PSFSThe Patient Specific Functional Scale This useful questionnaire can be used to quantify activity limitation, and measure functional outcome for patients with any orthopedic condition. Complete at the end of the history and prior to physical examinationName First Last Date MM slash DD slash YYYY Assessment Type* Initial Assessment Follow-up DischargeList*"I am going to ask you to identify up to 3 important activities that you are unable to do or are having difficulty with as a result of your (ie; hip, knee, ankle, shoulder etc.) problem. Today, are there any activities that you are unable to do or are having difficulty with because of you (ie; hip, knee, ankle, shoulder etc.) problem? " PLEASE SHOW THE PATIENT THE NUMERICAL RATING SCALE TO RATE EACH ACTIVITYActivity0 to 10Patient confirmation Evidenced-Based DateTotal score = sum of the activity scores/number of activities. Minimal detectable change (90% CI) for average score = 2 points Minimal detectable change (90% CI) for a single activity - 3 points. PSFS developed by: Stratford, P., Gill, C., Westaway, M., & Binkly, J. (1995). ASsessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada, 47;258-263Δ
