Functional impairment rating scales: Useful or no?

[R. Matey]

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I'm curious for this group's opinion on the use of functional impairment scales (e.g., Weiss, Barkley for ADHD; WHODAS) vs. just sussing out impairment in the clinical interview. Specifically, do you feel if these have any incremental validity above the interview? Are there use cases in clinical practice where rating scales are helpful or do you find that these are superfluous?

 

[WisNeuro]

I'm curious for this group's opinion on the use of functional impairment scales (e.g., Weiss, Barkley for ADHD; WHODAS) vs. just sussing out impairment in the clinical interview. Specifically, do you feel if these have any incremental validity above the interview? Are there use cases in clinical practice where rating scales are helpful or do you find that these are superfluous?

Really depends on the population being measured. If it's high base rate of malingering/exaggeration, not as useful as you'll get overreporting. In say a dementia sample, if you don't have collateral, you'll get a lot of under-reporting. Generally, in clinical settings, I prefer to get the info through clinical interview with patient and collateral.

 

[psych.meout]

It can also depend on what your goal is. Is this for a one time assessment for some purpose or would you want to use them for measurement-based care?

 

[oliversacks4thewin]

I'll tread carefully here because I use the BDEFS-CA (Barkley Deficits In Executive Functioning Scale-Children and Adolescents) and not the BFIS, but I find it is useful to quantify the domains of impairment and compare/contrast this with a Connor's rating scale (which is widely used) or some equivalent, and my observations and clinical impressions when discussing/referring the case to psychiatry. They seem to readily understand the numerical values and it makes the process much more cogent for both parties.

 

[bcliff]

PCRS Rating Forms

The primary purpose of the PCRS is to evaluate self-awareness (the ability to appraise one's current strengths and weaknesses) following traumatic brain injury. The PCRS is a 30-item self-report instrument which asks the subject to use a 5-point...

www.tbims.org

Quick. Free. Useful for my purposes.

 

[PsyDr]

Useful to document the individuals perception of function. Useless as a measure of actual function. About the same utility as asking someone why their ex dumped them.

Also: the WHODAS is based upon a Pollyanna view of the world.

 

[R. Matey]

It can also depend on what your goal is. Is this for a one time assessment for some purpose or would you want to use them for measurement-based care?

Good question. I was mainly thinking about it in a one time assessment context. I've never seen it used in MBC, except for maybe GAF scores 100 years ago.

 

[albatross_at_crossroads]

Useful to document the individuals perception of function. Useless as a measure of actual function. About the same utility as asking someone why their ex dumped them.

I agree. Recently used the Weiss exactly for this - to document the person's perception of function in various domains.

 

[AcronymAllergy]

Useful to document the individuals perception of function. Useless as a measure of actual function. About the same utility as asking someone why their ex dumped them.

Also: the WHODAS is based upon a Pollyanna view of the world.

Yep, perceived functioning can be useful to know/document, for various reasons. To add on a prior recommendation: the PCRS has a collateral/relative (and clinician) rating form for this reason. The BDEFS (Barkley's EF measure) actually has an informant rating form as well, although it's not formally scored; it's just used for comparison to patient ratings.

Edit: I completely missed that the BDEFS was already mentioned as well. I've used the adult form numerous times in the past. It's okay. I wish it had embedded validity metrics.

 

[borne_before]

In my evaluations, I basically measure adaptive functioning (via an ABAS) to document "significant functional impairments in the following' domains or else my patients risk not being able to qualify for services from the state. Even then, the state does their own "pre-admission screener" when seeing if they will qualify for long-term state funded gucci health insurance program.

 

[AcronymAllergy]

In my evaluations, I basically measure adaptive functioning (via an ABAS) to document "significant functional impairments in the following' domains or else my patients risk not being able to qualify for services from the state. Even then, the state does their own "pre-admission screener" when seeing if they will qualify for long-term state funded gucci health insurance program.

Also yeah, I would not group the ABAS, Vineland, or other similar measures in with the WHODAS or PCRS. The ABAS and Vineland are more in-depth and with (some) more specific behavioral anchors.

It's also pretty much impossible to get a direct report on functioning from a patient with severe or profound intellectual disability, so some sort of structured collateral assessment of functioning becomes more important.

 

[tr]

I love these for research. I feel like they provide a more complete picture in combination with the various psych-specific rating scales.
MHQoL is concise and covers a lot of territory. Instruments | Value set - iMTA

Not totally sure if they make sense in a clinical setting, esp if only one or a few providers are involved. Could make more sense in a team/wraparound care setting for helping team members who are unfamiliar with the patient to get a rapid gestalt of their overall functioning and main areas of need.