Hi Shankar!

Very important question for PT!

From what I learned, I would say that talking about the first situation: "patient walking 10 meters in 5 minutes using an AFO" assessed in his/her natural environment (home, community) it´s performance! However, I think I picked your point: assessments that happen in a "standardized environment", like rehab or other clinical settings, right? If so, we we are not talking about performance, neither capacity. His capacity is "walking 10 meters in 15 minutes without an AFO" (and standardized environment). However, for PT, assessing capacity + AFO could be the correct act and fundamental to take decisions about prescribing or not that specific AFO (or other assistive technologies). In my opinion, the optional qualifiers are very interesting and useful in PT settings, but very much unknown. Please, read topic "4.3 Coding Activities and Participation", from Appendix 2 (ICF, 2001). I would like to keep this discussion :) (Hope my English has been understandable).

Dear Anabela,

Thanks for your input. But I am still not clear. Capacity is defined as the highest probable level of functioning that a person may reach. Does it mean that a capacity qualifier will always be better than a performance qualifier? So even if an assessment is made in a standardized setup, and if a person is denied using an assistive device, his capacity will drop lower than performance. Isn't it contradictory? What should I infer?

Qualifiers are all-together a different area where there no common consensus. I would like to know , how you grade qualifiers?

Thanks and regards

I am not a clinician but I may be able to help if I had context as a researcher. What is it you seek to measure in your study?

Hello Shankar,

Maybe this article will help you a bit further.

In my opinion, capacity is indeed the highest possible level of functioning of a person in a given domain at a given moment, measured in a standardized environment. And performance can be defined as: the level of functioning in a given domain at a given moment in his/her current environment. Performance can be further devided into perceived perdormance (subjectively experienced by the patient) or actual performance (objectively measured).

The main difference between capacity and performance is the situation (i.e. standardized for capacity and daily life for performance). When measuring performance (in daily life) factors like fatigue might play a role. Capacity can also be measured while the patient is using an assistive device.

I hope this helps you in answering your question.

Kind Regards,

Ryanne

Article Valid and reliable instruments for arm-hand assessment at IC...

Dear all,

Thanks for your inputs. I was mainly confused whether to include the role of assistive devices in measuring performance. I think the answer is NO. The difference between capacity and performance is in the environment. Please correct me, if I am wrong.

Special thanks to Melissa Selb for this example:

Case 1/d450.32 (capacity higher than performance): PT assesses a person’s walking ability without the person using any assistive devices in a treatment room. The room’s floor is flat, has no obstacles, temperature/lighting regulated, no noise… thus standardized. Then the PT tests the person’s walking ability, again without any special devices, at the person’s workplace, where the ground is uneven, where small furniture are sometimes in the way of the normal path of walking, machines are noisy…thus current environment. In this case, the person may have more problems walking due to the environmental factors like uneven ground, obstacles, noise…

Case 2/d450.22 (capacity is equal to performance): Same as above with regards to the assessment in treatment room, but in the assessment at the person’s workplace, the person was able to use an assistive device that enabled him/her to overcome the barriers that were posed by the uneven flooring and obstacles.

Case 3/d450.12 (capacity lower than performance): Same as above with regards to the assessment in treatment room, but in the assessment at the person’s workplace, the person’s walking ability was even further facilitated by use of an assistive device as well as removing the obstacles permanently.

Regards

Hello Shankar,

I would like to give my opinion too. I am a physiotherapist and I am writing a paper about differences among performance and capacity (applied for older people).

I think that for conduct a treatment and to evaluate patient's evolution, it is extremely necessary using capacity instruments. On the other hand, we can aggregate a subjective perspective (that can improve our treatment for patient's specific objectives), using instruments that evaluate self-reported performance and QOL of our patients.

There aren't a perfect recipe, we need to innovate every day and work in the best way to promote good rehabilitation experiences for them.

And another important point: not always capacity will be better than performance!! It is not a rule!!

Best Regards,

Etienne Duim

University of São Paulo