ADL Assessment

Why This Matters for MTs

• Clients care about function, not ROM numbers. A client does not come in because their shoulder flexion is 120 degrees — they come in because they cannot reach overhead to put dishes away.
• ADL assessment links impairments to participation. The ICF (International Classification of Functioning, Disability, and Health) framework distinguishes between body structure/function impairments, activity limitations, and participation restrictions. ADL assessment bridges the gap between what you find on the table and what the client experiences in daily life.
• Treatment goals should be functional. "Improve shoulder flexion" is an impairment-level goal. "Client able to reach overhead shelf without pain" is a functional goal that the client understands and can verify.
• Insurance and third-party reporting require functional status. WSIB, MVA, and extended health benefit claims increasingly require documentation of how the condition affects the client's daily activities. See Third-Party Reporting.

Key Principles

Categories of Daily Activities

The Barthel Index Concept

The Barthel Index is a standardized tool that scores 10 basic ADLs on a 0-100 scale. While RMTs do not formally administer the Barthel Index (it is primarily used in rehabilitation and institutional settings), understanding its structure helps frame ADL conversations: Score interpretation: 0-20 = total dependence; 21-60 = severe dependence; 61-90 = moderate dependence; 91-99 = slight dependence; 100 = independent. RMTs use this framework conceptually — not as a scored test, but as a checklist of functional domains to ask about during the health history interview.

How to Assess ADLs in MT Practice

During the health history interview, ask:

• "What activities are hardest for you right now?"
• "Is there anything you've stopped doing because of this problem?"
• "How does this affect your work / sleep / exercise / daily routine?"
• "What would you most like to be able to do that you can't right now?"
• "On a typical day, walk me through where the problem bothers you most"

During the physical assessment, correlate findings to function:

Clinical Application

Setting Functional Treatment Goals

Framework: Impairment → Activity limitation → Functional goal Functional goals are more meaningful to clients and more useful for third-party reporting than impairment-level goals alone.

Using ADL Status to Guide Self-Care Recommendations

Match self-care exercises and recommendations to the client's actual functional limitations:

Reassessing ADLs to Measure Outcomes

At each follow-up visit, reassess the specific ADL limitations identified at intake:

• "Last time you said you couldn't reach the overhead shelf — how is that now?"
• "You mentioned driving was difficult because of your neck. Has that changed?"
• "On a scale of 0-10, how much does this affect your daily activities compared to your first visit?"

Document ADL changes in the treatment record. Functional improvement is the strongest evidence that treatment is working — for the client, for insurance reports, and for your own clinical decision-making.

ADL Assessment in Specific Populations

• Elderly clients: Focus on BADLs (bathing, dressing, transfers, mobility, stairs). Fall risk is a critical ADL factor. See Patient Transfers for safe transfer protocols.
• Post-surgical clients: Focus on return to specific activities as cleared by the surgeon. Document pre-surgical functional baseline for comparison.
• Chronic pain clients: Use ADL limitations to track functional impact over time. The Pain Disability Index or similar concept can frame the conversation.
• WSIB/MVA clients: ADL documentation is required for claims. Be specific: "Client reports inability to lift objects >5 kg overhead" rather than "client has shoulder pain."