The Functional Autonomy Measurement System (smaf): a Clinical-based Instrument for Measur- Ing Disabilities and Handicaps in Older People

The SMAF (Functional Autonomy Measurement System) is a 29-item scale developed according to the WHO classification of disabilities.It measures functional ability in 5 areas: activities of daily living (ADL) [7 items], mobility [6 items], communication [3 items], mental functions [5 items] and instrumental activities of daily living (IADL) [8 items]. For each item,the disability is scored on a 5-point scale:0 (independent), -0.5 (with difficulty), -1 (needs supervision), -2 (needs help), -3 (dependent). Resources available to compensate the disability are also evaluated, and a handicap score is deducted. Stability of the resources is also assessed. A disability score (on -87) can be calculated, together with sub-scores for each dimension. SMAF must be administered by a health professional (nurse or social worker) who scores the subject after obtaining the information, either by questioning the subject and proxies, or by observing and even testing the subject.This instrument was submitted to many validity and reliability studies. It is responsive to interventions, and a change of 5 points or more should be considered the minimal metrically d e t e c t a ble ch a n ge and cl i n i c a l ly significant. Correspondence of the SMAF score with the required nursing-care time and the cost of long-term care, either at home or in different institutional settings,has been established.It has been utilized in many epidemiological and evaluative studies.It is also used in the clinical setting for assessment and follow-up of elderly disabled patients in the institution, in the community and in rehabilitation programs.