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Rehabilitation Measures

Functional Status Questionnaire

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Purpose

The Functional Status Questionnaire (FSQ) is a self-administered functional assessment that provides information on the patient's physical, psychological, social and role functions.

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Instrument Details

Acronym FSQ

Area of Assessment

Activities of Daily Living
Mental Health
Negative Affect
Depression
Stress & Coping
Occupational Performance
Social Support
Social Relationships
Life Participation
General Health
Quality of Life

Assessment Type

Patient Reported Outcomes

Cost

Free

Actual Cost

$0.00

Key Descriptions

  • 5 main sections addressed:
    (1) physical function in the activities of daily living
    (2) psychological function
    (3) role function
    (4) social function
    (5) variety of performance measures
  • Scores range from a 0 - 4, 1 - 4, and 1 - 6 scale per question depending on section
  • 34 total items

Number of Items

34

Equipment Required

  • Computer

Time to Administer

15 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Older Adults

+

years

Instrument Reviewers

David Basirico, SPT, Duke University School of Medicine; Elisabeth Bulliner, SPT, Duke University School of Medicine; Janae Chinn, SPT, Duke University School of Medicine; Sean Hunter-Siegert, SPT, Duke University School of Medicine; Jensen LeJeune, SPT, ATC, Duke University School of Medicine 

Updated by Tri Pham, UTSW Medical School

ICF Domain

Body Function
Participation
Activity

Measurement Domain

Activities of Daily Living
General Health

Considerations

●    The patient must be ambulatory in order to utilize the FSQ
●    The FSQ may be utilized most often in a geriatric or older adult patient population
●    Older outcome measure that may not be widely used in today’s clinical setting
●    Requires patient understanding of questions, may be difficult to use with cognitively impaired patients

Mixed Populations

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Cut-Off Scores

Mixed Patients: (Jette et al., 1986)

Interpretation of Scores
Parameter Warning Zone Good
Basic Activities of Daily Living (ADL) 0-87 88-100
Intermediate ADL 0-77 78-100
Mental Health 0-70 71-100
Work Performance 0-78 79-100
Social Activities 0-78 79-100
Quality of Interactions 0-69 70-100

 

Internal Consistency

Mixed Population: (Cleary & Jette, 2000, sample consisted of patients recruited from a variety of sources including hospital settings, internal medicine patients, medicate beneficieries, etc.)

  • Adequate: Cronbach’s alpha range from 0.77-0.84 for Basic Activities of Daily Living (BADL)
  • Excellent: Cronbach’s alpha range from 0.82-0.89 for IADL
  • Adequate: Cronbach’s alpha range from 0.77-0.88 for mental health
  • Poor: Cronbach’s alpha of 0.65 for work performance
  • Poor: Cronbach’s alpha range from 0.65-0.83 for social activity
  • Poor: Cronbach’s alpha range from .42-.79 for quality of social interaction.

Patients Hospitalized for Suspected Acute Myocardial Infarction: (Cleary & Jette, 2000; n=2484)

  • Adequate: Cronbach’s alpha range from 0.69-0.82 for BADL 
  • Adequate: Cronbach’s alpha range from 0.71-0.93 for IADL
  • Excellent: Cronbach’s alpha rage from 0.76-0.93 for social activity
  • Adequate: Cronbach’s alpha range from 0.74-0.82 for mental health

Congestive Heart Failure Patients NYHA functional class III or IV (Gallanagh et al., 2011; n=337 )

  • Excellent: Cronbach’s alpha was 0.861 for physical functioning
  • Excellent: Cronbach’s alpha was 0.806 for social activity
  • Poor: Cronbach’s alpha was 0.656 for social interaction
  • Adequate: Cronbach’s alpha range from 0.709-0.799 for the rest of the dimensions.

Mixed Patients: (Jette et al., 1986)

  • Excellent: Cronbach’s alpha of 0.82 for Intermediate ADL
  • Excellent: Cronbach’s alpha of 0.81 for mental health
  • Adequate: Cronbach’s alpha of 0.79 for basic ADL
  • Poor: Cronbach’s alpha of 0.65 for work performance, 0.65 for social activity, and 0.64 for quality of itneractions

Post-Hernia Repair Patients: (Swan et al., 1998; n=100)

  • Adequate: Cronbach’s alpha range of 0.61-0.82 for basic ADL
  • Excellent : Cronbach’s alpha range of 0.47-0.85 for intermediate ADL

 

Multiple Sclerosis (Murphy et al., 1998)

  • Excellent: Cronbach’s alpha of >0.9 for physical function
  • Adequate: Cronbach’s alpha range from >0.6 to >0.8 for psychological function
  • Poor: Cronbach’s alpha of >0.6 for social function 

Criterion Validity (Predictive/Concurrent)

Predictive Validity
Mixed Patients
(Cleary & Jette, 2000; n=282)
•    Poor predictive validity of all FSQ subscales with death (-0.25-0.08)
 

Construct Validity

Convergent Validity
Medicare Patients under 80 with Primary Diagnosis of Acute MI: (Cleary & Jette, 2000; n=2282)
 

Convergent Validity between FSQ and Minnesota LIVING WITH HEART FAILURE® Questionnaire
FSQ Physical Dimension Emotional Dimension
BADL −0.58 (n = 334) −0.36 (n = 335)
IADL −0.66 (n = 332) −0.38 (n = 333)
Physical Functioning −0.68 (n = 331) −0.41 (n = 332)
Mental Health −0.28 (n = 334) −0.61 (n = 335)
Social Activity −0.58 (n = 311) −0.41 (n = 311)
Quality of interaction −0.24 (n = 333) −0.47 (n = 334)
Work Performance −0.27 (n = 41) −0.33 (n = 42)
Social Role Function −0.48 (n = 307) −0.57 (n = 307)

•    Excellent convergent validity between the FSQ IADL scale and the Schedule of specific activities (0.72)
•    Excellent convergent validity between the FSQ IADL scale and Global rating (0.60)
•    Adequate convergent validity between the FSQ IADL scale and the Dyspnea measure (0.59), Angina measure (0.48), and Percevied health status measure (0.49)
•    Adequate convergent validity between the FSQ mental health scale and the Dyspnea measure (0.40), Angina measure (0.42), Schedule of specific activities (0.37), Perceived health status (0.44), and Global rating (0.51)
Women Medicare Patients under 80 with Primary Diagnosis of Acute MI: (Cleary & Jette, 2000; n=924)
•    Excellent convergent validity between the FSQ IADL scale and the Schedule of specific activities (0.73)
•    Adequate convergent validity between the FSQ IADL scale and the Dyspnea measure (0.58), Angina measure (0.50), Perceived health status (0.52), and Global rating (0.58)
•    Adequate convergent validity between the FSQ mental health scale and the Dyspnea measure (0.37), Angina measure (0.46), Schedule of specific activities (0.36), Perceived health status (0.42), and Global rating (0.50)
Medicare Patients Hospitalized for Acute MI: (Cleary & Jette, 2000; n=3259)
•    Excellent convergent validity between the FSQ IADL scale with the Schedule of specific activities (0.73) and the SF-12 Physical Health measure (.75)
•    Adequate convergent validity between the FSQ IADL scale and the Dyspnea measure (0.58), Angina measure (0.39), Percevied health status measure (0.51), and Global rating (0.54)
•    Excellent convergent validity between the FSQ mental health scale and SF-12 Mental health scale (0.82)
Medicare Patients Hospitalized for Acute MI: (Cleary & Jette, 2000; n=1377)
•    Excellent convergent validity between the FSQ IADL scale with the Schedule of specific activities (0.70) and the SF-12 Physical Health measure (.72)
•    Adequate convergent validity between the FSQ IADL scale and the Dyspnea measure (0.56), Angina measure (0.41), Percevied health status measure (0.49), and Global rating (0.54)
•    Excellent convergent validity between the FSQ mental health scale and SF-12 Mental health scale (0.84)

 

Discriminant Validity
Mixed Population (Murphy et al., 1998; population comprised of multiple sclerosis patients + controls without MS)

  • Statistical analysis indicated correlation coefficients of either strong or substantial discriminant validity between main scales and subscales (results not shown).

Content Validity

Mixed Patients: (Jette et al., 1986)

Validity Correlations between Individual Functional Status Questionnaire (FSQ) Scales and Seven Health-related Variables
  Basic ADL Intermediate ADL Social Activity Work Performance Mental Health Quality of Interaction
Age   -0.15 -0.12   0.15 0.24
Bed disability days -0.28 -0.26 -0.26   -0.15  
Restricted activity days -0.33 -0.36 -0.35 -0.32 -0.20 -0.13
Satisfaction with health 0.35 0.43 0.38 0.21 0.45 0.26
Work role limitations -0.44 -0.61 -0.53 -0.36 -0.25 -0.12
Number of close friends/Frequency of social contact 0.07 0.07 0.13   0.18 0.26

 

Parkinson's Disease

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Internal Consistency

Parkinson’s: (Rubenstein et al., 1998)  n = 187; mean age = 61.0 (10.0) years; mean duration of PD = 86.2 (65.3) months)

  • Excellent internal consistency (Cronbach’s alpha > 0.92)
    • Excellent: Basic ADL (0.80)
    • Excellent: Intermediate ADL (0.87)
    • Excellent: Mental Health (0.86)
    • Poor: Social Activity (0.68)
    • Adequate: Interaction (0.78)

Construct Validity

Convergent Validity: 

Parkinson’s Disease: (Rubenstein et al., 1998) 

  • Excellent correlations between SF-36 physical function scores with FSQ BADL and IADL scores (r = 0.75 and 0.77)
  • Excellent correlations between SF-36 physical summary scores SF-36 and FSQ BADL and IADL scores (r = 0.64 and r = 0.66)
  • Excellent correlation between SF-36 mental summary (0.68) and mental health (0.78) with FSQ mental health scores 
  • Excellent convergent validity between FSQ social activity and SF-36 social function (0.64)
  • Adequate convergent validity between SF-36 social function with BADL (0.56) and IADL (0.59)
  • Excellent correlation between FSQ BADL and IADL scores and UPDRS ADL scores (r = 0.68 and 0.67)
  • Adequate correlation between FSQ health satisfaction and SF-36 general health perception (r = 0.57)
  • Adequate correlation between SF-36 vitality and FSQ BADL and IADL scores (r = 0.46 and r = 0.56)
Pearson correlations between FSQ and SF-36
  FSQ dimensions and single item scores
SF-36 dimensions and summary scores Basic ADL Intermediate ADL Social activity Interaction Sexual relations Health satisfaction Mental health
Physical function 0.75 0.77 0.56 0.14 0.33 0.48 0.31
Physical Role 0.36 0.40 0.43 0.11* 0.08* 0.38 0.27
Bodily pain 0.30 0.31 0.30 0.14 0.11* 0.23 0.30
General health 0.42 0.47 0.38 0.33 0.32 0.57 0.53
Vitality 0.46 0.56 0.52 0.21 0.26 0.54 0.53
Social function 0.56 0.59 0.64 0.25 0.20 0.41 0.51
Emotional role 0.30 0.34 0.36 0.22 0.18 0.27 0.38
Mental health 0.33 0.38 0.42 0.47 0.25 0.43 0.78
Physical summary 0.64 0.66 0.53 0.12 0.24 0.51 0.29
Mental summary 0.30 0.36 0.45 0.38 0.21 0.37 0.68

*Correlation coefficient not significantly different from zero; all other coefficients significantly different from 0, p-value</=0.0545

Pearson correlations between clinical measures and the FSQ dimensions
  Subsections of the Unified Parkinson's Disease Rating Scale
FSQ Dimensions Disease Severity Summary Scores
  Hohn-Yohr Schwab-England Disability Index Mental ADL Motor Total
Basic ADL 0.54 0.68 0.33 0.68 0.65 0.70
Intermediate ADL 0.59 0.70 0.42 0.67 0.68 0.73
Mental Health 0.22 0.29 0.45 0.25 0.32 0.35
Social Activity 0.48 0.59 0.30 0.56 0.56 0.59
Interaction 0.13* 0.15 0.30 0.14 0.21 0.22
Sexual Relations 0.20 0.26 0.37 0.30 0.24 0.31
Health Satisfaction 0.29 0.36 0.32 0.42 0.34 0.41

Discriminant Validity: 

  • Poor correlations with FSQ interaction quality and sexual relations scores between SF-36 and UPDRS summary scores (r = 0.13 - 0.47 and r = 0.08 - 0.37)

Bibliography

Cleary, P., & Jette, A. (2000). Reliability and Validity of the Functional Status Questionnaire. Quality of Life Research, 9(6), 747-753. See full text here.

Gallanagh, S., Castagno, D., Wilson, B. et al. Cardiovasc Drugs Ther (2011) 25: 77. See full text here.

Jette, A.M., Davies, A.R., Cleary, P.D. et al. J Gen Intern Med (1986) 1: 143. See full text here. 

Rubenstein, L.M., Voelker, M.D., Chrischilles, E.A. et al. Qual Life Res (1998) 7: 279. See full text.

Tedesco, C (03/1990). "Functional assessment of elderly patients after percutaneous aortic balloon valvuloplasty: New York Heart Association classification versus functional status questionnaire.". Heart & lung : the journal of critical care (0147-9563), 19 (2), p. 118. 
     
Yarnold, P.R., Bryant, F.B., Repasy, A.B. et al. J Behav Med (1991) 14: 141. See full text.

Murphy, N., Confavreux, C., Haas, J., König, N., Roullet, E., Sailer, M., ... & Cost of Multiple Sclerosis Study Group. (1998). Quality of life in multiple sclerosis in France, Germany, and the United Kingdom. Journal of Neurology, Neurosurgery & Psychiatry, 65(4), 460-466. Find it on PubMed.

Swan, B. A., Maislin, G., & Traber, K. B. (1998). Symptom distress and functional status changes during the first seven days after ambulatory surgery. Anesthesia & Analgesia, 86(4), 739-745. See full text here.

Akosile, C. O., Mgbeojedo, U. G., Maruf, F. A., Okoye, E. C., Umeonwuka, I. C., & Ogunniyi, A. (2018). Depression, functional disability and quality of life among Nigerian older adults: prevalences and relationships. Archives of gerontology and geriatrics, 74, 39-43. See full text here.

Clark, F., Azen, S. P., Zemke, R., Jackson, J., Carlson, M., Mandel, D., ... & Palmer, J. (1997). Occupational therapy for independent-living older adults: A randomized controlled trial. Jama, 278(16), 1321-1326.

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