FREQUENTLY ASKED QUESTIONS
GENERAL AM-PAC INFORMATION
Why are there different versions (e.g., inpatient, outpatient) of AM-PAC short forms?
AM-PAC short forms are comprised of items that were carefully selected from large, calibrated item banks developed for the three AM-PAC domains (Basic Mobility, Daily Activity, Applied Cognitive). Each short form version includes items appropriate for a specific care setting (e.g., Inpatient, Outpatient) or ability level (e.g., Generic Outpatient, Low Function Outpatient). The different AM-PAC short forms can be used to monitor outcomes across different care settings. Transformed scores (but not raw scores) for different AM-PAC short form versions can be compared even though different items are administered because the short form items were selected from the same calibrated item bank.
Can transformed scores from different domains (e.g., Basic Mobility and Daily Activity) be compared?
No. AM-PAC items in a specific domain are calibrated on the same metric, but the three domains are based on different metrics.
Why are there different AM-PAC item formats?
Two different formats for AM-PAC items are used to cover the range of patient abilities. One item format, which is used to assess the abilities of patients who may not function independently, asks “how much help from another person” the patient requires to do the activity. This format is used for the Basic Mobility and Daily Activity Inpatient, Low Functioning Outpatient and Surgical (Version B) short forms. The other AM-PAC item format asks “how much difficulty” a patient has doing an activity. This format is used for all Applied Cognitive short forms and for the Basic Mobility and Daily Activity Outpatient, Home Care and Surgical (Version A) short forms.
What is the difference between AM-PAC raw scores and transformed scores?
Raw scores are the sum of the numeric values associated with the response for each item. Each AM-PAC short form has a corresponding transformation table that is used to convert the raw score to a standardized score. Within a domain, AM-PAC scores from different short form versions (e.g., inpatient, outpatient) can be compared by using the corresponding transformation table to convert the raw scores to a standardized score. For example, if the goal is to compare scores from AM-PAC Basic Mobility Inpatient and Outpatient Short Forms to assess changes in function across settings, raw scores derived from the Basic Mobility Inpatient and Outpatient Short Forms must be converted to standardized scores (using the corresponding transformation tables) to place raw scores from the two short form versions on the same metric. Raw scores from different short form versions cannot be compared.
SELECTING ITEM RESPONSES
Are there guidelines for selecting AM-PAC item responses?
Yes, there are guidelines for the two different types of AM-PAC items.
Use the guidelines below for items that ask about how much difficulty a patient experiences.
- Select ‘Can’t Do’ if the patient is not able to do the activity without special equipment or help from another person.
- Select ‘A Lot’ if it is a struggle, requiring great effort and/or time.
- Select ‘A Little’ if the patient can manage to do the activity, but it takes more effort and/or time than it should.
- Select ‘None’ if the patient does not experience any problems.
Help from Another Person Items
Use the guidelines below for items that ask how much help from another person the patient requires to do the activity. Responses should reflect the amount of human assistance required, but the person can use an assistive device (e.g., walking aid).
- Select ‘Total’ if the person is dependent and requires total assistance.
- Select ‘A Lot’ if the person requires maximum to moderate assistance.
- Select ‘A Little’ if the person required minimal assistance, contact guarding or supervision.
- Select ‘None’ if no human assistance is required.
Can AM-PAC administration instructions be modified to target specific patient issues?
Example: A patient is recovering from surgery to the right hand (dominant hand) and now uses her left (non-dominant) hand to do self-care activities. Should the patient be instructed to answer Daily Activity questions based on the difficulty experienced using her right hand? Example: A patient may have difficulty doing an activity due to a specific condition (e.g., arthritis). Should the patient be instructed to answer AM-PAC questions based on difficulty doing activities due to his arthritis?
No. The AM-PAC assesses a person’s ability to do an activity as he/she currently does it without attribution to a specific diagnosis or condition. AM-PAC scores are based on items that were calibrated using standardized instructions in a large sample of patients with different diagnoses and conditions. The integrity of the AM-PAC scores depends on using the same instructions used to calibrate the AM-PAC items. Therefore, AM-PAC instructions should not be modified to target specific patient issues.
How are impairments that can impact the patient’s ability to do an activity considered when selecting an AM-PAC item response?
The AM-PAC is an activity limitation measure that assesses the patient’s ability to do specific activities. Impairments that do not specifically impact the activity are not considered when selecting a response. For example, a balance impairment impacts the ability to transfer and is considered when selecting a response. In contrast, a balance impairment is not considered when selecting a response for personal grooming activities since these activities can be done while sitting.
How are item responses selected if the patient cannot reliably assess his/her abilities?
The AM-PAC is a patient-reported measure, but a patient proxy can select item responses if the patient cannot reliably respond. The proxy respondent can be a clinician, family member or close friend who is familiar with the patient. The proxy respondent should determine the best item response based on direct observation of the patient or knowledge of the patient’s abilities. Clinicians can use their clinical judgement to select the item response.
How can I redirect a patient who does not understand the activity?
Some items assess an activity that is part of a more complex activity or task. For example, a Daily Activity item asks about inserting a key in a lock and turning it to unlock a door. A patient may focus on the overall activity (e.g., “I can’t open my door”). The patient can be instructed to focus on the specific task assessed by the item (e.g., “This item only asks about inserting a key in a lock and turning it, not the activity of opening a locked door”).
What if the patient’s functional status fluctuates throughout the day?
The response selected should reflect the patient’s ability at the time that the assessment is completed.
Can a response be selected if the patient has not done the activity?
Yes. An item response can be selected if the patient (or patient proxy) can reliably estimate how much difficulty he/she would experience or how much help from another person would be required to do the activity. If the response cannot be reliably estimated, the item should be skipped.
AM-PAC SHORT FORM SCORING
How are AM-PAC short forms scored?
Item responses are associated with a numeric value and values for each item are summed to yield a raw score. The raw score is then converted to a standardized score (T-metric) using the transformation table that corresponds to the specific short form. Each short form version is accompanied by a unique transformation table (e.g., Inpatient Basic Mobility transformation table is only used to convert Inpatient Basic Mobility short form raw scores).
Can I score an AM-PAC Short Form if an item is skipped?
Yes. If an item response cannot be reliably estimated, the item is skipped and the short form is scored by imputing a response for the missing item using the following process: calculate the average of the responses completed, enter the average as the response for the missing item, sum the item responses and use the corresponding transformation table as you would normally do.
How do I interpret the standardized AM-PAC score?
Standardized AM-PAC scores are based on a T-metric where a score of 50 is the average score for patients receiving post-acute care services and 10 points is one standard deviation from the average score. For example, a standardized score of 30 is two standard deviations lower than the average patient receiving post-acute care services based on over 1,000 patients in the AM-PAC development sample.
How does use of an assistive device affect the response selected?
Consideration of assistive device use when selecting an item response differs based on the item format. For example, Basic Mobility ‘6-Clicks’ Inpatient Short Form items ask “how much help from another person” the patient requires to do an activity. This item format allows the patient to use an assistive device and the item is scored based on the assistance required to do the activity.
Example: If a patient walks independently in the hospital room, but requires a walker, the response selected for Basic Mobility item # 5 is ‘None’ (assistance required).
In contrast, Basic Mobility Outpatient Generic Short Form items ask “how much difficulty” the patient has doing an activity. This item format assumes that the patient does not use an assistive device. If the patient can ONLY do the activity when an assistive device is used, the response selected is ‘Unable.’ However, if the patient uses an assistive device, but is also able to do the activity without the device, the response selected should reflect the level of difficulty without the assistive device.
What response is selected if the patient requires assistance to manage medical equipment (e.g. IV pole, catheter bag)?
If a patient has medical equipment that interferes with mobility (e.g., IV pole, catheter bag), assess the help from another person required to do the activity, but not the help required ONLY to manage the medical equipment.
For items that ask “how much help” from other person is required, how is the item scored if two persons are required to help with the activity.
If the patient can ONLY do the activity with assistance from two persons, the item response selected is ‘Total.’
How do I score item #6 (Climbing 3-5 stairs with a railing), if I cannot evaluate the patient’s ability and cannot estimate the amount of assistance required using my clinical judgement?
If you cannot evaluate stair climbing, you can administer items 1-5, sum the scores for the 5 items, use the 5-item conversion table and record the t-scale score. IMPORTANT: You must record t-scores derived from the conversion tables to use the 5-item Basic Mobility Short Form. Do not use the 5-item basic mobility short forms if you only record raw scores.
What are the AM-PAC® Basic Mobility Inpatient Short Form (6-Clicks) Version 2 Psychometric Properties
A recent study Administered the AM-PAC® Basic Mobility Inpatient (Version 2) Short Form and demonstrated the following test-retest reliability results: ICCs = 0.91, 0.93, 0.96 for an average ICC of 0.93 . The score standard deviations = 8.1 and 9.5 for an average of 8.8.
- Standard Error of the Measure (SEM) = 3.16
- Minimal Detectable Difference at the 90% confidence level (MDC90) = 5.29
For dressing and personal grooming items, is the patient’s ability to retrieve items and set-up the activity included when selecting a response?
No, only the specific activity stated in the item is assessed.
What aspects of toileting (e.g., clothing management, hygiene) are considered when selecting a response for the toileting item?
Toileting includes the ability to get on/off a toilet, position a bedpan or urinal along and manage clothing management and hygiene. The response is selected based on the overall help from another person needed for toileting.
If the patient has a catheter, what response is selected for the toileting item?
Use clinical judgement to select the best response when the patient has a catheter. If the patient has a catheter due to the inability to manage toileting, select ‘Total.’
If the patient has a feeding tube, what response is selected for the eating meals item?
Use clinical judgement to select the best response when the patient has a feeding tube. If the patient has a feeding tube due to the inability to manage eating, select ‘Total.’
What are the AM-PAC® Daily Activity Inpatient Short Form (6-Clicks) Psychometric Properties
In a study by Jette et al (2015), four pairs of occupational therapists completed AM-PAC® Daily Activity Short Forms (6-Clicks) in the inpatient setting.
- Interclass Correlation Coefficient (ICCs) were calculated with the following results:
- Overall reliability = .783 (95% confidence interval =.696 to .847)
- Standard Error of the Measure = 3.46
- Minimal Detectable Difference at the 90% confidence level = 8.06