Walking
Functional Ambulation Category (FAC)
The Functional Ambulation Category classifies walking ability on six levels, from non-ambulatory to independent on all surfaces including stairs. It summarises walking status in a single figure, which makes it useful for reporting and for describing a patient to a referring clinician in one word.
The six levels
0 — non-functional walking. 1 — dependent on continuous physical assistance from one person. 2 — dependent on intermittent assistance. 3 — dependent on supervision only, no physical contact. 4 — independent on level surfaces. 5 — independent on all surfaces, including stairs and uneven ground.
Because there are only six levels, substantial improvement can happen without the category changing. We therefore always report it alongside gait speed or the six-minute walk test.
Key facts
| Abbreviation | FAC |
|---|---|
| Number of items | 1 |
| Score range | 0–5 |
| Time to administer | Under 5 minutes; observational |
| Training required | No |
| Cost | Free |
| Equipment | A walking surface, ideally including stairs and an uneven section |
| Domains | Walking |
| ICF domain | Activity |
| Age range | Adult |
| Populations | Stroke · Traumatic brain injury · Spinal cord injury |
| Languages | Universal |
Psychometrics by population
The same instrument behaves differently in different conditions. A cut-off established in older adults does not transfer to Parkinson's disease, and a minimal detectable change from one study does not apply to another population.
| Population | Cut-off | MDC / MCID | Reliability | Validity |
|---|---|---|---|---|
| StrokeCoarse scale — insensitive to change within a category | — | — | Good to excellent inter-rater reliability | Correlates with gait speed and the Berg Balance Scale |
Things to be careful about
- Only six levels, so real improvement can occur with no change in score
- Should always be paired with a continuous measure such as gait speed or the 6MWT
Frequently asked questions
What do the six FAC levels mean?
0 is non-functional walking. 1 means continuous physical assistance from one person, 2 intermittent assistance, and 3 supervision only with no physical contact. 4 is independent on level surfaces, and 5 is independent on all surfaces including stairs and uneven ground. The step from 3 to 4 is the one families notice most, because it is the point at which someone no longer needs another person present.
Why has my category not changed although I am walking better?
Because there are only six levels, so substantial improvement can happen entirely within one category. This is the known cost of a scale that summarises walking in a single figure. It is why we always report the FAC alongside gait speed or the six-minute walk test, which record change continuously.
What is the FAC useful for, then?
For describing walking status in one word — to a referring clinician, in a discharge summary, or in a report that has to travel. It takes under five minutes, needs no training and no equipment beyond a walking surface, and it is understood without explanation. Precision is what it trades away for that.
Sources
Topic
Related instruments
- Rehabilitation outcomeFunctional Independence Measure (FIM)The FIM is an 18-item scale scoring how much assistance a person needs across thirteen motor and five cognitive tasks.
- Daily livingBarthel IndexThe Barthel Index is a ten-item scale of independence in daily activities, scored from 0 to 100 in five-point increments.
- Balance and fallsBerg Balance ScaleThe Berg Balance Scale assesses static and dynamic balance through fourteen everyday tasks, each scored 0 to 4, giving a total out of 56.
