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Practical Information
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Instrument Name:
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Functional Status Index (FSI)
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Instrument Description:
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The Functional Status Index has 45 items in the full length form and 18 items in the short form. The Functional Status Index assesses three aspects of function including the degree of dependence, the amount of pain, and the degree of difficulty adults experience when they complete specific activities of daily living in the areas of gross mobility, hand activities, personal care, home chores, and interpersonal activities. (Ref: 1-2)
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Price:
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Free (public domain)
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Administration Time:
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Length (45 items)=1 to 1.5 hours (Ref: 2); Shortened (18 items)=20 to 30 minutes (Ref: 1)
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Publication Year:
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1982
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Item Readability:
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Items are worded simply, as they are phrases such as "walking inside", "doing laundry", and "visiting family and friends".
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Scale Format:
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4- and 5-point response scales
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Administration Technique:
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Self-report or interview
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Scoring and Interpretation:
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Persons completing the FSI will rate each item three times. First, the items are rated according to the degree of functional dependence using a 5-point response scale. Second, the items are rated according to the degree of pain experienced using a 4-point response scale. Third, the items are rated according to the degree of difficulty using a 4-point response scale. In the development article, items were assessed using three self-report formats: multiple choice, a ladder scale, and a Q-sort technique. No information about score differences across formats was presented. (Ref 1). Add scores from items in each dimension to obtain totals.
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Forms:
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Full length (45 items each assessed for dependence, pain, and difficulty, so total of 135 items) and Short (18 items each assessed for dependence, pain, and difficulty, so total of 54 items)
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Research Contacts
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Instrument Developers:
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Alan M. Jette, PT, PhD, Associate Professor and Director
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Instrument Development Location:
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Aging Research Consortium
635 Commonwealth Ave.
Boston, MA 02215
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Instrument Developer Email:
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No information found.
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Instrument Developer Website:
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www.bu.edu/hdr/products/
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Annotated Bibliography
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1. Jette AM. Functional Status Index: reliability of a chronic disease evaluation instrument. Arch Phys Med Rehabil. 1980 Sep;61(9):395-401. [PMID: 7416929]
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Purpose: To examine the reliability of the 3 dimensions of the Short Form of the FSI. |
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Sample: 149 adults (18 or older) receiving care for rheumatoid arthritis. |
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Methods: Data came from 149 personal interviews, 65 of which were repeated for test-retest. |
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Implications: 4 of the 5 indexes received reliability of 0.66 to 0.91. Test-retest and interobserver reliability range from 0.65 to 0.81. |
2. Jette AM. The Functional Status Index: reliability and validity of a self-report functional disability measure. J Rheumatol. 1987 Aug;14 Suppl 15:15-21. [PMID: 3656304]
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Purpose: To examine reliability and validity of Short Form of the FSI for use with patients who have hip fractures. |
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Sample: 47 patients with hip fracture, 74% female, 96% white, and mean age of 54 years. |
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Methods: Performance on the FSI (through personal interview) was compared to results of objective functional performance tests. |
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Implications: The self-report measure showed evidence for reliability and validity. |
3. Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care. 1990 Jul;28(7):632-42. [PMID: 2366602]
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Purpose: To compare the measurement properties of five health status instruments including the Arthritis Impact Measurement Scales (AIMS), the Functional Status Index Short Form, the Health Assessment Questionnaire, the Index of Well Being, and the Sickness Impact Proile. |
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Sample: 38 patients with end-stage arthritis |
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Methods: Participants completed the five measures at three occasions. |
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Implications: The FSI pain scale was as sensitive to change as the other measures. The FSI global health status measure was less sensitive than the AIMS and Index of Well Being. The FSI mobility scale was less sensitive than the AIMS and more sensitive than the other two measures. The FSI social measure was one of the most sensitive, even though the social measures overall demonstrated the least responsiveness. |
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Factors and Norms
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Factor Analysis Work:
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Five factors were found under each of the three areas of function: 1) gross mobility, 2) hand activities, 3) personal care, 4) home chores, 5) interpersonal activities (social/role activities). Factors obtained from exploratory factor analysis of full length form (45 items) with 1,089 adults with rheumatoid arthritis.
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Normative Information Availability:
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No information found.
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Reliability Evidence
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Test-retest:
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Intraclass correlation coefficient using two administrations that were 1-3 days apart with 65 adults were 0.60 and higher. (Ref 1) Intraclass correlation coefficients using two administrations that were 1-3 days apart were 0.72 to .87 for Dependence categories, except for Social/role activities (.40).The ICCs for the pain indices ranged from 0.69 to 0.88, and the ICCS for the difficulty indices ranged form 0.69 to 0.88. (Ref 2)
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Inter-rater:
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0.60 and higher (Ref 1). Correlation coefficient=0.64 to .89 for dependence categories. r=0.71 to .82 for pain categories. r=0.71 to .82 for difficulty categories. (Ref 2)
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Internal Consistency:
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Calculated using the Spearman Brown Formula, internal consistency for dependence categories ranged from 0.55 to 0.87, except for hand activities (0.23 and 0.42). Internal consistency for difficulty categories ranged from 0.66 to 0.91. Internal consistency for pain categories ranged from 0.66 to 0.92. (Ref 1) Cronbach’s alpha for dependence categories = 0.67 to 0.81, except for hand activities (0.23). Difficulty categories = 0.66 to 0.89. Pain categories = 0.66 to 0.90. (Ref 2)
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Alternate Forms:
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No information found.
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Validity Evidence
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Construct/ Convergent/ Discriminant:
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FSI was correlated with measures of American Rheumatism Association (ARA) stage of disease, ARA functional class, and physician classification of overall functional ability and disease activity in order to determine convergent validity. Results follow, p <= 0.05 for all. (Ref: 2)
| Assessment
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Dependence
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Difficulty
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Pain
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| ARA functional class
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0.44
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0.43
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0.40
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| Professional assessment of function
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0.49
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0.42
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0.43
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| ARA stage of disease
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0.31
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0.28
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0.25
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| Professional assessment of disease activity
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0.25
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0.32
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0.32
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Criterion-related/ Concurrent/ Predictive:
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Concurrent validity calculated by the rate of agreement between FSI and therapist’s observation obtained by standardized functional performance tests. Basic ADLs correlated at 0.77 to 0.95, and instrumental ADLs correlated at 0.71 to 0.81. (Ref: 2)
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Content:
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No evidence presented to demonstrate how well the 18 items span the range of activities of daily living.
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Responsiveness Evidence:
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The responsiveness of the FSI was compared to the responsiveness of four other orthopedic health status instruments. Jackknife estimates of the Standardized Response Means (SRM) for the measures from baseline to 3 months and again from baseline to 12 to 15 months indicated that the FSI pain, mobility, and social dimensions were relatively responsive and the global dimension was relatively unresponsive. (Ref 3)
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Scale Application in VA Populations:
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No information found.
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Scale Application in non-VA Populations:
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Yes. (Ref 1-3)
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Comments
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The FSI was developed to assess physical dependence, pain, and difficulty performing activities of daily living. The FSI is easy to administer and does not seem to require high levels of cognitive ability for completion. The bulk of the psychometric analyses conducted on the FSI came from studies with small samples, calling into question the generalizability of the FSI measurement properties in other populations. Since the items in the short form require relatively low levels of functioning, such as walking inside, writing, putting on pants, reaching into low cupboards, and attending meetings, an examination of the floor and ceiling effects of this measure in more diverse populations is needed. Reliability coefficients were relatively high, as most exceeded .60. The low reliability estimates for the hand activities indicates a need for revision of this subscale. The validity evidence was not extremely strong, as the correlations between measures of ARA stage of disease, ARA functional class, physician estimate of disease activity, and overall rating of functional activity ranged from .25 - .49, indicating that the FSI and these clinical assessments shared less than 25% variance. However, it is not clear that these low correlations indicate poor performance of the FSI. They could just as easily indicate poor performance of the clinical assessments. The responsiveness evidence of three of the four FSI dimensions was strong relative to the evidence of four other measures of health status, although the sample size for this analysis was small. Overall, the FSI seems to represent a measure of health status best suited for use with lower-functioning individuals with orthopedic conditions. Since no study that we found demonstrated the application of this measure in VA populations, researchers interested in using the FSI with veterans should carefully consider how their sample relates to the non-VA samples in which these past studies have been conducted.
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Updates
No information found.
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