Journal of Physiotherapy 69 (2023) 126

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j p hy s

Appraisal

Clinimetrics: The Patient-Specific Functional Scale

The Patient-Specific Functional Scale (PSFS) is an individualised Disability and Health. A recent systematic review5 found, with low to
measure of functional limitation widely used in physiotherapy and moderate certainty, that the PSFS has sufficient test-retest reliability
rehabilitation.1 Respondents are asked to self-identify three to five ac- (ICC = 0.71 to 0.97) and sufficient responsiveness in musculoskeletal
tivities they have difficulty performing due to their condition, and then conditions such as shoulder pain, neck pain, cervical radiculopathy,
rate each activity on an ordinal scale of 0 (‘unable to perform activity’) to knee amputations and low back pain. It has similar or sometimes
10 (‘able to perform activity at the same level as before injury or disease’). better responsiveness than condition-specific scales in low back pain
If patients struggle to nominate activities, an activity list from relevant and neck pain.6,7 The minimum important change for musculoskel-
condition-specific scales (eg, Oswestry Disability Index) can be read to etal conditions is a 2-point difference in the average score or a 3-
them. Scores are averaged and higher scores indicate lesser disability. point difference for a single activity; however, the evidence for its
During repeat assessments, patients are generally not informed of their construct validity is uncertain.5
initial scores. The scale is freely available, takes less than 5 minutes to Although used in paediatric, neurological and cardiovascular
complete, does not require any special training, has been translated into conditions, the measurement properties of the PSFS in these pop-
at least 12 languages,2–5 and can either be self-administered or ulations are not well studied.5 Evidence with very low certainty
completed via interviews. It has been used in 87 unique health condi- suggests that it has sufficient reliability in Parkinson’s disease and
tions but without evidence of validity and reliability in many conditions.5 coronary artery disease, but insufficient reliability in chronic
The PSFS predominantly measures the ‘activity limitation’ obstructive pulmonary disease. Responsiveness in Parkinson’s disease
component of the International Classification of Functioning, was found to be insufficient in a small study.8

Commentary

The PSFS offers distinct advantages as an intuitive, patient-centred Overall, the PSFS is a useful clinical tool with which to assess ac-
and personalised scale with minimal patient and clinician burden. The tivity limitations unique to an individual with musculoskeletal con-
scale encourages clinicians and patients to focus on functional activities ditions. As it is not intended to provide a comprehensive assessment,
important to the patient when planning treatment. Given its simplicity, it should be used alongside other appropriate condition-specific
it may be easier to complete than longer and nuanced condition- scales that assess impairments and general health. Its utility in pae-
specific scales, especially for patients from diverse cultural diatric, neurological and cardiopulmonary conditions is uncertain and
backgrounds and those with low literacy. Overall, it has the potential to needs further exploration.
be used in a wide variety of clinical populations, health conditions
and health settings; it can also be used during telerehabilitation,
as telephone administration has also been shown to be reliable Anupa Pathaka and Saurab Sharmab,c
and valid.5 a
School of Public Health, Faculty of Medicine and Health, University of
Despite the potential, there are limitations to its clinical utility. The Sydney, Sydney, Australia
first is the uncertainty around its construct validity. In a systematic re- b
Department of Exercise Physiology, School of Health Sciences, Faculty of
view, the a priori hypotheses that the PSFS would strongly correlate Medicine and Health, University of New South Wales, Sydney, Australia
(coefficient . 0.50) with other measures of physical function/disability c
Centre for Pain IMPACT, Neuroscience Research Australia, Sydney,
were not met.5 One plausible reason for this is that in the PSFS, patients Australia
select activities that are most affected and highly specific to them. This
results in lower baseline scores (ie, greater disability) compared with
fixed-item scales. Therefore, the correlations with fixed-item scales are
weaker at baseline than at follow-up.5,9 Second, a criticism of the PSFS is
References
that multiple patient data cannot be combined; however, one study from
New Zealand reported that PSFS scores can be aggregated for valid 1. Stratford P, et al. Physiother Can. 1995;47:258–263.
2. Sharma S, et al. J Orthop Sports Phys Ther. 2018;48:659–664.
group-level comparisons.9 Third, the measurement properties of the
3. Alnahdi AH, et al. Disabil Rehabil. 2021;1–8.
scale have not yet been studied in several musculoskeletal and non- 4. Lehtola V, et al. Eur J Physiother. 2013;15:134–138.
musculoskeletal conditions,5 especially its utility in progressive dis- 5. Pathak A, et al. J Orthop Sports Phys Ther. 2022;52:262–275.
6. Cleland JA, et al. Spine. 2006;31:598–602.
eases. Fourth, the 0 to 10 numeric response format may be problematic
7. Hall AM, et al. Eur Spine J. 2011;20:79–86.
for many cultures, especially for uneducated and older adults.10 Finally, 8. Burgos-Martinez G. McMaster University (MSc Thesis). 2011.
the reference to ‘before illness or injury’ might be confusing or inappli- 9. Abbott JH, et al. J Clin Epidemiol. 2014;67:681–688.
cable for patients with congenital and chronic conditions.10 10. Pathak A, et al. Qual Life Res. 2021;30:613–628.

https://doi.org/10.1016/j.jphys.2022.07.001
1836-9553/© 2022 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).