The Adult Functional Independence Test (AFIT)

Commentary by Carole Lewis, PT, DPT, FAPTA

The July 19, 2022 Journal Club discussed the research article from Journal of Geriatric Physical Therapy:

Puthoff, M. Participants’ Perceptions and the Implementation of a Physical Fitness Screen for Aging

Adults. J Geriatr Phys Ther. 2021;44(1):E1-E8. Questions were raised by participants about the AFIT, the physical fitness screen from the research study. Carole Lewis, developer of this proprietary screening tool, and regular GeriNotes’ GetLit columnist, provides this invited commentary on the webinar and questions.

Bold, clear, forward thinking, and informative come to mind as I viewed the Journal Club webinar led by Michael Puthoff and Vanessa Everett. I was delighted to see that they both use the AFIT and find it useful.

I created the AFIT several years before the 2018 APTA House of Delegates charged PT to conduct an annual health screen of older adults. I brought up the annual screen in my 2016 McMillan Lecture. I felt that the profession needed a comprehensive measure that reflected a physical therapist’s ability to get the most crucial information on the most pressing health concerns of older adults. We have the primary role in keeping older adults moving well; we need good measures that predict future independence. The AFIT is a work in progress. We have taken the comments from this webinar and will be implementing some changes such as including norms for 50–60-year-olds, where available. We recognize more measures could be included; however, we want to keep the tool as brief, yet as comprehensive as possible. To that end, along with assembling the evidence-based outcomes measures in the AFIT, a certification process for administration was also established. I personally was shocked when developing the Functional Standards for Optimal Aging Expert (FSOAE) certification by how many aspects there were to these standard tests that were being done incorrectly by therapists and could be done more quickly with guidance. That is one of the reasons both a 5 hour and 20-hour certification course is offered by Great Seminars, www. greatseminarsonline.com.

Some concern was expressed at the meeting regarding how long it takes to administer the AFIT. The time varies widely but can be expedited with training. I routinely perform the AFIT, including a full consult, in one hour. I credit my efficiency to the FSOAE certification and to practice. Before COVID, I worked in an integrative health center one morning a week and administered 5 AFITs in 5 hours without difficulty. Some Journal Club members expressed concern as to whether the AFIT was for wealthy people and not for those of lesser means. Michael and Vanessa discussed how the AFIT has been used at community health fairs and other events designed for the public. Shortly before the Pandemic, I was contacted by the Johns Hopkins managed care plan to provide the AFIT to underserved areas, so there’s potential for using the AFIT in different settings. I hope therapists walk away from this excellent Journal Club meeting with a greater awareness of the efficacy of preventive screens for working with older adults, and that if they choose not to use the AFIT, that they will use assessment tools that are comprehensive and meaningful.

Thank you to APTA Geriatrics for developing and sponsoring the wonderful presentations to assist members in best practice; I strongly urge you all to consider participation in Journal Club. Thanks also to Mike and Vanessa for their time and skill creating such a wonderful presentation.