Functional Needs Assessment Tool for estimating population-level functional difficulties and the need for services and assistive products: pilot testing in Western Uganda.
Dorothy Boggs, Annet Birabwa, Suzanne Adkins and 9 others
PMID 42553601WHAT IT FOUND
A new population-level survey tool for identifying who needs rehabilitation services was found workable in rural Uganda, but its screening questions for self-care and thinking need tightening before it can be used at scale.
It is not yet a validated clinical assessment.
Key findings
01The two-stage survey (day 1 screening, day 2 clinician assessment) was feasible with high follow-up rates, and a cluster size of 45 participants per day was workable for all age groups.
02Screening-positive rates ranged from 5.1% to 25.1% across the seven functional domains for all ages, but the self-care and cognition criteria generated too many positives who did not actually need services, so these criteria require further refinement before a full survey.
03The tablet-based application could not load the Luganda translations due to a technical issue, so the survey was administered through real-time translation, introducing a risk of inconsistent wording across interviewers.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Single rural district in Uganda; findings about feasibility and throughput may not transfer to urban settings or other countries. Small sample (550 in pilot 2) and only two survey teams (three were planned), so daily throughput figures are based on limited data. The Luganda translations could not be loaded into the tablet application, so the survey relied on real-time translation, which may have introduced inconsistent wording across interviewers. Screening criteria for self-care and cognition were still being adjusted during the study and are not yet final; the tool is explicitly not validated. Hearing screening for all participants was not feasible due to limited equipment, so that objective was only partially met. The tool requires four different clinical cadres (ophthalmic officer, ENT officer, physiotherapist, occupational therapist), making it resource-intensive to deploy. No comparison against a gold-standard assessment was made; the tool's accuracy in identifying true service needs has not been established.
Declared interests
Funded by UK Aid through the AT2030 programme (Global Disability Innovation Hub, project 300815). No industry sponsor, no conflicts of interest declared by the authors.
The easy way to misread this
Do not read the feasibility findings as evidence that the FNAT tool accurately identifies who needs rehabilitation services. The screening criteria for self-care and cognition were still being revised during the pilot, the tool has not been validated against a gold standard, and the authors themselves state that a full field survey is needed before the tool can be used for policy or service planning. It is a methodology pilot, not a clinical assessment tool you can apply to an individual patient.