Functional Status Questionnaire

Use the Functional Status Questionnaire (FSQ) to assess your patient’s disabilities related to their functional status to help you determine what should go into your care plan for them!

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What is the Functional Status Questionnaire (FSQ)?

The is a functional status assessment developed by researchers from the Beth Israel Hospital in Boston and the University of California in Los Angeles. It serves as a screening tool for possible disabilities that a person may have in relation to their functional abilities, as well as a monitoring tool to track any changes in the patient over time.

What this functional assessment tool does is that it zooms into certain aspects of a person to conduct a comprehensive evaluation of them. It asks them questions about their physical function, psychological function, and social/role function. The answers for these are set, and the scores for each answer have been assigned, so the patient only needs to pick which answer best applies to them. The context of this questionnaire is based on how the patient was for the last month or the last thirty-one days.

This questionnaire also comes with single-item questions that ask the client how they feel about their health in general, if they were bedridden because of an illness or injury, had to limit what they did in a day because of an illness or injury, what their work situation is, if they are satisfied with their sex life, and how often they got together with family and/or friends.

Printable Functional Status Questionnaire

Download Functional Status Questionnaire to assess the functional status of your patients.

How to use the Functional Status Questionnaire

Issue the questionnaire to your patient.

You can issue this functional status assessment in two ways:

  1. As a sort of interview:
  • You can ask them the sets of questions mentioned in the tool, then provide them with the answer sets for each, and last, have them pick which answer best applies to them for each question.
  1. Hand this to them and have them answer on their own:
  • Self-explanatory. This is the easiest and usual way to administer the Functional Status Questionnaire. This screening tool is technically a self-administered functional status assessment. If you opt for this choice, you can do so by having them answer on the spot or as something to take home. If they decide to take it home, make sure to come to an agreement as to when you should receive it.

Have the patient answer the following sections:

Whichever option you go for, they need to answer the following:

  1. Physical Function: During the past month, have you had difficulty…

Basic ADLs (Activities of Daily Living)

  • Taking care of yourself, that is, eating, dressing, or bathing?
  • Moving in and out of a bed or chair?
  • Walking indoors, such as around your home?

Intermediate ADLs 

  • Walking several blocks?
  • Walking one block or climbing one flight of stairs?
  • Doing work around the house, such as cleaning, light yard work, home maintenance?
  • Doing errands, such as grocery shopping?
  • Driving a car or using public transportation?
  • Doing vigorous activities such as running, lifting heavy objects or participating in strenuous sports?

Answer Set: usually did with no difficulty (4), some difficulty (3), much difficulty (2), usually did not do because of health (1), usually did not do for other reasons (0)

  1. Psychological Function: During the past month…

Mental Health

  • Have you been a very nervous person?
  • Have you felt calm and peaceful?*
  • Have you felt downhearted and blue?
  • Were you a happy person?*
  • Did you feel so down in the dumps that nothing could cheer you up?

Answer Set: all of the time (1), most of the time (2), a good bit of the time (3), some of the time (4), a little of the time (5), none of the time (6)

  1. Social/Role Function: During the past month have you…

Work Performance (must be/have been employed for the past thirty-one days)

  • Done as much work as others in similar jobs?*
  • Worked for short periods of time or taken frequent rests because of your health?
  • Worked your regular number of hours?*
  • Done your job as carefully and accurately as others with similar jobs?*
  • Worked at your usual job, but with some changes because of your health?
  • Feared losing your job because of your health?

Answer Set: all of the time (1), most of the time (2), some of the time (3). none of the time (4)

Social Activity

  • Had difficulty visiting with relatives or friends?
  • Had difficulty participating in community activities, such as religious services, social activities, or volunteer work?
  • Had difficulty taking care of other people such as family members?

Answer Set: usually did with no difficulty (4), some difficulty (3), much difficulty (2), usually did not do because of health (1), usually did not do for other reasons (0)

Quality of Interactions

  • Isolated yourself from people around you?
  • Acted affectionate toward others?*
  • Acted irritable toward those around you?
  • Made unreasonable demands on your family and friends?
  • Gotten along well with other people?*

Answer Set: all of the time (1), most of the time (2), a good bit of the time (3), some of the time (4), a little of the time (5), none of the time (6).

  1. Single Item Questions:

Which of the following statements best describes your work situation during the past month?

  • Working full-time
  • Working part-time
  • Unemployed
  • Looking for work
  • Unemployed because of my health
  • Retired because of my health
  • Retired for some other reason

During the past month, how many days did illness or injury keep you in bed all or most of the day? 

  • Indicate anything from 0-31 days.

During the past month, how many days did you cut down on the things you usually do for one-half day or more because of your own illness or injury?

  • Indicate anything from 0-31 days.

During the past month, how satisfied were you with your sexual relationships?

  • Very satisfied
  • Satisfied
  • Not sure
  • Dissatisfied
  • Very dissatisfied
  • Did not have any sexual relationships

How do you feel about your own health?

  • Very satisfied
  • Satisfied
  • Not sure
  • Dissatisfied
  • Very dissatisfied

During the past month, about how often did you get together with friends or relatives, such as going out together, visiting in each other's homes, or talking on the telephone?

  • Every day
  • Several times a week
  • About once a week
  • Two or three times a month
  • About once a month
  • Not at all

How do you score the Functional Status Questionnaire?

For your benefit, we wrote the possible answer sets for each question and indicated assigned scores for each answer. And, if you noticed, some of the questions have asterisks on them. For those specific questions, the scoring will be done inversely.

Now, in order to score it, you’ll have to follow this equation for each section:

  1. Scale Score = (added scores per question) - (number of questions in the section) / (number of questions in the section).
  1. Scale Score x 100 / (number of questions in the section) = (the total score for the section)

To give you a better picture, we’ll give you an example. For this one, we will be looking at the Basic ADLs section, which has three questions. Let’s say they got the highest score possible for each question. The calculation for this would be:

  1. (4+4+4) - 3 / 3 = 3 (Scale Score)
  1. 3 x 100 / 3 = 100 (total score for the section)

Here’s another example, but this time, without the highest scores possible:

  1. (2+3+2) - 3 / 3 = 1.33 (Scale Score)
  1. 1.33 x 100 / 3 = 44.33 (total score for the section)

It looks complicated, but just follow those equations, and you should be fine!

Once you have calculated the scores for each category, you may refer to this scoring interpretation table below:

Functional Status Questionnaire Scoring Table

If your patient has a score for the warning zone of a particular category, then that is a problem that needs to be investigated more, so you might need to conduct comprehensive assessments using other types of assessments to get more information from the patient and to cover more ground.

If you are wondering why the last set of questions isn’t included, that’s because they are more for your reference. Their answers for those might help you determine more points for evaluation and investigation.

Functional Status Questionnaire Example

Phew. That was a lot, wasn’t it? While there is a lot to this functional status assessment and the scoring might be a little complex (especially if you were not expecting math to be involved), we hope the sections above have made it easy to grasp. And, now that you know what this assessment is all about, it’s best for you to see what it looks like.

We’ve created a Functional Status Questionnaire PDF with ease of use in mind so that you don’t have to worry about scoring. Here’s what a filled-out sample looks like:

Download this Functional Status Questionnaire Example (Sample) here:

Functional Status Questionnaire Example

If you like what you see, then feel free to download our Functional Status Questionnaire PDF for your practice! You can choose to print it, if you feel like issuing this in person and on the spot, or you can definitely go paperless and just use the PDF version on a computer! The PDF has tickable radio buttons for patients to select their answers and there are editable fields to help you compute your scores.

When is the best time to use the Functional Status Questionnaire?

Given that this particular functional assessment tool is, first and foremost, a screening tool, the best time to issue this to your patient is during your initial sessions with them.

Since this tool covers various aspects of their life, you will be able to get a general sense of your patient in terms of how they can function in the context of their ADLs and work, how they are mentally, and if they can be social or not. Emphasis on general because there will surely be more to what information you will get from a fully-accomplished questionnaire.

That’s why the next step will be to endorse them for a more comprehensive examination based on their scores per category. If they are in the warning zones for both ADL categories, they might need physical therapy-related examinations. Same with mental health and the other categories.

Just to reiterate, the Functional Status Questionnaire is not a diagnostic tool and should not be used as such under any circumstance. That’s why the recommended action is to always investigate the patient further based on what aspects of their lives they seem to have problems with as per on the questionnaire scores.

Who can use the Functional Status Questionnaire?

Since this questionnaire covers several aspects of a person, most healthcare professionals can definitely use this, including the following:

  • Psychologists
  • Psychiatrists
  • (Mental Health) Therapists
  • Counselors
  • Physical Therapists
  • Occupational Therapists
  • Primary Care Physicians

So long as the healthcare professional is highly trained and experienced in dealing with the categories included in the questionnaire, this is a nifty functional assessment tool to add to their roster of instruments.

Given its nature as a self-assessment tool, anyone can use this. And because it covers several aspects of a person, it is not the best tool to be used as the sole reason for treatment. Given this, it’s best to have a team with different healthcare professionals so they can share the questionnaire results with one another and best determine the approaches based on their scores.

Even non-healthcare professionals can use this, given that it’s a self-assessment tool. However, if non-healthcare professionals use this for themselves, they should not use it to self-diagnose themselves with anything they suspect themselves of having. The only decision they should make that is medically related is to see an actual professional to determine what to do and if they have to undergo an actual diagnostic evaluation.

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Commonly asked questions

Can I use this functional status assessment as a diagnostic tool?

No. Under no circumstance should you use this as a diagnostic tool because it’s just a general questionnaire. While it zooms into different aspects of a person’s life, it doesn’t exactly cover nuances that might need to be covered. It’s best to have patients undergo further examinations and an official diagnosis after interpreting the results.

What if someone doesn’t answer a certain question, how do we go about scoring it?

You will need to have them answer it. The scoring equation is strict, so answering all questions is best to get a more accurate score. If the person is not working or has not worked in the past 31 days prior to answering the questionnaire, you don’t need to score it.

What if I’m not a healthcare professional? May I use this, given that it’s a self-assessment tool?

If you are not a healthcare professional and you stumbled upon this questionnaire, then feel free to use this! It is a self-assessment tool, after all. However, we would like to remind you that you should not self-diagnose or make any medically related decisions based on whatever scores you get. If you have scores that fall on the warning zones, please get in touch with a professional so that a more comprehensive examination can be done.

What are the benefits of using the Functional Status Questionnaire?

It’s a good way to get a general picture of a patient.

No patient is the same. Some might have problems with all categories in the questionnaire, while others might only have one. This functional status assessment will help healthcare professionals pinpoint what aspects of a patient’s life have been impacted by an illness or disease and then determine what particular examinations need to be conducted on the patient to get more information that will eventually lead to the development of a tailor-fitted treatment plan.

It also serves as a monitoring tool.

While this is primarily a screening tool, the Functional Status Questionnaire can later be used as a monitoring tool. Let’s say that a treatment plan was created for the patient and they are currently following it. This treatment plan covers all the categories indicated in the questionnaire. You can use this to track if the patient is getting better or worse as they follow their treatment plan or after it ends.

It can also be used to evaluate treatment plans.

Speaking of monitoring the patient for any improvements, the Functional Status Questionnaire can also be used to evaluate treatment plans. If patients are improving based on their new questionnaire scores, that’s a good indicator that the treatment plan is working and should be maintained. If they show no signs of improvement or their scores are getting lower, they are not exactly getting better. This might mean that some parts of the treatment plan or the whole plan are not working, so something should be tweaked or the whole thing must be overhauled.

Why use Carepatron for functional status-related work?

Throughout this guide, one of the points that we kept repeating is that this particular functional assessment tool takes a look at several aspects of a patient’s life that have been impacted by an illness or injury. We also discussed that the next step should always be further investigation through more comprehensive examinations based on the scores.

Here at Carepatron, we have the tools for you to conduct the further investigations needed for your patient. We’re all about helping healthcare professionals with their work by helping them streamline their workflow and providing support via our resource repository! We have a wide variety of assessments covering mental health and physical therapy, which should help you conduct further examinations of your patient and lead you and your team to make official diagnoses and tailor-fitted treatment plans for patients who have answered this questionnaire.

You can even store all your questionnaire results with us in a HIPAA-compliant manner via our storage system, which will essentially create digital backups of your files and secure them with access permissions! Make sure to grant your team access to the questionnaires! That way, they can simply use Carepatron and check the files rather than go up and down floors (if that is the layout of your clinic or hospital) to hand each other physical copies of the questionnaire and other assessments.

Convenience. Accessibility. Security. You get all three with Carepatron.

Electronic Health Records Software
Can I use this functional status assessment as a diagnostic tool?
Can I use this functional status assessment as a diagnostic tool?
Written by
Matt Olivares
Matt Olivares

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