Functional Assessment Inventory (FAI)

Abstract

The Functional Assessment Inventory (FAI) is a standardized psychological instrument designed to systematically evaluate the functional limitations and strengths of individuals, primarily within the context of Vocational Rehabilitation. Developed by Crewe and colleagues, the FAI provides a structured method for clinicians and counselors to assess key domains—including cognition, physical condition, communication, and adaptive behavior—that directly impact an individual’s potential for employment and successful rehabilitation outcomes. The scale uses a severity rating system for limitations (0 to 3) across 30 items and identifies 10 specific strengths to facilitate comprehensive diagnosis and personalized goal setting.

Keywords

Functional Assessment Inventory, FAI, vocational rehabilitation, functional limitations, disability assessment, cognitive impairment, adaptive behavior, vocational diagnosis, employability.

Authors

Nancy M. Crewe, G.T. Athelstan, G.K. Meadows, R.R. Turner, Marcel Dijkers, Laura A. Cushman, Marcia J. Scherer.

Purpose

The primary purpose of the Functional Assessment Inventory (FAI) is to offer a systematic and quantifiable framework for diagnosing functional impediments that hinder competitive employment. By translating complex medical or psychological conditions into concrete functional limitations, the FAI assists rehabilitation professionals in making informed decisions regarding treatment planning, job placement, and necessary accommodations.

The scale is intended not only to identify deficits but also to highlight existing client strengths (e.g., vocational motivation, supportive family) that can be leveraged during the rehabilitation process. This dual focus ensures a holistic approach to vocational planning and assists in predicting the likelihood of successful job retention and overall rehabilitation success.

Construct

The FAI is designed to measure the construct of functional capacity as it relates to employability. It operationalizes this construct across six major domains of potential limitation: Cognition, Vision, Communication, Motor Function, Physical Condition, and Vocational Qualifications, along with an Adaptive Behavior section. The scale effectively assesses the degree to which an impairment results in a practical limitation on daily life and work performance.

Specific sub-constructs measured include Cognitive Impairment (e.g., learning ability, memory), physical capacity (e.g., endurance, ambulation, exertion), and psychosocial factors (e.g., work history, acceptability to employers, social support system). The combination of these factors provides a comprehensive profile of an individual’s readiness for and barriers to vocational success.

Validity

Validation studies for the FAI have focused primarily on its utility in predicting vocational outcomes and its correlation with other measures of functioning. Early research by Crewe and Athelstan established the scale’s relevance for vocational diagnosis by demonstrating that FAI scores could differentiate between various levels of rehabilitation potential based on functional limitations.

Further evidence of criterion validity was demonstrated by Robinson et al. (1986), who validated the FAI against the independent assessments provided by a multidisciplinary home care team. This established that the FAI ratings accurately reflected real-world functional status, underscoring its utility as a reliable measure of functional limitations relevant to medical and vocational settings. These psychometric properties support the FAI as a valuable tool for comprehensive functional assessment.

Reliability

Reliability of the FAI is generally assessed through inter-rater consistency, as the inventory relies on professional judgment and interpretation of clinical data rather than self-report. High inter-rater reliability is crucial for the FAI to ensure consistent diagnosis and goal setting across different clinicians performing the assessment.

The structured, categorical nature of the FAI items aids in achieving high agreement among trained assessors. The detailed descriptions for each severity level (0 to 3) are instrumental in minimizing subjective interpretation and enhancing the scale’s stability and consistency across various clinical settings where rehabilitation services are provided.

Factor Analysis

Initial development and subsequent studies of the FAI structure suggest that the 30 limitation items group logically into the defined domains (Cognition, Motor Function, Physical Condition, etc.). While the FAI is designed to provide a profile across these distinct functional areas rather than a single global score, factor analytic work confirms the intended multidimensional nature of the inventory.

The factor structure reflects the necessity in vocational rehabilitation for specific, targeted interventions rather than broad classification. The factors identified align closely with the major categories of impairment that typically restrict an individual’s ability to perform essential job functions, confirming the instrument’s ecological relevance for employment planning.

Instrument

Test Type: Observer-Rated Functional Assessment Inventory / Criterion-Referenced Rating Scale

Format: 30 Limitation Items (rated 0-3 based on severity of impairment) and 10 Strength Items (used descriptively or as exceptional assets).

Language Available: English (Original)

Population Group: Adults with physical, cognitive, or psychological disabilities requiring rehabilitation services.

Age Group: Typically working-age adults (18+).

Population Details: Used extensively in vocational rehabilitation, physical medicine, and geriatric settings to quantify functional deficits and predict long-term occupational outcomes. The emphasis is on translating medical diagnoses into practical work capabilities.

Test Methodology: A trained assessor uses clinical judgment or a review of medical and psychological records to rate each of the 30 limitation items on a four-point scale (0 = No significant impairment, 3 = Severe impairment/Total loss of function). The 10 strength items are noted as exceptional assets in areas like personality or educational qualifications, contributing to a holistic assessment of Adaptive Behavior.

Keywords

Disability scale, psychometric properties, functional capacity evaluation, rehabilitation outcome, vocational placement, impairment rating, activities of daily living, motor speed, endurance.

Authors

Author ORCID Identifier: N/A (Information not provided in source material).

Affiliation Email addresses: N/A (Information not provided in source material).

Correspondence Address: N/A (Information not provided in source material).

Permissions & Fee and Test Year

The Functional Assessment Inventory (FAI) was initially developed in the mid-1970s, with the comprehensive manual published in 1984 (Crewe & Athelstan). The instrument is widely used in academic research and public rehabilitation settings. Information regarding current permissions and fees for commercial use should be sought from the primary authors or the publisher of the manual, typically the Rehabilitation Services Administration (RSA) or relevant academic bodies.

Reference’s

• Crewe, N.M., Athelstan, G.T., Meadows, G.K. (1975). Vocational diagnosis through assessment of functional limitations. Archives of Physical Medicine and Rehabilitation, 56:513–516.
• Crewe, N., & Athelstan, G. (1979). Functional assessment in vocational rehabilitation. International Journal of Rehabilitation Research, 2, 535-536.
• Crewe, N.M., Athelstan, G.T. (1981). Functional assessment in vocational rehabilitation: a systematic approach to diagnosis and goal setting. Archives of Physical Medicine and Rehabilitation, 62(7):299–305.
• Crewe, N.M., Athelstan, G.T., (1984). Functional Assessment Inventory Manual. Rehabilitation Services Administration (ED), Washington, DC.
• Crewe, N.M., Turner, R.R. A functional assessment system for vocational rehabilitation. In: Halpern AS, Fuhrer MJ, eds. Functional assessment in rehabilitation. Baltimore: Paul H Brookes, 1984:223–238.
• Robinson, B.E., Lund, C.A., Keller, D., Cuervo, C.A. (1986). Validation of the Functional Assessment Inventory against a multidisciplinary home care team. Journal of the American Geriatric Society, 34(12), 851-854.
• Crewe, Nancy M., Dijkers, Marcel., Cushman, Laura A., Scherer, Marcia J. (1995). Psychological assessment in medical rehabilitation. (pp. 101-144). Washington, DC, US: American Psychological Association, xv, 471 pp.
• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

The original PDF of the instrument and related materials can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf and http://files.eric.ed.gov/fulltext/ED277841.pdf.

Items of the Functional Assessment Inventory (FAI)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Cognition

1. Learning ability
• 0. No significant impairment.
• 1. Can learn complex, employable skills but not at a normal rate of speed.
• 2. Can ma‎ster fairly complex ideas and operations with special training.
• 3. Is capable of learning only very simple tasks and then only with adequate time and repetition.
2. Ability to read and write
• 0. No significant impairment
• 1. Has some difficulty reading or writing the English language due to lack of education or foreign language background; or cannot read standard print due to vision but can use Braille or large print.
• 2 Has considerable difficulty with reading or writing the English language.
• 3. Is unable to read or write English in print or Braille.
3. Memory
• 0. No significant impairment.
• 1. Occasional memory deficit causes some difficulty.
• 2. Memory deficit interferes significantly with new learning. Information or directions must be repeated frequently.
• 3. Is confused or disoriented Remembers very little from day to day.
4. Spatial and form perception
• 0. No significant impairment.
• 1. Difficulty with perception inteeres with tasks requiring fine discrimination.
• 2. Occasionally gets lost or shows other evidence of perceptual impairment in daily living.
• 3. Extreme perceptual distortion evidenced by behavior (e.g., becoming lost even in familiar places or inability to identify objects.)

Vision

5. Vision
• 0. No significant impairment.
• 1. Has difficulty handling work involving fine visual details.
• 2. Impairment is sufficient to interfere with major activities such as driving or reading.
• 3. Total or nearly total loss of vision. (Uses cane for mobility outdoors.)

Communication

6. HEARING
• 0. No significant impairment.
• 1. Has some difficulty understanding conversation or using a telephone.
• 2. Can handle face-to face conversation with the help of lip-reading, but is unable to use a standard telephone. Is unable to pick up certain environmentally relevant sounds (e.g., bells or high-pitched tones).
• 3. Extremely hard-of-hearing or deaf; or is unable to comprehend any speech.
7. Speech
• 0. No significant impairment
• 1. Speech is easily intelligible, but voice quality or speech pattern is distracting: or speech can be easily intelligible with special effort (e.g., taking care to talk slowly).
• 2. Speech is difficult to Understand. Repetition is often necessary.
• 3. Speech is not usable as a means of communication.
8. Language functioning
• 0. No significant impairment.
• 1. Ability to communicate orally in the English language may be slightly to moderately impaired. If hearing-Impaired, is able to use lip-reading and speech to communicate.
• 2. Has considerable difficulty communicating, is limited to single words or short phrases or to simple concepts that can be communicated nonverbally. If hearing-impaired, uses sign language effectively but does not lip-read or speak.
• 3. Verbal communication is nearly impossible

Motor function

9. UPPER EXTREMITY FUNCTIONING
• 0. No significant impairment.
• 1. Partial or total loss of functioning in one upper extremity, The other is Intact and functions well.
• 2. Loss of function to at least some extent in both upper extremities; or severe loss of functioning in dominant side.
• 3. No useful functioning in either upper extremity.
10. HAND FUNCTIONING
• 0. No significant impairment.
• 1. Would be unable to perform most tasks requiring fine dexterity, speed, or coordination.
• 2. Seriously impaired, but with or without the use of aids or prostheses can write and perform activities of daily living such as feeding.
• 3. Little or no hand functioning.
11. MOTOR SPEED
• 0. No significant impairment.
• 1. Moves more slowly than average.
• 2. Moves very slowly.
• 3. Extreme motor retardation

Physical condition

12. AMBULATION OR MOBILITY
• 0. No significant impairment.
• 1. Mild impairment, but does not require assistance f:om others to get around in the community.
• 2. Moderate impairment. Sometimes requires help from others In order to get around in the community.
• 3. Severe impairment. Usually requires assistance from others in order to get around in the community.
13. CAPACITY FOR EXERTION
• 0. No significant impairment.
• 1. May encounter some difficulties in occupations requiring substantial physical exertion (e.g.. occupations requiring frequent lifting of 25 lbs. or a great deal of walking or bending). However, physical activity in moderate amounts is acceptable.
• 2. Occupations requiring moderately strenuous physical activity are ruled out. Limited to jobs classified as light by the Department of Labor.
• 3. Limited to sedentary jobs.
14. ENDURANCE
• 0. No significant impairment.
• 1. Can work a full day with special rest periods arranged.
• 2. Can work only part-time (16 to 32 hours per week).
• 3. Unable to work for more than one sr two hours a day (15 hours or less per week).
15. LOSS OF TIME FROM WORK
• 0. No significant impairment.
• 1. Requires 1-2 days or parts of several days off each month for medical supervision, therapy (including psychotherapy), or recurring medical or personal problems.
• 2. Requires an average of one day off each week.
• 3. Requires frequent or extended absences from jobs.
16. STABILITY OF CONDITION
• 0. No significant impairment.
• 1. Stable if controlled by diet, treatment, or exercise.
• 2. Condition is likely to be slowly progressive: or course is unpredictable and may result in further loss of functioning.
• 3. Condition is likely to worsen significantly in the foreseeable future.

Vocational qualifications

17. WORK HISTORY
• 0. No significant impairment.
• 1. Has little or no work experience due to youth or other reasons acceptable to most employers; or had a good work record prior to disability, but has now been out of work for more than one year,
• 2. Work history includes negative aspects, such as frequent tardiness or frequent job changes with periods of unemployment.
• 3. Work history is a clear liability, possibly including long periods of unemployment and poor references.
18. ACCEPTABIUTY TO EMPLOYERS
• 0. No significant impairment.
• 1. Some physical, demographic, or historical characteristics may interfere with client’s acceptability to some employers.
• 2. Possesses characteristics which have a very low degree of employer and public acceptance, despite their lack of interference with performance (e.g, age, controlled epilepsy, or history of severe or recurring mental illness).
• 3. Current or recent characteristics which cannot be avoided or modified are likely to make this person unacceptable to most potential employers (e.g., recent criminal history, uncontrolled epilepsy, or noticeable behavior deviation),
19. PERSONAL ATMACTIVENESS
• 0. No significant impairment.
• 1. Some aspect of personal appearance or hygiene Is unattractive to others but tolerable with familiarity.
• 2. Has more severe problems with personal appearance or hygiene that are difficult for others to accept even with familiarity.
• 3. Very severe problems with personal appearance or hygiene are likely to muse avoidance by others.
20. SKILLS
• 0. No significant impairment.
• 1. No available skills that are job-specific. However, possesses general skills (Le., educational or interpersonal) that could be used in 3 number of jobs.
• 2. Has few general skills. Job specific skills are largely unusable due to disability or other factors.
• 3. Has no job-specific skills and has very few general Or personal skiils transferable to a job situation.
21. ECONOMIC DISINCENTIVES
• 0. No significant impairment,
• 1. Potential for employment is affected to some degree by economic disincentives (e.g., may need an unusually high salary or special conditions that could be difficult to find).
• 2. Job options are quite restricted because of potential loss of benefits (e.g., may choose to consider only part-time or low-income jobs that allow benefits to continue).
• 3. In all probability cannot afford to take a job or will choose not to take a job because of resulting loss of benefits (e.g., financial support, medical coverage, or attendant care).
22. ACCESS TO JOB OPPORTUNITIES
• 0. No significant impairment.
• 1. Employment opportunities are somewhat limited (e.g., due to transportation problems or geographic location).
• 2. Employment opportunities are significantly limited. Few accessible and appropriate work settings are available.
• 3. Extremely limited opportunities. May be homebound or living in an area where very few jobs exist.
23. REQUIREMENTS FOR SPECIAL WORKING CONDITIONS
• 0. No significant impairment.
• 1. Placement options are limited to some degree by disability requirements. (e.g., may need freedom to sit, stand, and move around as needed, or may need to avoid exposure to dangerous equipment.)
• 2. Multiple environmental restrictions related to the disability substantially limit placement alternatives.
• 3. Capable of functioning only in highly selected settings. Special placement efforts essential.

Adaptive behavior

24. WORK HABITS
• 0. No significant impairment.
• 1. Is deficient in work habits (e.g., punctuality, ability to persist at work tasks with minimal supervision, or appropriate interview behavior). However, is willing and able to learn these skills quite readily.
• 2. Work habit deficiencies may require that work adjustment training precede employment.
• 3. Has severe deficiencies in work habits and seems to have little potential for improving through work adjustment training.
25. SOCIAL SUPPORT SYSTEM
• 0. No significant impairment.
• 1. Little or no support system available.
• 2. Support system at times encourages values or behaviors that are contrary to rehabilitation goals.
• 3. Support system is clearly working against rehabilitation behaviors.
26. ACCURATE PERCEPTION OF CAPABILITIES AND LIMITATIONS
• 0. No significant impairment.
• 1. Has an inadequate understanding of what his or her vocational capacities are as a result of disability (e.g., may rule out too many vocational possibilities or deny the significance of some limitations).
• 2. Has an unrealistic understanding of his or her vocational capacities (e.g., may rule out all vocational possibilities or deny important limitations).
• 3. Refuses to accept or significantly distorts his or her limitations. Frequently gives others false, misleading, or extremely inappropriate information about the disability.
27. EFFECTIVE INTERACTION WITH EMPLOYERS AND CO-WORKERS
• 0. No significant impairment.
• 1. Is somewhat awkward or unpleasant in social interactions.
• 2. Lacks many of the skills necessary for effective social interaction.
• 3. Overtly aggressive, withdrawn, defensive, bizarre, or inappropriate behavior often impairs personal interactions.
28. JUDGMENT
• 0. No significant impairment,
• 1. Sometimes makes unsound decisions. Does not take time to consider alternatives or consequences of behavior. 2. Frequently makes rash or unwise decisions. Often displays inappropriate behavior or choices.
• 3. Could be dangerous to self or others as a result of foolish or impulsive behavior.
29. CONGRUENCE OF BEHAVIOR WITH REHABIUTATION GOALS
• 0. No significant impairment.
• 1. Behavior with respect to rehabilitation program appears inconsistent (i.e., it varies from day to day or from one area to another).
• 2. May express desire to work but often does not act accordingly.
• 3. Behavior is often in contradiction to goals of program.
30. INMATIVE AND PROBLEM-SOLVING ABIUTY
• 0. No significant impairment.
• 1. Is able to see alternatives and work effectively toward solutions to problems, but needs frequent direction and encouragement to take action.
• 2. Often needs help identifying tasks or solutions to problems, and needs repeated urging to take action.
• 3. Usually seems unable to identify tasks or possible solutions to problems. Needs constant urging to undertake tasks and seldom completes them without help.

The strength items include exceptional assets in the following areas:

31. Physical appearance
32. Personality
33. Intelligent or has verbal fluency
34. Vocational skill in demand
35. Suitable educational qualifications
36. Supportive family
37. Financial resources
38. Vocational motivation
39. Job available with employer
40. Initiative and problem-solving Ability