Use of Functional Assessment to Define Therapeutic Goals and Treatment

Abstract

This article summarizes the presentations and discussions from a workshop, "Using Functional Assessment to Define Therapeutic Goals and Treatment," which took place on November 30 to December 1, 2017. This workshop brought together transdisciplinary leaders in the fields of function and disability and clinical investigators engaged in research on geriatric populations to outline opportunities and challenges for incorporating measures of function in clinical research. Topics addressed included reliable and clinically feasible measures of function and key domains of health (eg, musculoskeletal, cognitive, and sensory) that are most strongly associated with patients' perceptions of well-being, independence, and quality of life across a wide array of diseases and interventions. The workshop also focused on the importance of function in medical decision making to inform communications between specialty physicians and patients about prognosis and goals of care. Workshop participants called for more research on the role of function as a predictor of an intervention's effectiveness and an important treatment outcome. Such research would be facilitated by development of a core set of simple, short, functional measures that can be used by all specialties in the clinical setting to allow "big data" analytics and a pragmatic research. J Am Geriatr Soc 67:1782-1790, 2019.

Keywords: frailty; functional assessment; functional impairment; functional status; resilience.

Figure 1.

Elements of outcomes research that should be informed by functional assessment. In geriatric care, health outcomes are determined by patients’ risk profiles and the interventions they receive. The interventions are determined by a dynamic medical decision-making process that accounts for patients’ goals and preferences and viable treatment options. Goals and preferences often relate to function, and treatment options depend in part on knowledge of how well the patient responded to prior treatments (ie, prior outcomes) and current functional status. We assert that functional assessment should be integrated into each of these elements of outcomes research in older adults.