Frenchay Activities Index
Also known as: FAI
The Frenchay Activities Index (FAI) is a self-report or informant-rated questionnaire designed to measure participation in activities of daily living and instrumental activities over a 3-month period. Developed by Holbrook and Skilbeck (1983) at the Frenchay Hospital in Bristol, the FAI evaluates participation in 15 activities spanning domestic, leisure, and work domains. The FAI is widely used in stroke rehabilitation and aging research to measure broader functional recovery, social participation, and return to valued activities beyond basic self-care.
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When to use it
The FAI is appropriate for stroke survivors at any post-stroke phase (acute, subacute, chronic) to measure broader functional recovery and return to valued activities. It is particularly useful when clinical motor recovery has plateaued but psychosocial adjustment and return to role engagement are ongoing concerns. The FAI is also useful in aging research, geriatric rehabilitation, and studies of activity limitation in chronic disease. It is less suitable for acutely ill patients requiring intensive medical care or those with severe cognitive impairment preventing reliable reporting. The FAI is ideal for outcome measurement in community-based rehabilitation, home therapy programs, and long-term follow-up studies.
Strengths & limitations
- Captures real-world activity participation: Measures what people actually do, not just capability; reflects genuine return to valued occupations.
- Broad domain coverage: Includes domestic, leisure, social, and work-related activities; holistic view of functional recovery and quality of life.
- Sensitive to psychosocial recovery: Captures confidence, motivation, and role resumption, not just motor/physical recovery.
- Informant-rated option: Collateral information from family or caregiver can reduce bias from patient report, particularly in stroke survivors with anosognosia.
- Simple, accessible: 15-item questionnaire, straightforward frequency scale, no special equipment or examiner training.
- Reflects real recovery goals: Return to gardening, socializing, or work often matter more to patients than isolated motor function.
- Longitudinal tracking: Administered at 3+ month intervals, sensitive to longer-term changes in activity engagement.
- Research utility: Widely validated in stroke and aging; extensive normative data and responsiveness evidence.
- Long recall period: 3-month retrospective recall may be subject to recall bias or difficulty remembering activity frequency accurately.
- Activity relevance varies: Not all 15 activities are relevant to all individuals (e.g., gardening irrelevant in urban apartment; employment completed by some).
- Subjective frequency judgments: Distinctions between '<1/week' and '1–2/week' require accurate recall and subjective judgment prone to bias.
- Does not explain barriers: FAI documents whether activities occur but not why (capability, motivation, access, pain, confidence?); supplementary assessment may be needed.
- Environmental/situational dependence: Activity participation reflects environmental factors (living situation, weather, transportation, caregiver availability) as much as individual capability.
- Lack of responsiveness in severely impaired: In individuals with severe motor impairment, most FAI activities may score 0, yielding floor effects.
- Cultural/contextual variability: Activities may be culturally specific (e.g., gardening more common in some cultures/climates); less universally applicable than motor measures.
- Informant disagreement: Family and patient may disagree on activity frequency; protocol for handling discrepancies unclear.
Frequently asked
How is the FAI different from other ADL scales like the Barthel Index or modified Rankin Scale?
The Barthel Index and mRS focus on basic self-care ADLs (bathing, toileting, feeding); the FAI measures instrumental ADLs and social/leisure participation. Barthel and mRS are sensitive to acute, severe disability; FAI is sensitive to subtle differences in community engagement and role resumption. Both types of measures are valuable; they answer different questions. Barthel/mRS assess survival-level functioning; FAI assesses quality-of-life-level functioning.
What if a patient doesn't do an activity because it's not relevant to them (e.g., gardening)?
If an activity is not relevant, it should be scored as 0 (not done in past 3 months). However, clinicians should clarify whether non-participation reflects irrelevance, environmental barriers (e.g., no garden), or inability. Some modified versions of the FAI allow respondents to skip activities labeled 'N/A'; however, the standard FAI does not explicitly allow this. Documenting which activities are not applicable provides context for interpretation.
Should FAI be completed by the patient or an informant (family member)?
Either is acceptable, but with caveats. Patient self-report may be biased by depression, anosognosia (lack of awareness), or effort. Family informant-report may be more objective but may reflect caregiver restrictions rather than patient capability. Best practice is to obtain both when possible and note any disagreement. In research, consistency (always patient, or always informant) is important for comparability. Protocol should specify the respondent used.
What is a clinically meaningful change in FAI score?
A change of 5–10 points on the total FAI (0–45 scale) is generally considered clinically meaningful, reflecting increased or decreased activity participation. Individual activity changes (e.g., returning to work, resuming hobbies) are also informative. Early post-stroke, expected FAI gains are often 10–20 points over 3–6 months; in chronic phases, gains of 2–5 points may reflect meaningful engagement changes.
Can FAI be used in non-stroke populations?
Yes, the FAI has been used and validated in aging research, geriatric rehabilitation, and chronic disease populations (cardiac, COPD, arthritis). The 15 items are general enough to apply broadly. However, the FAI was specifically developed and most extensively validated in stroke; application to other populations should acknowledge this and consider item relevance to the specific population.
Sources
- Holbrook, M., & Skilbeck, C. E. (1983). An activities index for use with stroke patients. Age and Ageing, 12(2), 166-170. DOI: 10.1093/ageing/12.2.166 ↗
- Schuling, J., de Haan, R., Limburg, M., & Groenier, K. H. (1993). The Frenchay Activities Index. Assessment of functional status in stroke patients. Stroke, 24(8), 1173-1177. DOI: 10.1161/01.str.24.8.1173 ↗
How to cite this page
ScholarGate. (2026, June 3). Frenchay Activities Index. ScholarGate. https://scholargate.app/en/occupational-therapy/frenchay-activities-index
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