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The Patient-Specific Functional Scale


Name:(Required)
MM slash DD slash YYYY

This useful questionnaire can be used to quantify activity limitation and measure functional outcome for patients with any orthopaedic condition.

Clinician to read and fill in below: Complete at the end of the history and prior to physical examination.

Initial Assessment:

Can you identify up to 3 important activities that you are unable to do or are having difficulty with as a result of your current condition. Rate each activity, 0 being unable to perform the activity and 10 being able to perform the activity at the same level as before the injury/condition

Initial Assessment:

I am going to ask you to identify up to three important activities that you are unable to do or are having difficulty with as a result of your _________________ problem. Today, are there any activities that you are unable to do or having difficulty with because of your _________________ problem? (Clinician: show scale to patient and have the patient rate each activity).

Patient-specific activity scoring scheme (Point to one number):

0 1 2 3 4 5 6 7 8 9 10
Unable to perform activity Able to perform activity at the same level as before injury or problem

(Date and Score)

MM slash DD slash YYYY
Activity(Required)
Activity
Rate
 

Total score = sum of the activity scores/number of activities

Minimum detectable change (90%CI) for average score = 2 points

Minimum detectable change (90%CI) for single activity score = 3 points

PSFS developed by: Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada, 47, 258-263.

Reproduced with the permission of the authors.

Total score = sum of the activity scores/number of activities

Minimum detectable change (90%CI) for average score = 2 points

Minimum detectable change (90%CI) for single activity score = 3 points

PSFS developed by: Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada, 47, 258-263.

Reproduced with the permission of the authors.


Thank you for completing this questionnaire. It will be sent to your Clinician at Precision Physio.