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Performance Assessment of Self-Care Skills

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Purpose

PASS is a performance-based, criterion-referenced, and client-centered observational tool. The purpose of the PASS is to have a holistic snapshot (person-task-environment) of the client’s ability to live independently and safely in the community by assessing performance on various ADLs and IADLs. Independence, adequacy, and safety are rated on four-point scales.

Acronym PASS

Area of Assessment

Activities of Daily Living
Balance – Vestibular
Cognition
Coordination
Dexterity
Executive Functioning
Functional Mobility
Hearing
Occupational Performance
Reading Comprehension
Reasoning/Problem Solving
Seating
Strength
Upper Extremity Function
Vision & Perception

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Cost of Equipment

CDE Status

Not a CDE--last searched 4/6/2023.

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Cardiac Dysfunction
  • Multiple Sclerosis
  • Parkinson's Disease & Movement Disorders
  • Pulmonary Disorders
  • Spinal Cord Injury
  • Stroke Recovery

Populations

Stroke
Pulmonary Diseases
Parkinson's Disease
Osteoarthritis
Older Adults and Geriatric Care
Non-Specific Patient Population
Alzheimer's Disease and Progressive Dementia
Intellectual Disability

Key Descriptions

  • 26 tasks in four different domains (Chisholm, Toto, Raina, Holm, & Rogers, 2014):
    -Functional mobility (5)
    -Basic Activities of Daily Living (3)
    -Instrumental Activities of Daily Living - physical emphasis (4)
    -Instrumental Activities of Daily Living - cognitive emphasis (14)
  • 163 criterion-referenced sub tasks (Chisholm et al., 2014)

    Each subtask is rated for independence, safety, and adequacy on a scale from 0-3.
    A higher score indicates greater independence, safety, or adequacy.
    Independence scores:
    -Depend both on level of assistance needed and on frequency of prompts
    -Independence for task is the mean of the independence scores for each subtask
    Safety score:
    -Accounts for risks to client or to environment
    -Safety score for task is the lowest observed safety score for any subtask within that task
    Adequacy score:
    -Accounts for efficiency with which task is performed and quality of product
    -Adequacy score for task is the lowest observed adequacy score for any subtask within that task
  • Tasks are administered to client in a standardized way, including placement of objects and verbal instructions (Chisholm et al., 2014).
    -Client attempts to perform task, and therapist provides assistance only when needed
    -Least assistive prompts are used prior to more assistive prompts
    -Frequency of prompts and types of assistance are recorded to aid in intervention planning
  • Two versions of PASS exist – clinic version and home version; they are nearly identical except that home version uses client’s own materials for the tasks (Raina, Rogers, & Holm, 2006).
  • PASS assessment is flexible (Chisholm et al., 2014)
    -Therapist may administer only those tasks deemed relevant to client
    -Therapist may use PASS template to develop new PASS items

Number of Items

163

Equipment Required

  • Varied Household Items

Time to Administer

3 hours

Administration times range from 1.5 to 3 hours

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Initially reviewed by Beth Basin, Jazmin Carranza, and Sarah Easton, Occupational Therapy Students at the University of Illinois at Chicago, in March 2015. Updated in Spring, 2023 by UIC Occupational Therapy Students Shemin Lee, Yunshen Li, Rachel Paul, and Julia Gabrielle Sim under the direction of Susan Magasi, PhD, Associate Professor, Departments of Occupational Therapy and Disability Studies, UIC.

Body Part

Head
Neck
Upper Extremity
Back
Lower Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation
Environment

Measurement Domain

Activities of Daily Living
Cognition
Motor
Sensory

Professional Association Recommendation

None found--last searched 1/9/2024.

Considerations

  • Length of time it takes to administer the assessment.
  • No certification for administrator.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Alzheimer's Disease and Progressive Dementia

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Test/Retest Reliability

Dementia : (Holm and Rogers, 2008, Dementia)

  • PASS-Clinic
    • Excellent test-retest reliability for Independence (ICC = 0.92)
    • Excellent test-retest reliability for Safety (ICC = 0.89)
    • Excellent test-retest reliability for Adequacy (ICC = 0.82)
  • PASS-Home
    • Excellent test-retest reliability for Independence (ICC = 0.96)
    • Excellent test-retest reliability for Safety (ICC = 0.90)
    • Excellent test-retest reliability for Adequacy (ICC = 0.97)

Interrater/Intrarater Reliability

Interrater reliability was established as percentage of agreement among examiners

Dementia (Chisholm, 2005, Dementia)

  • 97% for Functional Mobility (average kappa 0.43)
  • 91% for ADLs (average kappa 0.38)
  • 94% IADL – physical (average kappa 0.43)
  • 93% for IADL – cognitive (average kappa 0.29)

(Holm and Rogers 2008)

  • PASS-Clinic
    • 92% for Independence
    • 93% for Safety
    • 90% for Adequacy
  • PASS-Home
    • 96% for Independence
    • 97% for Safety
    • 88% for Adequacy

Non-Specific Patient Population

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Normative Data

Heart Failure : (Raina, Rogers, & Holm, 2006; n = 55; mean age = 78.3 (± 5.3) years, Heart Failure)

Independence Scores: Mean (SD)

  • Clinic= 2.81 (0.12)
    • Functional mobility = 2.88 (0.17)
    • Personal care = 2.70 (0.48)
    • Cognitive IADLs = 2.80 (0.14)
    • Physical IADLs = 2.81 (0.32)
  • Home= 2.64 (0.16)
    • Functional mobility = 2.78 (0.29)
    • Personal care = 2.46 (0.61)
    • Cognitive IADLs = 2.88 (0.12)
    • Physical IADLs = 2.80 (0.39)

Safety Scores: Mean (SD)

  • Clinic: 2.84 (0.10)
    • Functional mobility = 2.75 (0.18)
    • Personal care = 2.95 (0.17)
    • Cognitive IADLs = 2.85 (0.17)
    • Physical IADLs = 2.86 (0.17)
  • Home: 2.94 (0.07)
    • Functional mobility = 2.76 (0.17)
    • Personal care = 2.95 (0.17)
    • Cognitive IADLs = 2.96 (0.10)
    • Physical IADLs = 2.99 (0.06)

Adequacy Scores: Mean (SD)

  • Clinic: 2.38 (0.23)
    • Functional mobility = 5.52 (0.38)
    • Personal care = 2.31 (0.55)
    • Cognitive IADLs = 2.34 (0.24)
    • Physical IADLs = 2.41 (0.44)
  • Home: 2.56 (0.27)
    • Functional mobility = 2.47 (0.49)
    • Personal care = 2.19 (0.67)
    • Cognitive IADLs = 2.64 (0.25)
    • Physical IADLs = 2.65 (0.45)

Test/Retest Reliability

Depression : (Holm and Rogers, 2008; n=20, Depression)

  • PASS-Clinic
    • Excellent test-retest reliability for Independence (ICC = 0.92)
    • Excellent test-retest reliability for Safety (ICC = 0.89) 
    • Excellent test-retest reliability for Adequacy (ICC = 0.82)
  • PASS-Home
    • Excellent test-retest reliability for Independence (ICC = 0.96)
    • Excellent test-retest reliability for Safety (ICC = 0.90)
    • Excellent test-retest reliability for Adequacy (ICC = 0.97)

 

Heart Failure : (Holm and Rogers, 2008, Heart Failure)

  • PASS-Clinic
    • Excellent test-retest reliability for Independence (ICC = 0.92)
    • Excellent test-retest reliability for Safety (ICC = 0.89)
    • Excellent test-retest reliability for Adequacy (ICC = 0.82)
  • PASS-Home
    • Excellent test-retest reliability for Independence (ICC = 0.96)
    • Excellent test-retest reliability for Safety (ICC = 0.90)
    • Excellent test-retest reliability for Adequacy (ICC = 0.97)

Interrater/Intrarater Reliability

Interrater reliability was established as percentage of agreement among examiners

Depression: (Chisholm, 2005, Depression)

  • 97% for Functional Mobility (average kappa 0.43)
  • 91% for ADLs (average kappa 0.38)
  • 94% IADL – physical (average kappa 0.43)
  • 93% for IADL – cognitive (average kappa 0.29)

 

Heart Failure: (Holm and Rogers 2008; n = 25, Heart Failure)

  • PASS-Clinic
    • 92% for Independence
    • 93% for Safety
    • 90% for Adequacy
  • PASS-Home
    • 96% for Independence
    • 97% for Safety
    • 88% for Adequacy

 

Heart Failure: (Raina, Rogers, & Holm, 2006, Heart Failure)

  • PASS-Clinic
    • Independence: 94% (range = 91-97%)
    • Safety: 88% (range = 83-92%)
    • Adequacy: 90% (range = 80-94%)
  • PASS-Home
    • Independence: 96% (range = 94-99%)
    • Safety: 94% (range = 93-97%)
    • Adequacy: 88% (range = 86-93%)

Internal Consistency

Individuals with Cognitive and/or Physical Disabilities: (Ferreira et al., 2020; n = 98, mean age = 64.2 (22.9), 38.8% > age 80, female = 61.2%; Portuguese version of PASS)

  • Excellent for Functional Mobility (FM):
    • Independence (Cronbach’s alpha = 0.927)
    • Safety (Cronbach’s alpha = 0.916)
    • Adequacy (Cronbach’s alpha = 0.917)
  • Excellent for Physical Instrumental Activities of Daily Living (PIADL):
    • Independence (Cronbach’s alpha = 0.924)
    • Safety (Cronbach’s alpha = 0.911)
    • Adequacy (Cronbach’s alpha = 0.904)
  • Excellent for Cognitive Instrumental Activities of Daily Living (CIADL)
    • Independence (Cronbach’s alpha = 0.951)
    • Adequacy (Cronbach’s alpha = 0.939)
  • Adequate for Basic Activities of Daily Living (BADL):
    • Independence (Cronbach’s alpha = 0.787)
    • Safety (Cronbach’s alpha = 0.755)
    • Adequacy (Cronbach’s alpha = 0.782)

Construct Validity

Depression (Chisholm, 2005, Depression)

  • Cattell’s scree test determined that the PASS Independence data has a dominate construct meeting the criteria of unidimensionality for the Rasch Model

Individuals with Cognitive and/or Physical Disabilities: (Ferreira et al., 2020; n = 98, Portuguese version of PASS)

  • The majority of scores across all domains and constructs were significantly lower for individuals 80 years old or older than for younger individuals.
    • No significant differences were found for the FM task “stair use” (independence: p = 0.358, safety: p = 0.298, adequacy: p = 0.628), for the BADL independence tasks “oral hygiene” (p = 0.263) and “trimming toenails” (p = 0.191), and for the CIADL tasks “stovetop use” (independence: p = 0.247, adequacy: p = 0.268) and “use of sharp utensils (independence: p = 0.281, safety: p = 0.808) 
  • No significant differences were found between the performance of males and females on 20 of the 22 tasks for independence, safety, and adequacy.
    • The two exceptions were for independence, with males scoring higher than females for “bill paying by ATM” (p = 0.035) and “changing TV command batteries” (p = 0.052)

Content Validity

Data not available, but authors state:

“Content validity of the PASS is based on the OARS Multidimensional Functional Assessment Questionnaire: Activities of Daily Living (Pfeiffer 1975), the Comprehensive Assessment and Referral Evaluation (Gurland et al., 1977), the Physical Self-Maintenance and Instrumental Self-Maintenance Scale (Lawton et al., 1982), and the Functional Assessment Questionnaire (Pfeffer 1987). Construct validity of the unidimensionality of the Independence and Safety scales of the PASS was established using exploratory factor analysis (Chisholm 2005)” (Chisholm et al., 2014)

Parkinson's Disease

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Normative Data

Parkinson’s Disease : (Foster, 2014; n = 77; mean age = 62.5 (±5.1) years; disease duration = 5.0 (±3.8) years; Hoehn & Yahr stages = 1-3, Parkinson’s Disease)

  • Independence: Mean (SD)
    • Meal preparation = 2.94 (0.07)
    • Money management = 2.94 (0.06)
  • Adequacy
    • Meal preparation = 2.67 (0.29)
    • Money management = 2.65 (0.28)

Number of cues required: Mean (SD)

  • Among all participants
    • Meal preparation = 3.1 (3.9)
    • Money management = 3.6 (4.0)
  • Among only those participants who required cues
    • Meal preparation = 5.2 (3.8)
    • Money management = 3.1 (1.6)

Interrater/Intrarater Reliability

Parkinson’s Disease without Dementia (Foster, 2014, Parkinson’s Disease without Dementia)

  • 95% for Independence
  • 92% for Adequacy
  • 91% for Safety

Internal Consistency

Parkinson’s Disease without Dementia (Foster, 2014, Parkinson’s Disease without Dementia)

  • Acceptable= (α=.73)

Stroke

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Normative Data

Stroke : (Skidmore et al., 2006; n = 67; mean age = 64 years (± 15 years; time post CVA: 3 months, Stroke)

PASS-Clinic

  • Independence Scores: Mean (SD)
    • Functional Mobility: 2.14 (1.18)
    • Self-Care Skills: 1.88 (1.03)
    • IADLs: 1.64 (1.10)

Osteoarthritis

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Normative Data

Osteoarthritis : (Rogers et al., 2001; n = 56; mean age = 81.2 years (± 4.8 years, Osteoarthritis)

PASS-Home

  • Independence: Mean (SD)
    • Functional Mobility = 2.75 (0.39)
    • ADLs = 2.49 (0.62)
    • IADLs = 2.86 (0.18)
  • Safety: Mean (SD)
    • Functional Mobility = 2.86 (0.26)
    • ADLs = 2.97 (0.12)
    • IADLs = (2.95 (0.13)
  • Adequacy: Mean (SD)
    • Functional Mobility = 2.49 (0.51)
    • ADLs = 2.33 (0.73)
    • IADLs = 2.63 (0.30)

Test/Retest Reliability

Osteoarthritis : (Holm and Rogers, 2008, Osteoarthritis)

  • PASS-Clinic
    • Excellent test-retest reliability for Independence (ICC = 0.92)
    • Excellent test-retest reliability for Safety (ICC = 0.89)
    • Excellent test-retest reliability for Adequacy (ICC = 0.82)
  • PASS-Home
    • Excellent test-retest reliability for Independence (ICC = 0.96)
    • Excellent test-retest reliability for Safety (ICC = 0.90)
    • Excellent test-retest reliability for Adequacy (ICC = 0.97)

Interrater/Intrarater Reliability

Interrater reliability was established as percentage of agreement among examiners

Osteoarthritis (Chisholm, 2005, Osteoarthritis)

  • 97% for Functional Mobility (average kappa 0.43)
  • 91% for ADLs (average kappa 0.38)
  • 94% IADL – physical (average kappa 0.43)
  • 93% for IADL – cognitive (average kappa 0.29)

(Holm and Rogers 2008, Osteoarthritis)

  • PASS-Clinic
    • 92% for Independence
    • 93% for Safety
    • 90% for Adequacy
  • PASS-Home
    • 96% for Independence
    • 97% for Safety
    • 88% for Adequacy

Construct Validity

Osteoarthritis (Rogers et al., 2001, Osteroarthritis)

  • Construct validity was supported using a contrasted groups approach. Subjects were divided based on the presence or absence of knee osteoarthritis. Subjects with knee osteoarthritis had significantly lower scores for independence and adequacy in all domains.
    • Osteoarthritis: n = 56; mean age 81.2 (4.8)
    • Well-Being: n = 57; mean age 78.7 (2.9)

Performance-Based Ratings

Well-Being (n=57)

 

 

Knee Osteoarthritis (n=56)

 

 

 

Mean

SD

Mean

SD

Functional Mobility

 

 

 

 

Independence

2.92

0.16

2.75

0.39**

Safety

2.94

0.12

2.86

0.26*

Adequacy

2.83

0.23

2.49

0.51**

ADLs

 

 

 

 

Independence

2.74

0.44

2.49

0.62*

Safety

2.97

0.11

2.97

0.12

Adequacy

2.68

0.51

2.33

0.73**

IADLs

 

 

 

 

Independence

2.93

0.12

2.86

0.18*

Safety

2.96

0.08

2.95

0.13

Adequacy

2.78

0.20

2.63

0.30**

Row Comparisons: *P<0.05 in t-test of significance between groups.

** P<0.01 in t-tests of significance between groups.

 

 

 

 

 

 

Older Adults and Geriatric Care

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Cut-Off Scores

Mental Status: (Marks et al., 2021; n = 197, age = 55 or older, convenience sample of persons living independently in the community; PASS Checkbook Balancing and Shopping Tasks (PCST)

  • Cut-off score of 8
  • Scores of 9 or higher on PCST classified as impaired
  • The independent effects of sex and education suggests that the current cut-off scores may require re-evaluation in larger, more diverse samples.

Test/Retest Reliability

Physical and Cognitive Status: (Grenier et al., 2022; n = 22, mean age = 78 (7.20), female = 12 (54.5%), hospitalized older adults age 70 or older discharged after hospitalization, average of 6.8 (4.08) comorbidities per person)

  • Acceptable to Excellent test-retest reliability for PASS-Clinical (r = 0.82 to 0.92) and PASS-Home (r = 0.96 to 0.97)
    • 4 of the 26 tasks of the PASS (telephone use, medication management, meal preparation (stovetop use), and bathroom/shower mobility) were administered as they were judged to be most relevant to older adults.

Interrater/Intrarater Reliability

Well-elderly (Chisholm, 2005, Well-elderly)

  • 97% for Functional Mobility (average kappa 0.43)
  • 91% for ADLs (average kappa 0.38)
  • 94% IADL – physical (average kappa 0.43)
  • 93% for IADL – cognitive (average kappa 0.29)

Pulmonary Diseases

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Interrater/Intrarater Reliability

Interrater reliability was established as percentage of agreement among examiners

Cardiopulmonary Disease (Chisholm, 2005; n=23, Cardiopulmonary Disease)

  • 97% for Functional Mobility (average kappa 0.43)
  • 91% for ADLs (average kappa 0.38)
  • 94% IADL – physical (average kappa 0.43)
  • 93% for IADL – cognitive (average kappa 0.29)

Intellectual Disability

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Interrater/Intrarater Reliability

Amnestic Mild Cognitive Impairment (a-MCI): (Ciro et al., 2015; n = 12 (a-MCI = 7 and gender- and age-matched controls = 5); a-MCI group were community-dwelling adults age 50 or greater)

  • Excellent interrater reliability on scores for all tasks (>=93% agreement)

Bibliography

American Occupational Therapy Association. (2014). Selected Assessment Tools for Occupational Therapy Reporting of Outpatient Functional Data (G-Codes and Modifiers) to the Medicare Program. Retrieved from. https://www.aota.org/-/media/Corporate/Files/Advocacy/Reimb/News/AOTAG-CodeChart2013.pdf.

Chisholm D (2005) Disability in older adults with depression. (Doctoral dissertation). University of Pittsburgh, Pittsburgh, PA. Available at: http://d-scholarship.pitt.edu/9697/1/Chisholmd_etd2005.pdf Accessed 03.02.15.

Chisholm, D., Toto, P., Raina, K., Holm, M., & Rogers, J. (2014). Evaluating capacity to live independently and safely in the community: Performance Assessment of Self-care Skills. British Journal Of Occupational Therapy, 77(2), 59-63. doi:10.4276/030802214X13916969447038

Ciro, C. A., Anderson, M. P., Hershey, L. A., Prodan, C. I., & Holm, M.B. (2015). Instrumental activities of daily living performance and role satisfaction in people with and without mild cognitive impairment: A pilot project. American Journal of Occupational Therapy, 69 (3), 1-10. 

Ferreira PL, Sim?es AL, Dourado M, Holm MB, Rogers JC. The Portuguese Performance Assessment of Self-Care Skills Measure: Validity and Reliability. OTJR: Occupational Therapy Journal of Research. 2021;41(4):299-308. doi:10.1177/15394492211021309

Foster, E. R. (2014). Instrumental Activities of Daily Living Performance Among People With Parkinson's Disease Without Dementia. American Journal Of Occupational Therapy, 68(3), 353-362. doi:10.5014/ajot.2014.010330

Grenier, A., Viscogliosi, C., Delli-Colli, N., Mortenson, W. B., Macleod, H., Lemieux-Courchesne, A.-C., & Provencher, V. (2022). The performance assessment of self-care skills to predict adverse events Post-Discharge. Canadian Journal of Occupational Therapy, 89(2), 190-200, https://doi.org/10.1177/00084174221084459

Holm, M.B., Rogers, J.C. (2008) The Performance Assessment of Self-Care Skills (PASS). In Hemphill-Pearson BJ ed. Assessments in Occupational Therapy Mental Health. 2nd ed. Thorofare, NJ: SLACK.

Marks, T. S., Giles, G. M., Al-Heizan, M. O., & Edwards, D. F. (2021). How Well Does the Brief Interview for Mental Status Identify Risk for Cognition Mediated Functional Impairment in a Community Sample?. Archives of rehabilitation research and clinical translation, 3(1), 100102. https://doi.org/10.1016/j.arrct.2021.100102

Raina, K., Rogers, J., Holm, M. (2007). Influence of the environment on activity performance in older women with heart failure. Disability and Rehabilitation, 29(7), 545-557 doi: 10.1080/0963828060084 5514

Rogers, J., Holm, M., Beach S., Schulz R., & Starz, T. (2001). Task Independence, safety, and adequacy among nondisabled and osteoarthritis-disabled older women. Arthritis care & research, 45(5), 410-418.

Skidmore, E.R., Rogers, J.C., Chandler, L.S., & Holm, L.B. (2006). Dynamic interactions between impairment and activity after stroke: examining the utility of decision analysis methods. Clinical rehabilitation, 20(6), 523-535.

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