Functional Ambulation Categories (FAC)

Purpose of the measure

The Functional Ambulation Categories (FAC) is a functional walking test that evaluates ambulation ability. This 6-point scale assesses ambulation status by determining how much human support the patient requires when walking, regardless of whether or not they use a personal assistive device (Teasell et al., 2011). The FAC does not evaluate endurance, as the patient is only required to walk approximately 10 ft (Holden, Gill, Magliozzi, Nathan & Piehl-Baker, 1984). The FAC can be used with, but is not limited to, patients with stroke.

Available versions

The FAC was developed at Massachusetts General Hospital and first described by Holden et al. in 1984.

Features of the measure

Items
There are no actual items to the FAC.

To use the FAC, an assessor asks the subject various questions (Mehrholz et al., 2007) and briefly observes their walking ability to provide a rating from 0 to 5 (Collen, Wade and Bradshaw, 1990).

  • A score of 0 indicates that the patient is a non-functional ambulator (cannot walk);
  • A score of 1, 2 or 3 denotes a dependent ambulator who requires assistance from another person in the form of continuous manual contact (1), continuous or intermittent manual contact (2), or verbal supervision/guarding (3)
  • A score of 4 or 5 describes an independent ambulator who can walk freely on: level surfaces only (4) or any surface (5=maximum score) (Holden et al., 1984)

What to consider before beginning
To prepare for the FAC, the client should be encouraged to:

  • Wear comfortable clothing
  • Wear appropriate footwear
  • Use their usual walking aides during the test (cane, walker, etc.)

To prepare for the FAC, clinicians should be aware that provision of human support to the patient may be required.

Scoring and Score Interpretation

Score Category Interpretation
0 Nonfunctional ambulator  
1 Ambulator, dependent on physical assistance – level I Indicates a patient who requires continuous manual contact to support body weight as well as to maintain balance or to assist coordination.
2 Ambulator, dependent on physical assistance – level II Indicates a patient who requires intermittent or continuous light touch to assist balance or coordination.
3 Ambulator, dependent on supervision Indicates a patient who can ambulate on level surface without manual contact of another person but requires standby guarding of one person either for safety or verbal cueing.
4 Ambulator, independent level surface only Indicates a patient who can ambulate independently on level surface but requires supervision to negotiate (e.g. stairs, inclines, nonlevel surfaces).
5 Ambulator, independent Indicates a patient who can walk everywhere independently, including stairs.

(Mehrholz et al., 2007)

Time:
The average completion time has not been reported, however, it is estimated that the FAC takes approximately 1 to 5 minutes to complete.

Training requirements
No special training is required to administer the FAC but the administrator should be familiar with the scale prior to its use.

Subscales
None typically reported.

Equipment:
The FAC does not require any specialized equipment and can therefore be accomplished in community as well as institutional settings.

  • 10 ft path free from obstruction
  • Stairs and uneven terrain in order to evaluate category 5 (Ambulator, independent)
Alternative Forms of the assessment

Also known as Functional Ambulation Classification.
There are no alternative forms of the FAC.

Client suitability

Can be used with: patients with stroke/hemiplegia (acute, sub-acute, and chronic) (Holden et al., 1984, 1986; Hesse et al. 1994)

Other groups tested with this measure:

  • Multiple Sclerosis (Holden et al., 1984, 1986)
  • Cerebral Palsy (Schindl et al., 2000).

Should not be used with:

  • A proxy – because the FAC is administered through direct observation, a proxy respondent cannot be used.
In what languages is the measure available?

No information available. As it is not a measure with specific items that are asked of the patient it is likely the scale can be used by any clinician who understands English sufficiently well to differentiate the coding structure.