title: Development of a language-independent functional evaluation.
abstract: Haig AJ, Jayarajan S, Maslowski E, Yamakawa KS, Tinney M, Beier KP, Juang D, Chan L, Boggess T, Loar J, Owusu-Ansah B, Kalpakjian C. Development of a language-independent functional evaluation.
  
  
  OBJECTIVE
  To design, validate, and critique a tool for self-report of physical functioning that is independent of language and literacy.
  
  
  METHODS
  Software design and 2 prospective trials followed by redesign.
  
  
  METHODS
  United States and African university hospitals.
  
  
  METHODS
  Outpatient and inpatient competent adults with diverse physical impairments.
  
  
  METHODS
  (1) Software design process leading to a Preliminary Language-Independent Functional Evaluation (Pre-L.I.F.E.); (2) patient surveys using a printed Pre-L.I.F.E. and a computer-animated Pre-L.I.F.E. tested in random order, followed by a questionnaire version of the standard Barthel Index; and (3) software redesign based on objective and qualitative experiences with Pre-L.I.F.E.
  
  
  METHODS
  Validation of the general concept that written and spoken language can be eliminated in assessment of function. Development of a refined Language-Independent Functional Evaluation (L.I.F.E.).
  
  
  RESULTS
  A viable Pre-L.I.F.E. software was built based on design parameters of the clinical team. Fifty Americans and 51 Africans demonstrated excellent (Cronbach alpha>0.8 Americans) and good (alpha>.425 Africans) reliability. In general, the relations between Pre-L.I.F.E. and Barthel scores were excellent in the United States (interclass correlation coefficient for stair climbing, .959) but somewhat less good in Africa, with elimination functions very poorly related. The computer-animated Pre-L.I.F.E. was faster and trended to be more reliable than the printed Pre-L.I.F.E. in both the United States and Africa. Redesign meetings corrected statistical and qualitative challenges, resulting in a new tool, the L.I.F.E.
  
  
  CONCLUSIONS
  Literacy and language translation can be eliminated from some aspects of functional assessment. The new L.I.F.E., based on solid empirical evidence and design principles, may be a practical solution to assessment of function in the global culture.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA. andyhaig@umich.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Haig
authors.forename: Senthil
authors.initials: S
authors.lastname: Jayarajan
authors.forename: Eric
authors.initials: E
authors.lastname: Maslowski
authors.forename: Karen S
authors.initials: KS
authors.lastname: Yamakawa
authors.forename: Melissa
authors.initials: M
authors.lastname: Tinney
authors.forename: Klaus P
authors.initials: KP
authors.lastname: Beier
authors.forename: Derek
authors.initials: D
authors.lastname: Juang
authors.forename: Lilliene
authors.initials: L
authors.lastname: Chan
authors.forename: Tony
authors.initials: T
authors.lastname: Boggess
authors.forename: Jesse
authors.initials: J
authors.lastname: Loar
authors.forename: Bertha
authors.initials: B
authors.lastname: Owusu-Ansah
authors.forename: Claire
authors.initials: C
authors.lastname: Kalpakjian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003196:Computer Graphics; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D005869:Ghana; D006801:Humans; D007803:Language Arts; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012985:Software Design; D014481:United States; D014584:User-Computer Interface