Assessing “function” in clinical practice and research

When a patient comes to us, he/ she almost always explains their problems in terms of the functions. For example: “I cannot comb my hair due to pain”, “I cannot walk”, I can’t climb the stairs because of pain” etc. Function is really important to a patient, and so it should be for a physiotherapist or a treating clinician. For the same reason, assessing function in clinical practice and research is essential and is recommended. Assessment of function is important so as to 1) measure the independency in work, 2) measure the effect of the disease or problem on the activities, 3) evaluate the effect of intervention and 4) identify the improvement in terms of functional outcome.

Patient Specific Functional Scale (PSFS) is a common and a very useful measure designed to assess functional status in variety of clinical conditions. It can be used to guide the treatment and assess patient’s outcome. PSFS is easy to administer to all groups of patients eg patients with neck pain, upper extremity problems, low back pain, lower extremity pain etc). The function that PSFS focuses is that a patient thinks is important to him/ her, not that what a therapist thinks is important to them.

PSFS can be administered to a patient after the subjective assessment and prior to physical examination in order to draw the focus of clinician and patient on functional limitation rather than just the impairment(s). The clinician reads out the instructions to the patient and records the activities the patient finds difficulty with. Each activity (up to 5) are rated by the patients on a scale between 0 (unable to perform the activity) to 10 (able to perform an activity at pre-injury state). At subsequent re-assessment(s), the clinician reads the follow-up instruction which reminds the patient of activities that they identified previously. Again, the clinician records the rating on each activities with date. The form also provide an additional space for additional activities if the patients have a slight difficulty to perform with their condition, as every individual have a set of different activities and some individuals have functional limitation more than 5.

PSFS is translated in different languages included Nepali. This tool can be very useful functional measure especially in Nepal to assess function. This is because it can be administered quickly (about five minutes), patients need not be educated (as the clinician can interview the patients) and non-response of the items when using existing outcome tools is solved (eg patient avoids the question on sex life when using Nepali version of Oswestry Disability Index). Also, this can be used in the problems in various parts of the body as not many disease specific functional outcome measures are available in Nepali. This tool is translated by Saurab and colleagues. I am working with Saurab to validate this functional measure for the use in clinical practice and research.


About Josna: She is an intern at the Department of Physiotherapy at Kathmandu University School of Medical Sciences who will graduate in next six months. She is currently involved in validation of patient specific functional scale with Saurab.