Cross cultural validation of functional autonomy

measurement system (SMAF) into Arabic geriatric

rehab-culture

Albandary Alhadlaq

, Saleh Al Oraibi

, Fayz S. Al-Shahry

, Areej Al-Hawas

Lamya Al-Qurashi

and Mona Al-Otibiy

Occupational Therapy Student CAMS, KSAU-HS, Riyadh Saudi Arabia

Professor

Assistant Professor CAMS KSAU HS Consultant Rehabilitation, KSAU-HS, Riyadh Saudi Arabia

Occupational Therapy Students, KSAU-HS, Riyadh Saudi Arabia

ABSTRACT

The Functional Autonomy Measurement System (FAMS) measures functional ability in Five domain: mobility, activities of daily liv-

ing, instrumental activities of daily living, mental function and communication. FAMS however was validated into many languages

such are English, Spanish, Japanese and Dutch, but it was not validated into Arabic. So, it may not suit Arabian cultures and society.

Thus, the validation of FAMS into Arabic is vital. The aim therefore was to validate FAMS into Arabic culture. This is a prospective

cross-sectional design. The study was conducted in Riyadh at King Abdul-Aziz Medical city (KAMC), in King Fahad Hospital (KFH)

/in rehabilitation department. The FAMS was translated from original English version into Arabic. Translated Arabic version was

distributed to 30 health professionals who work in rehabilitation department to check it for contents and accordingly FAMS was

modi ed. Then, the  nal modi ed version of Arabic FAMS was distributed to 30 Saudis elderly who are 60 years old and above to

test the question applicability and clarity. The results showed a measure of the internal consistency of our study by using Cronbach’s

alpha. The optimal value of this test is 0.7 and above. So, we found the value of our study was more than 0.7. The value was 0.9 for

the 5 domains (ADL, Mobility, Communication, Mental function, IADL) which means it reliable for Arabic patients in Arabic cultures.

The result revealed a new Arabic version of important assessment tool in the  eld of rehabilitation for the  rst time ever. The internal

consistency of the FAMS assessment tool is in line with other previous similar validation research globally. Conclusion and clini-

cal implications: The new translated Arabic version of FAMS was produced with Arabic cultural modi cations. Further studies are

needed to test this important assessment tools with larger population of Arab patients.

KEY WORDS: SOCIAL FUNCTIONING, FUNCTIONAL AUTONOMY, INSTRUMENTAL ACTIVITIES, OLDER PEOPLE, VALIDITY, ARABIC CULTURE

548

Medical

Communication

Biosci. Biotech. Res. Comm. 11(4): 548-555 (2018)

ARTICLE INFORMATION:

Corresponding Authors: shahryf@hotmail.com

Received 12

Oct, 2018

Accepted after revision 19

Dec, 2018

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC / Clarivate Analytics USA

Mono of Clarivate Analytics and Crossref Indexed

Journal Mono of CR

NAAS Journal Score 2018: 4.31 SJIF 2017: 4.196

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/11.4/3

Albandary Alhadlaq et al.

INTRODUCTION

The Functional Autonomy Measurement System (FAMS)

is a tool which developed in 1984 by a team from the

Community Health Department at Hôtel-Dieu in Lévis to

measure the demands and needs of the elderly handi-

capped (Hébert, Guilbault, Desrosiers, & Dubuc, 2001;

Hébert, Carrier, & Bilodeau, 1988). SMAF quanti es the

functional ability on 29-items scale which developed by

World Health Organization’s classi cation of impair-

ments, handicaps and disabilities (Hébert, Robichaud,

Roy, Bravo, & Voyer, 2001). It measures functional abil-

ity in 5 sectors: mobility [6 items], activities of daily

living (ADL) [7 items], instrumental activities of daily

living (IADL) [8 items], mental functions [5 items] and

communication [3 items] (Hébert, et al, 2001). These

items were standardized using four-level measurement

scale. Level 0: autonomous, Level 1: needs supervision

or stimulation, Level 2: needs help, and Level 3: depend-

ent (Hébert, et al 2001; Hébert et al, 1988; Hébert, et al,

2001). According to the occupational therapy practice

framework: Doman & process, activities of daily living

(ADLs) are activities that are specialized toward taking

care of one’s own body. Which are bathing, shower-

ing, toileting and toilet hygiene, dressing, swallowing/

eating, feeding, functional mobility, personal device

care, personal hygiene and grooming, and sexual activ-

ity (Amini, D. A., Kannenberg, K., Bodison, S., Chang,

P., Colaianni, D., Goodrich, B., & Lieberman, D., 2014).

Not all the ADLs covered in the SMAF. The seven items

included in SMAF are eating, washing, dressing, groom-

ing, urinary continence, facial continence, and toileting

(Hébert, Guilbault et al 2001).

Instrumental activities of daily living (IADLs) as in

occupational therapy practice framework are “activities

to support daily life within the home and community”

(Amini et al, 2014) Care of others, care of pets, child

rearing, communication management, driving and com-

munity mobility,  nancial management, health manage-

ment and maintenance, home establishment and man-

agement, meal preparation and cleanup, religious and

spiritual activities and expression, safety and emergency

maintenance, and shopping are all considered IADLs”

(Amini et al, 2014)

IADLs in the SMAF are meal preparation and cleanup,

 nancial management, shopping, health management

and maintenance, driving and community mobility,

home establishment and maintenance (cleaning the

house, and doing the laundry), and communication

(Hébert, et al, 2001).

Disability is any restriction or lack (resulting from

an impairment) of ability to perform an activity in the

manner or within the range considered normal for a

human being (World Health Organization,1980) World

Health Organization classi ed the disability into 9 cate-

gories (World Health Organization,1980). The  rst one is

behavior disabilities which mention to a person’s aware-

ness of himself, others, their roles and occupations,

places, and time (World Health Organization,1980). The

second one is communication disabilities that refer to

person’s ability to communicate with other such as dis-

ability in speaking, listening, seeing, and writing (World

Health Organization,1980). The third is personal care

disabilities which mean the person’s ability to take care

of himself, his personal hygiene, dressing, feeding, and

getting to bed (World Health Organization,1980). The

fourth is locomotor disabilities which are disability in

the walking, climbing stairs, running, transfer, transport,

and lifting (World Health Organization,1980). The  fth

is body disposition disabilities that mean the person’s

ability to carry out his own activities such as prepar-

ing food, cocking, serving food, reaching, and kneeling

(World Health Organization,1980). The sixth is dexterity

disabilities that refer to skill body movement such as

modify the environment, moving and handling objects,

 ne motor control, and body control (World Health

Organization,1980).

The seventh is situational disabilities that are disabil-

ity in dependence, endurance, and disability in tolerance

in the temperature, noise, and work stress (World Health

Organization,1980).

The eighth is particular skill disabil-

ities that is disability in behavior such as intelligence,

motivation, perception, learning, orientation, and con-

centration, and disability in achievement the tasks such

as problem solving, adaptability, and accuracy (World

Health Organization,1980). The last one is other activity

restrictions; this section has been developed, in order to

develop some of the categories that were not mentioned in

the previous classi cations (World Health Organization,

1980).

FAMS was validated into many languges such as

English, Spanish, Japanese and Dutch, but it was not

validated into Arabic. So, it may not suit our cultures

and society (Desrosiers et al., 1995). Thus, the validation

of FAMS into Arabic is vital (Desrosiers et al, 1995). It

would help occupational therapists who work with peo-

ple with disabilities and elderly who live in Arab coun-

teries and speak Arabic languges in evaluating the areas

of disability in them (Desrosiers et al, 1995).

Validation and realibility are independent on each

other. A measurement maybe valid but not reliable,

or reliable but not valid. Relibility is the reapition of

 ndings (Kimberlin, & Winterstein, (2008). Validity of

a test is that it measure what it is supposed measures

(Kimberlin et al, 2008). We conducted this study to vali-

ate SMAF culturally into Arabic culture. We choose pro-

spective cross-sectional design to insure the willing of

the participants.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS CROSS CULTURAL VALIDATION OF FUNCTIONAL AUTONOMY MEASUREMENT SYSTEM 549

Albandary Alhadlaq et al.

550 CROSS CULTURAL VALIDATION OF FUNCTIONAL AUTONOMY MEASUREMENT SYSTEM BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Literature Review

In 2009 Yount and Sibai found that By 2045-2050, the

researchers expected that most (20 of 23) Arab popula-

tions are have at least 10 percent of population aged

60 and older. Hence, the Arabic country which have a

largest number of elderly presently lived in it is Egypt

(Yount & Sibai, 2009). The epidemiological research in

Arab countries has been focused on non–communicable

disorders and mostly on those of the circulatory system

(Yount et al, 2009). The differences in Physical depend-

ence with elderly are noted through out Arab countries

with a high prevealance of ADL, IADL dif culties (Yount

et al, 2009). The highest rates of limitations in ADL were

shown in Tunisia, Egypt, Jordan and Lebanon (those

reported between 25 and 38 percent) these countries fol-

lowed by the UAE and Saudi Arabia which have between

17-19 percent (Yount et al, 2009). The limitations in

ADL and IADL due to disability among women more

than among men. However, there is lacking of measure-

ment tools to assess functional limitations resulting In

over-reporting of disabilities by the persons with dis-

ability (Yount et al, 2009). Based on that the women

have shown higher dif culties in performing physicals

tasks than men in Egypt, Tunisia, Jordan and Lebanon,

but Egypt was reported as highest rates of restriction

in performing physical tasks (PT) by 71 percent in men

and 88 percent in women (Yount et al, 2009). Yount

et al opined that capability to perform physical tasks

(PT) is the most commonly used measurement to evalu-

ate disability among elderly (Yount et al, 2009). “This

measure is presumably independent of one’s physical

and social environment (e.g., cultural and gender roles),

which would increase its validity and reproducibility

and thereby make it preferable to measures of ADL and

IADL disability” (Yount et al, 2009)

In two Canadian’s studies used the SMAF as a meas-

ure using same study designs. Both studies used qusi-

experimental design with elderly group patients aged

75 years. The  rst study included 151 elderlies from the

geriatric day hospital and the second study included

1,501 persons identi ed at risk of functional decline

(Tousignant, et al 2003; Hébert, et al 2009).

In another study using FAMS, they  nd that this tool

was important tool to reduce elderly functional decline

by identifying functional limitation at early stage, and

Similarly Hébert Brayne, and Spiegelhalter used SMAF

tool to measure functional movement, this helped identify

risk factors of dependency and this helped to reduced the

period of dependency in elderly group (Hébert, R., 1997;

Hébert, R., Brayne, C., & Spiegelhalter, D, 1999).

Other functional studies carried out with elderly

agreed that SMAF is very important tool and instrument

synthesizes and systematizes the various scales proposed

to measure the functioning of the elderly or disabled

(Mercier, et al, 2001; Pinsonnault, et al, 2003; Wales,

et al, 2016). In All previous studies, they recruited simi-

lar age groups of  fty- ve to seventy  fe years old. All

these studies were helped to evaluate the needs of indi-

viduals (elderly) by measuring the disabilities and the

handicaps with which they are af icted. These studies

indicate that the FAMS is vital tool to measure the func-

tional movement and independency in elderly groups as

well as in people with disabilities. These very important

in occupational therapy practice, make it worth study-

ing it and translated and validated for people from other

cultures rather than only people from western culture.

Additionally, another study aimed to apply the ISO-

SMAF classi cation to funding long-term care facilities

in one area of the Province of Quebec and to compare

the results of this new funding methodology to the for-

mal methodology (Desrosiers, et al, 2004).

FAMS was validated into many languges such are

English, Spanish, Japanese and Dutch, but it was not

validated into Arabic. So, it may not suit our cultures

and society (Desrosiers et al 1995). Thus, the validation

of SMAF into Arabic is vital. The aim of this study is to

valiate SMAF into Arabic culture. It would help occu-

pational therapists who work with people with disabili-

ties and elderly who live in Arab counteries and speak

Arabic languges in evaluating the areas of disability in

the Arabic elderly (Desrosiers et al, 1995). In the future,

when there is an Arabic version, the method of evaluat-

ing elderly will be easy for the specialist and for patients.

Also on the specialists’ side it will be comfortable and

easy for them because they will not make much effort

to explain the point to patients, and it will save a lot of

their time and effort (Desrosiers et al, 1995).

METHODS

The study was about cultural validation of Functional

Autonomy Measurement System (FAMS) into Arabic

culture. The study was conducted in Riyadh at King

Abdulaziz Medical city (KAMC), in King Fahad Hospi-

tal (KFH) speci cally in rehabilitation department. The

capacity of beds in KAMC is 1501 beds. In 2003, the

rehabilitation unite was only for neurological rehabilita-

tion. The neurological rehabilitation unite expanded to

be a rehabilitation department at 2004. Now, the reha-

bilitation department involve occupational and physi-

otherapy unites, In vitro fertilization (IVF), OB, medical

imaging, laboratory, pharmacy, and continues renova-

tion of patients’ wards. (Ngha.med.sa. 2018). The Ara-

bic version of FAMS was administered among 30 health

providers in rehabilitation team including occupational

therapists, physical therapists, physicans, nurses and

30 elderley patients 60 years and over after following

the inclusion and exclusion criteria. The inclosion cri-

Albandary Alhadlaq et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS CROSS CULTURAL VALIDATION OF FUNCTIONAL AUTONOMY MEASUREMENT SYSTEM 551

30 but we found only 19 health pro ssionals in reha-

bilitation team who are Arabic native speaker and for

Saudi elderly clients over 60 years the sample size were

30 also. There is no randomization needed for this study.

Purposeful sampling was used which means to select

people who are willing to participate and available. The

steps involved in the validation of SMAF to Arabic cul-

ture is given in Figure 1 and detailed as below.

Stage I & II: Initial Translation

The  rst and second stage in adaptation were the for-

ward translation. Two forward translations were made

by two different certi ed translators. One certi ed trans-

lator was translated from English language into Arabic

language, and then second translator was translated the

tool from the new Arabic version into English language.

Stage III & IV: Synthesis of The Translations

The third stage was to compare between the old English

and the new English version to  nd any discrepancies and

modify them. The fourth stage was to give the new Arabic

version to Arabic language expert to check it for errors.

Stage V: Back Translation

The  fth stage was to translate the new English into

Arabic language; This is a process of validity checking

to make sure that the translated version is re ecting the

same item content as the original versions.

Stage VI: Expert Committee

The sixth stage was to consult therapists about the new

Arabic version and to receive their comments on it with-

out using survey. Based on the comments from expert

committee, modi cation was done on the Arabic version

of FAMS.

Stage VII: Test of the Pre-Final Version

The  nal stage of adaptation process was the pretest.

This  eld test of the new questionnaire seeks to use the

pre- nal version in subjects. Ideally, 30 persons were

tested.

Accordingly, the  nal Arabic version of FAMS was

edited and  nalized and released to be used in upcom-

ing studies.

Ethical consideration and data management/

statistical plan:

Ethical consideration:

Approval from IRB (King Abdullah Medical Research

Center) was sought. An informed consent was completed

prior to data collection. The researchers were safeguard

the con dentiality of participants of the study. Personal

data was stored on a computer with accessibility only to

FIGURE 1. Validation of SMAF to Arab

culture

teria of this stude was the elderly should be 60 year-

old and above, assess both genders and for those who

have loss or limited of function. Howevere, participants

who were below 60 year-old and anyone who have cog-

nitive impairment were excloded from this study. The

design for this study was prospective cross sectional. The

sample size of this study was determined by the previ-

ous validation process in previous studies as listed in

the reference list, (Beaton et al, 2000, Elboim-Gabyzon,

et al 2015).

So, the estimated sample size for health providers

who work in rehabilitation department in KAMC were

Albandary Alhadlaq et al.

552 CROSS CULTURAL VALIDATION OF FUNCTIONAL AUTONOMY MEASUREMENT SYSTEM BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

the researchers. Subject data was coded and names were

not used in any of the documents related to this study.

Data management/ statistical plan:

Data was analyzed using SPSS statistical software,

version 22. Descriptive statistics of means was used.

Response frequencies and means or medians for the

survey items were determined and displayed in tabu-

lar formats. After we completed the pilot study with 30

patients, the reliability of the new questionnaires items

was tested using Cronbach’s alpha.

RESULTS

The  rst stage was the distribution of the Arabic version

of FAMS to nineteen native Arabic speakers both female

and male health professionals who work in rehabilita-

tion team to make sure that it is clear and valid for Ara-

bic culture. After two weeks, we received the distributed

FAMS. Following analysis of the data, twelve of them

were satis ed and happy with the objective and iden-

tify that the objective of Arabic version is the same as

the objective of original version. However, some of the

participants suggested that for cultural purpose this tool

needs to be completed by face to face interview instead

of  lling the form subjectively. The second step, after

taking the opinions of experts into consideration and

making modi cations for the tables arrangement and

sentence structure, we distributed the Arabic FAMS to

thirty female and male Saudi elderly. The age group of

the validation of FAMS differ from country to another,

in Arabic culture elderly stage starts at sixty which is the

retirement age in Arab countries. The mean of elderly

participants age was 71.6 as seen in table 1.

The participants in this research were representative

for Arabic culture. They have different level of educa-

tion; Master degree, Bachelor degree, high school, mid-

dle school, elementary school, and illiterate. Those par-

ticipants differ in health status, some of them were in

good health, however; others have chronic condition

such as Diabetes, Irritable Bowel Syndrome, Hyperten-

sion, Osteoporosis, and Rheumatoid Arthritis and sever

health conditions such as Hemodialysis, Breast Cancer,

and heart disease. The female participants were twenty-

one and male participants were nine as seen in table 2.

The result of distributing the FAMS to elderly in Arab

culture was clear, simple, and easily understood for the

participants. They satisfyingly answered all the ques-

tions of the Arabic version of FAMS. As a result, the

Arabic version of FAMS is valid to be used with elderly

in all Arab countries.

We used Cronbach’s Alpha to measure the validity of

the tool. The value of activity of daily living (ADL) was

0.914. And the value of mobility was 0.914. Also, the

value of communication was 0.918. The value of mental

function was 0.917. The value of instrumental activities

of daily living (IADL) was 0.913. The optimal value of

this test is 0.7 and above. The result that we found for

all items in SMAF was 0.9 as seen in table 3.

DISCUSSION

The suitability of the content of FAMS for elderly people

was reliable and valid and widely used in many coun-

tries. however the application of this scale in other non-

English speaking made the outcomes nonspeci c and

weary. In the Arab countries a notable boundaries were

addressed by patients and families during the applica-

tion of the FAMS in English version. the variation in

the language interpretation and diversity in the meaning

between Arabic and English was a real barrier. therefore

this study was of extreme importance and the optimiza-

tion of interpretation of the FAMS was the real chal-

lenge.

In this study, we validate the Arabic version of the

functional Autonomy measurement system for the

result, we have carried this study through two stages. In

stage one, we distributed the Arabic version of FAMS to

nineteen Arabic health professionals in rehab rehabili-

tation team. They were satis ed about it but they have

some comments regarding the sentence structure. Based

on their comments we modi ed the Arabic version to be

Table 1. mean of elderly age

Statistics

age

N Valid 30

Missing 0

Mean 71.6667

Table 2. number of male and female who are participate in research.

gender

Frequency Percent Valid Percent Cumulative Percent

male

Valid female

Total

9 30.0 30.0 30.0

21 70.0 70.0 100.0

30 100.0 100.0

Albandary Alhadlaq et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS CROSS CULTURAL VALIDATION OF FUNCTIONAL AUTONOMY MEASUREMENT SYSTEM 553

Table 3: shows the value of cronbach’s alpha for ADL, Mobility, Communication, Mental function, IADL.

Item-Total Statistics

Scale Mean

if Item

Deleted

Scale Variance

if Item Deleted

Corrected Item-

Total Correlation

Squared

Multiple

Correlation

Cronbach’s

Alpha if Item

Deleted

activities_of_daily_living_eating 93.6667 929.333 .699 . .915

activities_of_daily_living_bathing 93.6000 916.938 .835 . .914

activities_of_daily_living_dressing 93.6667 922.368 .851 . .914

activities_of_daily_living_grooming 93.7000 916.631 .886 . .913

activities_of_daily_living_urinary_

function

93.9333 935.237 .767 . .915

activities_of_daily_living_bowel_

function

94.1000 954.231 .631 . .917

activities_of_daily_living_toiletting 93.9000 941.610 .604 . .916

Mobility_TRANSFERS 93.8333 934.144 .756 . .915

Mobility_WALKING_INSIDE 93.6667 927.540 .678 . .915

Mobility_PROPELLING_A_

WHEELCHAIR_INSIDE

93.9000 931.059 .760 . .915

Mobility_NEGOTIATING_STAIRS 92.9667 900.930 .810 . .913

Mobiliy_MOVING_AROUND_

OUTSIDE

93.2333 901.151 .760 . .913

communication_vision 93.8667 962.051 .578 . .918

comunication_hearing 94.1333 966.602 .603 . .918

communication_speaking 94.2000 969.407 .569 . .919

mental_function_memory 93.8667 957.844 .687 . .917

mental_function_orientation 94.0667 952.685 .808 . .917

mental_function_COMPREHENSION

94.1333 962.740 .733 . .918

mental_function_JUDGMENT 93.9000 941.128 .749 . .916

mental_function_BEHAVIOUR 94.0333 968.723 .553 . .919

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_HOUSEKEEPING

93.0000 898.897 .812 . .913

INSTRUMENTAL_ACTIVITIES_

OF_DAILY_LIVING_MEAL_

PREPARATION

92.6000 902.041 .755 . .913

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_SHOPPING

93.0333 894.378 .829 . .912

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_LAUNDRY

92.7333 894.616 .769 . .913

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_TELEPHONE

93.1667 912.833 .835 . .913

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_TRANSPORTATION

93.1667 906.695 .894 . .913

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_MEDICATION_USE

93.2333 906.875 .805 . .913

INSTRUMENTAL_ACTIVITIES_OF_

DAILY_LIVING_BUDGETING

93.0667 898.133 .803 . .913

Albandary Alhadlaq et al.

554 CROSS CULTURAL VALIDATION OF FUNCTIONAL AUTONOMY MEASUREMENT SYSTEM BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

more suitable Setubal and understandable for the Arabic

speakers. The second stage, we distributed the modi ed

Arabic version to 30 individuals from a representative

elderly group. They were able to understand and answer

all the questions with no dif culty and help.

This study considered to be the  rst study that

validate FAMS to Arabic culture, which is one of the

strength of this cross-sectional study. Another strength

of this study, is that by now this version of FAMS is

available to be used by all Arabic countries with differ-

ent dialects. However, this study have some weakness.

Although, the validation of FAMS into Arabic version

has been completed, the sample size was small. Despite

that we try to make it representative for older people

living in Saudi Arabia in term of social-economic sta-

tus, ethnicity, level of education, age, and health status.

Thus, future research is needed to increase the sample

size and better sampling technique in order to obtain

valid information and to recheck our validity. The inter-

nal consistency for the study is 0.9 which consider a

high consistency. In a study carried out by Desrosiers,

et al., (1995) they used test re-test to measure the intra-

class correlation reliability. While, in our study we used

the Cronbach’s alpha to measure the reliability, despite

this the  nding from previous study were similar to the

present study (Desrosiers et al, 1995). In terms of ADL

our present study was in agreement with Desrosiers,

et al (1995) study. For the mobility part, present study

was also in line with both Desrosiers et al. (1995) study

and Desrosiers et al. (2004) study (Desrosiers et al, 1995;

Desrosiers, et al, 2004).

However, for communication part, our study was in

line with Desrosiers, et al. (1995); but was not in agree-

ment with Desrosiers, et al (2004). The possible explana-

tion could be because the 2004 study internal consist-

ency for this part was different from our study which

was range from 0.3 to 0.4 the same as the mental func-

tion. For IADL, our study In line with Desrosiers et al.

(1995) study and Desrosiers et al. (2004) study (Desro-

siers et al, 2004).

By using Cronbach’s alpha, the reliabil-

ity and validity of the Arabic FAMS was measured. The

internal consistency is used to measure the reliability.

Therefore, we found that the Arabic version of FAMS

is valid to be used in Arabic culture. However, further

study to implement SMAF as measurement tools in Arab

culture elderly will strengthen the tools and increase its

reliability.

CONCLUSION

This research revealed that it is possible to validate west-

ern based rehabilitation tool into Arabic culture in order

to use reliable measure. The new Arabic SMAF version is

valid and reliable measure and culturally adapted tool to

test ability of elderly people in Saudi Arabia and widely

in Arab population. For the  rst time ever we introduced

rehabilitation specialists with new tool appropriate for

Arab culture and resources.

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