pols, P. H. Peeters, M. C. Ocke, H. B Bueno-De-Mesquita, N. Slimani, H. C. Kemper & H. J. A Collette
Pols, M. A., Peeters, P. H., Ocke, M. C., Bueno-De-Mesquita, H. B., Slimani, N., Kemper, H. C., & Collette, H. J. A. (1997). Relative Validity and Repeatability of a New Questionnaire on Physical Activity. Preventive Medicine, 26, 37-43.
Correspondence: Margaret Pols, MD Department of Epidemiology Faculty of Medicine Utrecht University PO Box 80035 3508 TA Utrecht The Netherlands
Functional Status Physical Activity Physical Activity Questionnaires of the Kuopio Ischemic Heart Disease Study (KIHD)
J. T. Salonen & T. Lakka
www.ms-se.com Salonen, J. T. & Lakka, T. (1987). Assessment of physical activity in population studies – validity and consistency of the methods in the Kuopio ischemic heart disease risk factor study. Scandinavian Journal of Sports Science, 9(89), 89-95. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. Jukka T. Salonen Department of Public Health University of Kuopio P. O. Box 1627, 70211 Kuopio, Finland email: [email protected]
Functional Status Physical Activity Seven-Day Physical Activity Recall
J. F Sallis, W. L. Haskell, P. D. Wood, S. P. Fortmann, T. Rogers, S. N Blair & R. S.Paffenbarger, Jr.
http://www-rohan.sdsu.edu/faculty/sallis/sevendayphysicalactivityrecall.pdf Sallis, J. F., Haskell, W. L., Wood, P. D., Fortmann, S. P., Rogers, T., Blair, S. N. & Paffenbarger, Jr., R. S. (1985). Physical activity assessment methodology in the Stanford Five-City Project. American Journal of Epidemiology, 121, 91-106. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. James F. Sallis Department of Psychology San Diego State University 3900Fifth Avenue, Suite 310 San Diego, CA 92103 T: 619-260-5534 e-mail: [email protected]
Functional Status Physical Activity Stanford Usual Activity Questionnaire
J. F. Sallis, W. L. Haskell, P. D. Wood, S. P. Fortmann, T. Rogers, S. N. Blair, & R. S. Paffenbarger, Jr.
www.ms-se.com Sallis, J. F., Haskell, W. L., Wood, P. D., Fortmann, S.P., Rogers, T., Blair, S. N. & Paffenbarger, Jr., R. S. (1985). Physical activity assessment methodology in the Stanford Five-City Project.
Correspondence: Dr. William L. Haskell Stanford Prevention Research Center Stanford University School of Medicine 211 Quarry Road, room N
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American Journal of Epidemiology, 121, 91-106. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
229 Stanford, CA 94305-5705 T: 650-725-5012 e-mail: [email protected]
Functional Status Physical Activity Tecumseh Occupational Physical Activity Questionnaire
H. J. Montoye www.ms-se.com Montoye, H. J. (1971). Estimation of habitual physical activity by questionnaire and interview. AmericanJournal of Clinical Nutrition, 24, 1113—1118. Reiff, G. G., Montoyne, H. J., Remington, R. D., Napier, J. A., Metzner, H. L., & Epstein, F. H. (1967). Assessment of physical activity by questionnaire and interview. Journal of Sports Medicine and Physical Fitness, 7, 135-142. Montoye, H. J. (1989). Lessons from Tecumseh on the assessment of physical activity and fitness. In: Assessing Physical Fitness and Physical Activities in Population-Based Surveys. (1989). National Center for Health Statistics. Thomas F. Drury (Ed.). DHHS Pub. No. (PHS) 89-1253, Public Health Service. Washington, US Government Printing Office. 349-376. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Functional Status Physical Activity YALE Physical Activity Survey L. DiPietro, C. J. Caspersen, A. M. Ostfield & E. R. Nadel
www.ms-se.com DiPietro, L., Caspersen, C. J., Ostfield, A. M., & Nadel, E. R. (1993). A survey for assessing physical activity among older
Correspondence: Dr. Barbara Resnick, Ph.D., CRNP, FAAN, FAANPUniversity of Maryland
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adults. Medical Science in Sports and Exercise, 25, 628-642. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
School of Nursing655 W. Lombard St., 390D, SNB Baltimore, Maryland 21201email: [email protected] Primary source of information: Dr. Loretta DiPietro John B. Pierce Foundation Laboratory, Inc. Department of Epidemiology and Public Health 290 Congress Avenue New Haven, CT 06519 e-mail: [email protected] Dr. Carl Caspersen Physical Activity and Health Branch Division of Nutrition and Physical Activity National Center for Chronic Disease Prevention & Health Promotion Centers for Disease Control and Prevention Atlanta, GA 30314-3724
Functional Status Physical Activity Youth Risk Behavior Survey G. W. Heath, R. R. Pate & M. Pratt
http://www.cdc.gov/HealthyYouth/yrbs/questionnaire_rationale.htm www.ms-se.com Heath, G. W., Pate, R. R. & Pratt, M. (1993). Measuring physical activity among adolescents. Public Health Reports, 108, 42-46. (1997). A Collection of Physical Activity Questionnaires. Medicine
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& Science in Sports and Exercise, 29(6) Supplement.
Functional Status Physical Activity Zutphen Physical Activity Questionnaire
C. J. Caspersen, B. P. M. Bloemberg, W. H. M. Saris, R. K. Merritt & D. Kromhout
www.ms-se.com Caspersen, C. J., Bloemberg, B. P. M., Saris, W. H. M., Merritt, R. K., & Kromhout, D. (1991). The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen study, 1985. American Journal of Epidemiology, 133, 1078-1092. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Correspondence: Dr. Daan Kromhout Division of Public Health Research National Institute of Public Health and the Environment P. O. Box 1 3720 BA Bilthoven The Netherlands Tel: +31-30-2743310 e-mail: [email protected] or Dr. Carl Caspersen Physical Activity and Health Branch Division of Nutrition and Physical Activity National Center for Chronic Disease Prevention & Health Promotion Centers for Disease Control and Prevention Atlanta, GA 30314-3724
Functional Status Physical Activity Physical Activity Scale for the Elderly (PASE)
R. A. Washburn, K.W. Smith, A. M. Jette & C.A. Janney
Washburn, R. A., Smith, K.W., Jette, A.M., & Janney, C.A. (1993). The Physical Activity Scale for the Elderly (PASE): development and evaluation. Journal of Clinical Epidemiology, 46, 153-162. (1997). A Collection of Physical Activity Questionnaires. Medicine & Science in Sports and Exercise, 29(6) Supplement.
Copyright 1991 New England Institutes, Inc. Kevin Smith New England Research Institutes (NERI), Inc. 9 Galen St. Watertown, MA 02472 T: 617-923-7747 Fax: 617-926-8246 Ordering information: Distributor: NERI T: 800.775.6374 e-mail: [email protected]
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Functional Status QOL Functional Assessment of Chronic Illness Therapy (FACIT)
D. Cella, etc. http://www.facit.org Copyright. David Cella Psychiatry & Behavioral Sciences,Northwestern University and Center on Outcomes Research & Education Evanston Northwestern Healthcare Evanston, IL e-mail: [email protected]
Functional Status Respiratory Modified Pulmonary Functional Status & Dyspnea Questionnaire (PFSDQ)
S. C. Lareau, P. M. Meek & P. J. Roos
http://www.atsqol.org/sections/instruments/pt/pages/pfsdqm.html
Permission for use form. No Fee. Contact: Suzanne C. Lareau, RN, MS New Mexico VA Health Care System 1501 San Pedro Dr. SE Albuquerque, N.M. 87108 T: (505) 265-1711 ext 4508 e-mail: [email protected]
Functional Status Respiratory Pulmonary Functional Status Scale (PFSS)
T. E. Weaver, G. L Narsavage & M. J. Guilfoyle
http://www.atsqol.org/sections/instruments/pt/pages/pfss.html
Copyright Weaver & Narsavage 1990. Revised 1/97. Contact T Weaver for permission for use Terri Weaver PhD, RN, CS, FAAN University of Pennsylvania School of Nursing Philadelphia, PA 19104-6096 T: (215) 898-2992 e-mail: [email protected]
