Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder

TLDR

Bipolar disorder patients exhibit substantial functional impairment even during remission, yet most assessment tools focus on global recovery rather than specific psychosocial domains, prompting the development of the brief Functioning Assessment Short Test (FAST). FAST consists of 24 items covering autonomy, occupational, cognitive, financial, interpersonal, and leisure domains, was administered in 6 minutes to 101 bipolar patients and 61 healthy controls, and is designed for rapid, interview‑based assessment. FAST demonstrated excellent psychometric properties, with a Cronbach’s alpha of 0.909, a strong concurrent validity correlation with the GAF (r = –0.903), an ICC of 0.98 over one week, and clear discrimination between euthymic and acute patients, whose scores were significantly lower.

Abstract

Numerous studies have documented high rates of functional impairment among bipolar disorder (BD) patients, even during phases of remission. However, the majority of the available instruments used to assess functioning have focused on global measures of functional recovery rather than specific domains of psychosocial functioning. In this context, the Functioning Assessment Short Test (FAST) is a brief instrument designed to assess the main functioning problems experienced by psychiatric patients, particularly bipolar patients. It comprises 24 items that assess impairment or disability in six specific areas of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time.101 patients with DSM-IV TR bipolar disorder and 61 healthy controls were assessed in the Bipolar Disorder Program, Hospital Clinic of Barcelona. The psychometric properties of FAST (feasibility, internal consistency, concurrent validity, discriminant validity (euthymic vs acute patients), factorial analyses, and test-retest reliability) were analysed.The internal consistency obtained was very high with a Cronbach's alpha of 0.909. A highly significant negative correlation with GAF was obtained (r = -0.903; p < 0.001) pointing to a reasonable degree of concurrent validity. Test-retest reliability analysis showed a strong correlation between the two measures carried out one week apart (ICC = 0.98; p < 0.001). The total FAST scores were lower in euthymic (18.55 +/- 13.19; F = 35.43; p < 0.001) patients, as compared with manic (40.44 +/- 9.15) and depressive patients (43.21 +/- 13.34).The FAST showed strong psychometrics properties and was able to detect differences between euthymic and acute BD patients. In addition, it is a short (6 minutes) simple interview-administered instrument, which is easy to apply and requires only a short period of time for its application.