RehabMeasure Instrument
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  2. Short Musculoskeletal Function Assessment

Short Musculoskeletal Function Assessment

Last Updated

Purpose

This instrument is a self-report measure to assess the impact of a musculoskeletal condition on an individual’s functioning and on the impact of the condition on daily activities.

Link to Instrument

Instrument Details

Acronym SMFA

Area of Assessment

Activities of Daily Living
Functional Mobility
General Health
Life Participation
Negative Affect
Occupational Performance
Pain
Patient Satisfaction
Positive Affect
Quality of Life
Self-efficacy
Sleep
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Website includes a permission for institutional use letter if needed

Populations

Musculoskeletal Conditions
Joint Pain and Fractures

Key Descriptions

  • The instrument has 46 items with a minimum standardized score of 0 and maximum score of 100 per category, and it is comprised of 2 parts.
  • Part one is a 34-item questionnaire, the dysfunction index, focused on functional deficits and specific task limitations.
  • Part two is a 12-item questionnaire, focused on how much the patient is bothered by their dysfunction with certain tasks.
  • Items are scored based off of six categories: daily activities, emotional status, arm and hand function, mobility category, and bother index.
  • On a scale of 1 to 5, patients rate their ability on each item.
  • Higher total scores represent greater degree of dysfunction or bother.
  • Assessment administrator instructs the participant to mark one box per question.

Number of Items

46

Equipment Required

  • Manual Forms
  • Pen or Pencil

Time to Administer

10 minutes

Required Training

No Training

Age Ranges

Adults

18 - 64

years

Older Adults

65 +

years

Instrument Reviewers

Initial review completed by Amber DeWeese & Felicia Chew in December 2016; updated in April 2018 by University of Illinois at Chicago Master of Science in Occupational Therapy students Anna Goike, Claire Husaynu, and Antoinette Ledford.

Body Part

Head
Neck
Back
Upper Extremity
Lower Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation

Measurement Domain

Motor
Participation & Activities

Considerations

  • If fewer than 50% of the answers are missing from any one category, when scoring substitute the mean value of that category for the missing item(s).

  • The SMFA is available in multiple languages including Dutch, German, Chinese, Korean, and Japanese.

  • Foreign Adapted References:

    • Bohm, T., Kirschner, S., Kohler, M., Wollmerstedt, N., Walther, M., Matzer, M., & ... Konig, A. (n.d). The German Short Musculoskeletal Function Assessment questionnaire: reliability, validity, responsiveness, and comparison with the Short Form 36 and Constant score - a prospective evaluation of patients undergoing repair for rotator cuff tear. Rheumatology International, 25(2), 86-93.

    • De Graaf, M. W., El Moumni, M., Heineman, E., Wendt, K. W., & Reininga, I. H. F. (2015). Short Musculoskeletal Function Assessment: normative data of the Dutch population. Quality of Life Research, 24(8), 2015–2023. http://doi.org/10.1007/s11136-015-0929-3

    • Jung, K.-S., Jung, J.-H., In, T.-S., & Cho, H.-Y. (2016). Reliability and validity of the Korean version of the Short Musculoskeletal Function Assessment questionnaire for patients with musculoskeletal disorder. Journal of Physical Therapy Science, 28(9), 2568–2571. http://doi.org/10.1589/jpts.28.2568

    • Kirschner, S., Walther, M., Böhm, D., Matzer, M., Heesen, T., Faller, H., & König, A. (2003). German short musculoskeletal function assessment questionnaire (SMFA-D): comparison with the SF-36 and WOMAC in a prospective evaluation in patients with primary osteoarthritis undergoing total knee arthroplasty. Rheumatology International, 23(1), 15-20.

    • Sari Ponzer, Anne Skoog & Gunnar Bergström (2003) The Short Musculoskeletal Function Assessment Questionnaire (SMFA)Cross-cultural adaptation, validity, reliability and responsiveness of the Swedish SMFA (SMFA-Swe) , Acta Orthopaedica Scandinavica, 74:6, 756-763, DOI: 10.1080/00016470310018324

    • Taylor, M., Pietrobon, R., Menezes, A., Olson, S., Pan, D., Bathia, N., & ... Higgins, L. D. (2005). Cross-cultural adaptation and validation of the Brazilian Portuguese version of the short musculoskeletal function assessment questionnaire: the SMFA-BR. Journal Of Bone & Joint Surgery, American Volume, 87-A(4), 788-794.

    • Teicher C, et al. (2014). The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians. Injury http://dx.doi.org/10.1016/j.inju- ry.2014.10.003

    • Wang, Y., He, Z., Lei, L., Lin, D., Li, Y., Wang, G., … Lin, M. (2015). Reliability and validity of the Chinese version of the Short Musculoskeletal Function Assessment questionnaire in patients with skeletal muscle injury of the upper or lower extremities. BMC Musculoskeletal Disorders, 16, 161. http://doi.org/10.1186/s12891-015-0617-z

    • Wollmerstedt, N., Kirschner, S., Faller, H., & König, A. (2006). Reliability, validity and responsiveness of the German Short Musculoskeletal Function Assessment Questionnaire in patients undergoing surgical or conservative inpatient treatment. Quality Of Life Research: An International Journal Of Quality Of Life Aspects Of Treatment, Care & Rehabilitation, 15(7), 1233-1241. doi:10.1007/s11136-006-0066-0

Joint Pain and Fractures

back to Populations

Minimally Clinically Important Difference (MCID)

Tibial Plateau Fractures (SMFA Dysfunction Index): (Dattani et al., 2012; n = 55; mean age = 48 years (age range: 34-77); mean Injury Severity Score (ISS) = 10.4 (9-34); assessed at baseline and at 6 and 12 months post-operative follow-up)

  • MCID = 4.4 points (p < .03)

Test/Retest Reliability

Lower Extremity Fracture (Dutch SMFA): (Van Son et al., 2013; n = 105)

  • Excellent test-retest reliability (ICC = .90)

Upper Extremity Fracture (Dutch SMFA): (Van Son et al., 2013; n = 167)

  • Poor test-retest reliability (ICC = .68)

Internal Consistency

Lower Extremity Fracture (Dutch SMFA): (Van Son et al., 2013)

  • Excellent: Cronbach's alpha = 0.86-0.95*

Upper Extremity Fracture (Dutch SMFA): (Van Son et al., 2013)

  • Excellent: Cronbach's alpha = 0.81-0.95*

*Scores higher than .9 may indicate redundancy in the scale questions.

Construct Validity

Lower Extremity Fracture (Dutch SMFA): (Van Son et al., 2013)

  • Convergent validity: High correlations with Lower extremity dysfunction and the RAND-36 Physical functioning subscale (r = .80) and WHOQOL-BREF Physical health domain (r = .65)

  • Discriminant validity: Low correlation with the factor Upper extremity dysfunction and all RAND-36 subscales (r = .06-.28) and all WHOQOL-BREF domains (r = .10-.21)

Upper Extremity Fracture (Dutch SMFA): (Van Son et al., 2013)

  • Convergent validity: High correlation with RAND-36 Physical functioning subscale (r = .68) and the WHOQOL-BREF Physical health domain (r = .68)

  • Discriminant validity: Low correlation with RAND-36 subscale General health perception (r = .26) and the WHOQOL-BREF domain Social relationships (r = .23)

Floor/Ceiling Effects

Lower Extremity Fracture (Dutch SMFA): (Van Son et al., 2013)

  • Poor ceiling effect of 36.8% in Upper Extremity Dysfunction domain

  • Excellent floor effects

Upper Extremity Fracture (Dutch SMFA): (Van Son et al., 2013)

  • Poor ceiling effect of 30.5% in Lower Extremity Dysfunction domain

  • Adequate ceiling effect of 4.4% in Daily Life Consequences domain

  • Excellent floor effects

Tibial Plateau Fracture: (Dattani et al., 2012); assessed at baseline and at 6 and 12 months post-operative follow-up)

  • No floor or ceiling effects observed

Responsiveness

Femoral Neck Fracture: (Hedbeck et al., 2010; n = 120; age range = 70-90 years)

  • Statistically significant for internal responsiveness for both the Dysfunction Index and Bother Index (p = < 0.001)

Musculoskeletal Conditions

back to Populations

Standard Error of Measurement (SEM)

Musculoskeletal Disorders: (Bouffard, Bertrand-Charette, & Roy, 2015; n = 42)

  • SEM for the Dysfunction Index = 7.8

  • SEM for the Bother Index = 10.1

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004; n = 45; mean age = 58.2 years)

  • SEM for the Dysfunction Index = 2.44

  • SEM for the Bother Index = 8.15

Musculoskeletal Conditions: (Swiontkowski et al., 1999; n = 420)

  • SEM for the Dysfunction Index = 4.479

  • SEM for the Bother Index = 7.219

Severely Injured Patients (Dutch SMFA): (van Delft-Schreurs et al., 2016; n = 173; mean age of 46 years (SD 19); median ISS = 21; 1.3-4.4 years after injury;)

  • SEM for Upper Extremity Dysfunction = 5.34

  • SEM for Lower Extremity Dysfunction = 4.98

  • SEM for Emotion = 6.61

Skeletal muscle injury of upper or lower extremities (Chinese SMFA): (Wang et al., 2015; n = 339; mean age = 46 years (SD = 16.0))

  • SEM for Dysfunction Index = 3.468

  • SEM for Bother Index = 4.643

Minimal Detectable Change (MDC)

Musculoskeletal Disorders: (Bouffard, Bertrand-Charette, & Roy, 2015)

  • MDC for the Dysfunction Index = 21.6

  • MDC for the Bother Index = 28

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • MDC for the Dysfunction Index = 6.76

  • MDC for the Bother Index = 22.59

Musculoskeletal Conditions: (Swiontkowski et al., 1999; n = 420)

  • MDC at 95% for the Dysfunction Index = 12.42

  • MDC at 95% for the Bother Index = 20.01

Severely Injured Patients (Dutch SMFA): (van Delft-Schreurs et al., 2016)

  • MDC for Upper Extremity Dysfunction = 14.81

  • MDC for Lower Extremity Dysfunction = 13.80

  • MDC for Emotion = 18.32

Skeletal muscle injury of upper or lower extremities (Chinese SMFA): (Wang et al., 2015)

  • MDC for Dysfunction Index = 9.61

  • MDC for Bother Index = 12.87

Test/Retest Reliability

Musculoskeletal Disorders: (Bouffard, Bertrand-Charette, & Roy, 2015)

  • Excellent test-retest reliability for the Dysfunction Index: (ICC = 0.94)

  • Excellent test-retest reliability for the Bother Index: (ICC = 0.87)

Musculoskeletal Conditions: (Swiontkowski et al., 1999; n = 420)

  • Excellent test-retest reliability for the Dysfunction Index: (ICC = 0.93)

  • Excellent test-retest reliability for the Bother Index: (ICC = 0.88)

Musculoskeletal Conditions (German SMFA): (Wollmerstedt et al., 2006)

  • Excellent test-retest reliability for the Dysfunction Index: (ICC = 0.89-0.96)

  • Satisfactory test-retest reliability for the Bother Index: (ICC = 0.67-0.94)

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • Excellent test-retest reliability for the Dysfunction Index: (ICC = 0.96)

  • Satisfactory test-retest reliability for the Bother Index: (ICC = 0.75)

Internal Consistency

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • Excellent: Cronbach’s alpha = 0.93 for Dysfunction Index

  • Excellent: Cronbach’s alpha = 0.88 for Bother Index

Musculoskeletal Disorders: (Bouffard, Bertrand-Charette, & Roy, 2015)

  • Excellent: Cronbach’s alpha > 0.87 for both the Dysfunction and Bother Indices

Musculoskeletal Conditions: (Swiontkowski et al., 1999)

  • Excellent: Cronbach's alpha = 0.95-0.96* for Dysfunction Index

  • Excellent: Cronbach's alpha = 0.92-0.95* for Bother Index

Musculoskeletal Conditions (German SMFA): (Wollmerstedt et al., 2006)

  • Excellent: Cronbach’s alpha = 0.91 for Dysfunction Index

  • Excellent: Cronbach’s alpha = 0.88-0.98 for Bother Index.

Severely Injured Patients (Dutch SMFA): (van Delft-Schreurs et al., 2016; n = 173; mean age of 46 years (SD = 19); median ISS = 21; 1.3-4.4 years after injury;)

  • Excellent: Cronbach’s alpha > 0.90 for Upper Extremity Dysfunction, Lower Extremity Dysfunction, and Emotional Status Indices

Skeletal muscle injury of upper or lower extremities (Chinese SMFA): (Wang et al., 2015; n = 339; mean age = 46 years (SD = 16.0))

  • Satisfactory: Cronbach’s alpha = 0.87-0.94 for Arm and Hand Function, Mobility, Daily Activities, Emotional Status, Dysfunction, and Bother Indices

*Scores higher than .9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Musculoskeletal Conditions

  • Excellent predictive validity found with receiver operating characteristic analyses showing area under the curve to be 0.94 for both the Dysfunction and Bother Indices (Swiontkowski et al., 1999).

Extremity Vascular Injury

  • Excellent concurrent validity determined through:

    • Score comparisons between disabled and nondisabled patients as determined by Medicare Part A (p < 0.01 for dysfunction index, p = 0.004 for bother index).

    • Score comparisons between severe (MESS > 7) and nonsevere (MESS < 7) limb injury scores (p = 0.031 for dysfunction index and p = 0.032 for bother index). (Scott et al., 2014; n = 164)

Skeletal muscle injury of upper or lower extremities (Chinese SMFA): (Wang et al., 2015)

  • Good concurrent validity of the dysfunction and bother index of the SMFA discriminating between patients who differed in their age (p < 0.001, p = 0.008), gender (p = 0.008, p = 0.005), injury location (p < 0.001, p = 0.016) and operation status (p < 0.001, p < 0.001) - p-values evaluated at a significance level of 0.05

  • Poor concurrent validity for the dysfunction index and bother index of SMFA for subgroups based on BMI (p = 0.856, p = 0.294) - p-values evaluated at a significance level of 0.05

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • Criterion validity was established of the SMFA indices discriminating between pain intensity reported (p < 0.01) and shoulder function disability ratings by both patients (p < 0.01) and physicians (p < 0.01)

  • At the twelve month follow up examination the paint intensity reported by patients (p < 0.01) and shoulder function improvement ratings by patients (p < 0.01) and physicians (p < 0.05) correlated with the bother and function indices

Construct Validity

Discriminant validity:

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • The SMFA was able to differentiate between patients in both function and bother indices between patients having no to medium pain and those having medium to severe pain.

  • The Bother Index was 28.14 (10.7) and Function Index 40.8 (12.2) in patients reporting no to medium pain, and 40.0 (15.2) and 55.0 (15.0), respectively

Convergent validity:

Musculoskeletal Conditions

  • Poor to Adequate convergent validity of the SMFA with physician’s ratings was found with Spearman’s correlation values ranging from r = 0.10-0.46. (Swiontkowski et al., 1999)

  • Adequate to Excellent convergent validity of the SMFA with the SF-36 was found with correlation values ranging from r = 0.47-0.78. (Swiontkowski et al., 1999)

  • Adequate to Excellent construct validity was determined from comparison with SF-36, MCS and disease-specific questionnaires. (Wollmerstedt et al., 2006) (German SMFA)

Extremity Vascular Injury

  • Adequate to excellent convergent validity of the SMFA with the SF-36 was found with Pearson’s correlation values ranging from r = 0.48-0.67. (Scott et al., 2014)

Severely Injured Patients (Dutch SMFA): (van Delft-Schreurs et al., 2016)

  • Poor to Excellent convergent validity of the SMFA factors Lower Extremity Dysfunction and Upper Extremity Dysfunction with the WHOQOL-BREF Physical Health Domain r = 0.70 & r = 0.58, respectively (poor correlation with the WHOQOL-BREF Physical Health Domain Social Relationship and the factors Upper Extremity Dysfunction and Lower Extremity Dysfunction)

Skeletal muscle injury of upper or lower extremities (Chinese SMFA): (Wang et al., 2015)

  • Moderate to Good correlations between the Mobility category, Dysfunction Index, and the Bother Index with the three subscales (PF, RP, and BP) of the SF-36

  • Excellent correlations between SMFA and Kaiser-Meyer Olkin value, r = 0.953.

Musculoskeletal Disorders: (Bouffard, Bertrand-Charette, & Roy, 2015)

  • Adequate convergent-divergent validity of the SMFA was found between the dysfunction and bother index = 0.42-0.81

Content Validity

Musculoskeletal Disorder:(Bouffard, Bertrand-Charette, & Roy, 2015)

  • Researchers found content validity because both SMFA indices do not have significant floor or ceiling effects. In addition, both SMFA indices have an adequate proportion of missing items.

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • Researchers indicated normal distribution using the Kolmogorov-Smirnov test with p = 0.702 for Function Index and p = 0.455 for Bother Index.

Extremity Vascular Injury

  • Scott et al. (2014) noted content validity due to normal curve distribution of scores and little skew, limited ceiling and floor effects, and 0% nonresponse rates.

Floor/Ceiling Effects

Musculoskeletal Conditions: (Swiontkowski et al., 1999)

  • Excellent ceiling effect of 0% found for both indices

  • Adequate floor effect of 0.5% found for Dysfunction Index and 2.5% for the Bother Index.

Extremity Vascular Injury: (Scott et al., 2014)

  • Excellent ceiling effect of 0% found for both indices

  • Adequate floor effect of 4.3% found for both indices

Severely Injured Patients (Dutch SMFA): (van Delft-Schreurs et al., 2016)

  • Poor ceiling effect of 43% for patients for the factor Upper Extremity Dysfunction

Responsiveness

Musculoskeletal Disorders: (Bouffard, Bertrand-Charette, & Roy, 2015)

  • Researchers found the responsiveness of SMFA’s Dysfunction Index to be high while the Bother Index is moderately to highly responsive

Musculoskeletal Conditions: (Swiontkowski et al., 1999)

  • Statistically significant differences (p < 0.01) in scores from baseline to follow up for patients who reported their health was “worse” or “much worse” and for those who reported that their health was “better” or “much better.”

Rotator Cuff Tear (German SMFA): (Böhm et al., 2004)

  • Significant improvements on both SMFA indices were found (p < 0.001)

Bibliography

Agel, J., Obremskey, W. T., Kregor, P., Keeve, J., Abbott, P., Buss, D., Swiontkowski, M. F. (2003). Administration of the Short Musculoskeletal Function Assessment: Impact on office routine and physician-patient interaction. Orthopedics, 26(8), 783-788. Find it on PubMed

Böhm, T. D., Kirschner, S., Köhler, M., Wollmerstedt, N., Walther, M., Matzer, M., . . . König, A. (2004). The German Short Musculoskeletal Function Assessment questionnaire: Reliability, validity, responsiveness, and comparison with the Short Form 36 and Constant score: a prospective evaluation of patients undergoing repair for rotator cuff tear. Rheumatology International,25(2), 86-93. Find it on PubMed

Bouffard, J., Bertrand-Charette, M., & Roy, J. (2015). Psychometric properties of the Musculoskeletal Function Assessment and the Short Musculoskeletal Function Assessment: A systematic review. Clinical Rehabilitation,30(4), 393-409. Find it on PubMed

Busse, J. W., Bhandari, M., Guyatt, G. H., Heels-Ansdell, D., Mandel, S., Sanders, D., & ... Walter, S. D. (2009). Use of both the Short Musculoskeletal Function Assessment questionnaire and Short Form-36 among tibial-fracture patients was redundant. Journal Of Clinical Epidemiology, 62, 1210-1217. Find it on PubMed

Dattani, R., Slobogean, G. P., O’Brien, P. J., Broekhuyse, H. M., Blachut, P. A., . . ., Lefaivre, K. A. (2012). Psychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires. Injury, 44(6), 825-829. Find it on PubMed

Hedbeck, C. J., Tidermark, J., Ponzer, S., Blomfeldt, R., & Bergström, G. (2010). Responsiveness of the Short Musculoskeletal Function Assessment (SMFA) in patients with femoral neck fractures. Quality of Life Research, 20(4), 513-521. Find it on PubMed

Dale, L., Flanigan, J., Shipman, G., & Hummel, R. (2015, April). Outcomes of total knee and total hip arthroplasty as measured by the Short Musculoskeletal Function Assessment. Poster session presented at the 2015 American Occupational Therapy Association Annual Conference, Nashville, TN. Find it Here

Obremskey, W. T., Brown, O., Driver, R., & Dirschl, D. R. (2007). Comparison of SF-36 and Short Musculoskeletal Functional Assessment in recovery from fixation of unstable ankle fractures. Orthopedics, 30(2), 145-151. Find it on PubMed

Scott, D., Watson, J. D., Heafner, T. A., Clemens, M. S., Propper, B. W., & Arthurs, Z. M. (2014). Validation of the Short Musculoskeletal Function Assessment in patients with battlefield-related extremity vascular injuries. Journal of Vascular Surgery, 60(6), 1620-1626. Find it on PubMed

Swiontkowski, M., Engelberg, R., Martin, D. P., & Agel, J. (1999). Short Musculoskeletal Function Assessment questionnaire: Validity, reliability, and responsiveness. Journal of Bone and Joint Surgery, 81(9), 1245-1260. Find it on PubMed

Van Delft-Schreurs, C., Son, M. V., Jongh, M. D., Gosens, T., Verhofstad, M., & Vries, J. D. (2016). Psychometric properties of the Dutch Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients. Injury, 47(9), 2034-2040. Find it on PubMed

Van Son, M. A., Oudsten, B. L., Roukema, J. A., Gosens, T., Verhofstad, M. H., & Vries, J. D. (2013). Psychometric properties of the Dutch Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a fracture of the upper or lower extremity. Quality of Life Research, 23(3), 917-926. Find it on PubMed

Wang, Y., He, Z., Lei, L., Lin, D., Li, Y., Wang, G., . . . Lin, M. (2015). Reliability and validity of the Chinese version of the Short Musculoskeletal Function Assessment questionnaire in patients with skeletal muscle injury of the upper or lower extremities. BMC Musculoskeletal Disorders,16(1). Find it on PubMed

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