FAAM: Scoring, Interpretation, and Clinical Utility

How is the FAAM Scored?

The Foot and Ankle Ability Measure (FAAM) is scored by summing the points for each answered item within its two subscales (Activities of Daily Living and Sport) and then converting these raw scores into a percentage, where higher percentages indicate greater functional ability.

Understanding the FAAM: Purpose and Structure

The Foot and Ankle Ability Measure (FAAM) is a widely utilized patient-reported outcome measure (PROM) designed to assess the functional limitations and symptoms experienced by individuals with musculoskeletal conditions affecting the foot and ankle. Developed by Martin et al. (2005), it provides a quantitative and subjective measure of a patient's perceived ability to perform various daily and sport-specific activities.

The FAAM is comprised of two distinct subscales:

• Activities of Daily Living (ADL) Subscale: This subscale consists of 21 items that assess an individual's difficulty with common daily activities such as walking, standing, balance, stair climbing, and personal care.
• Sport Subscale: This subscale contains 8 items focused on more demanding, sport-specific activities like running, jumping, cutting, and landing. It is administered only if the patient participates in sport-related activities.

The FAAM Scoring Methodology

The scoring of the FAAM is standardized to ensure consistency and allow for reliable comparison of scores over time or between individuals. Each item on both subscales is rated using a 5-point Likert scale, reflecting the level of difficulty or pain experienced by the patient.

• Item Response Scale:

  • 4 points: No difficulty / No pain
  • 3 points: Slight difficulty / Mild pain
  • 2 points: Moderate difficulty / Moderate pain
  • 1 point: Extreme difficulty / Severe pain
  • 0 points: Unable to do / Unbearable pain

• Calculating Subscale Scores: To calculate a patient's score for each subscale, the points for each answered item are summed, and then converted into a percentage score. The higher the percentage, the better the patient's perceived functional ability.

  1. Sum Raw Scores: Add up the points for all answered items within each respective subscale.
  2. Determine Maximum Possible Score:
     • ADL Subscale: With 21 items, each worth a maximum of 4 points, the maximum possible raw score is 21 items * 4 points/item = 84 points.
     • Sport Subscale: With 8 items, each worth a maximum of 4 points, the maximum possible raw score is 8 items * 4 points/item = 32 points.

  3. Calculate Percentage Score: The percentage score for each subscale is calculated using the following formula:

     (Sum of Raw Scores / Maximum Possible Raw Score) * 100

     • Example (ADL): If a patient scores a raw total of 70 points on the ADL subscale: (70 / 84) * 100 = 83.3%
     • Example (Sport): If a patient scores a raw total of 25 points on the Sport subscale: (25 / 32) * 100 = 78.1%

• Handling Missing Data: If a patient leaves one or more items unanswered, the FAAM guidelines recommend adjusting the maximum possible score to reflect only the answered items. For instance, if one item is left blank on the ADL subscale, the maximum possible score for that patient's ADL subscale would be adjusted to 20 items * 4 points/item = 80 points. This ensures that the percentage score accurately reflects the responses provided. However, if a significant number of items are missing (e.g., more than 2 for ADL or 1 for Sport), the subscale score may be considered invalid.

Interpreting FAAM Scores

FAAM scores range from 0% to 100%.

• 100%: Indicates no perceived difficulty or pain with any of the activities listed in that subscale, representing full function.
• 0%: Indicates extreme difficulty or inability to perform all activities, representing severe functional limitation.

Scores are typically interpreted within the context of the patient's specific condition, treatment goals, and baseline measurements. A higher score signifies better function and fewer symptoms.

• Minimal Detectable Change (MDC): The MDC represents the smallest amount of change in a score that can be considered a true change, beyond measurement error. For the FAAM, the MDC90 (meaning 90% confidence that the change is real) has been established, typically around 5.4 points for the ADL subscale and 12.3 points for the Sport subscale.
• Minimal Clinically Important Difference (MCID): The MCID is the smallest change in score that a patient would perceive as beneficial and that would lead to a change in their management. For the FAAM ADL subscale, an MCID of approximately 8 points is often cited, while for the Sport subscale, it's around 34 points. These values help clinicians determine if an intervention has led to a meaningful improvement for the patient.

Clinical Utility and Application

The FAAM is a valuable tool in various clinical settings, including:

• Orthopedic and Sports Medicine Clinics: Used to assess baseline function, monitor progress during rehabilitation, and evaluate the effectiveness of interventions (e.g., surgery, physical therapy).
• Research: Employed as an outcome measure in clinical trials to quantify the impact of different treatments for foot and ankle conditions.
• Physical Therapy: Guides treatment planning by highlighting specific areas of functional deficit and helps demonstrate the efficacy of therapeutic exercises and modalities.

Its strengths lie in its reliability, validity, and responsiveness to change, meaning it consistently measures what it's intended to measure, and it can detect meaningful improvements or declines in patient function over time. While the FAAM is a patient-reported measure and thus subjective, its standardized scoring and robust psychometric properties make it a cornerstone in the comprehensive assessment of foot and ankle health.

Conclusion: Leveraging the FAAM for Patient Outcomes

Understanding how the FAAM is scored is fundamental for clinicians, researchers, and patients alike. By converting subjective experiences into quantifiable data, the FAAM provides an objective framework for tracking recovery, evaluating treatment efficacy, and ultimately, optimizing patient outcomes in the realm of foot and ankle rehabilitation. Its structured scoring system ensures that improvements, or declines, in functional ability are accurately measured and interpreted, guiding evidence-based practice in musculoskeletal care.