The Patient-Specific Functional Scale asks the patient to name the activities their problem makes hard, up to five, and rate each from 0, unable to do it, to 10, as able as before the problem. The score is the average of the ratings, and the same activities are rated again at each review. See how to choose good activities, work out the average, tell real change from noise, and record every rating with the free template.
PSFS result template
FreePSFS RECORD Date: [Date] Patient: [Name or ID, age] Assessment point: [First visit, review number, or discharge] Asked by: [Clinician who asked for or read back the activities; language and interpreter if used] PROBLEM BEING RATED Condition: [Diagnosis or main complaint, side if it applies, and date of onset or surgery] Roles it affects: [Work, caring, sport, or hobbies the problem gets in the way of] ACTIVITY RATINGS, 0 TO 10 Activity 1: [Activity in the patient's words; rating today; rating at the first visit] Activity 2: [Activity in the patient's words; rating today; rating at the first visit] Activity 3: [Activity in the patient's words; rating today; rating at the first visit] Activity 4: [Activity and ratings, or not named] Activity 5: [Activity and ratings, or not named] Added since the first visit: [New activity with its first rating and date, or none] AVERAGE PSFS average today: [Sum of today's ratings divided by the number of activities, to one decimal] Description: [Severe, moderate, or mild or no limitation] First-visit average: [Date and average] CHANGE SINCE THE FIRST VISIT Each activity: [Points gained or lost; 3 or more on one activity is beyond measurement error] Average: [Points gained or lost; 2 or more is beyond measurement error] Exam beside the ratings: [Range, strength, or tests that agree or disagree with them] TARGETS Target per activity: [Rating aimed for on each activity, and by when] Progress: [Met, getting there, or not met, for each target] PLAN Treatment focus: [What the next sessions work on, starting with the lowest-rated activity] Next rating: [Date or visit for the next PSFS, with the same activities] Clinician: [Name, credentials]
Use it for
At the first visit, after the history and before the exam, the clinician asks which everyday activities the problem makes hard or impossible. The patient names up to five; three is common.
Avoid: Choosing the activities for the patient. Prompt if they’re stuck, but the activities should be the ones that matter to them.
The patient rates each activity from 0, unable to do it, to 10, able to do it at the level before the problem. It takes a few minutes.
Avoid: Rating what you saw in the session. The PSFS records the patient’s own view of what they can do.
Add the ratings and divide by the number of activities, for an average from 0 to 10.
Avoid: Reporting the sum. A sum of 15 from three activities and a sum of 15 from five mean very different things.
At each review, read back the activities from the first visit, and the patient rates each one again.
Each activity is a ready-made goal: a target rating, tied to a date.
Avoid: Discharging on a high average when one activity that matters, such as a work task, is still low.
Each one follows the recording template. Use them to judge how much to write.
Outpatient physical therapy, re-assessment at visit 9
52-year-old roofer who runs a crew of three. Right shoulder pain for 10 weeks, worst reaching overhead and carrying; it began during a week of re-roofing. Ultrasound showed supraspinatus tendinopathy with no full-thickness tear. On light duties since: ground work and supervising only.
Carrying a bundle of shingles, about 30 kg (65 lb), up a ladder: 2 at the first visit, 6 today. Nailing at shoulder height and above for an hour: 3, now 7. Sleeping on his right side through the night: 5, now 8.
PSFS 7.0 today, 21 divided by 3: mild or no limitation. First visit, 6 weeks ago: 3.3, severe limitation.
Average up 3.7, well beyond the 2-point detectable change. Each activity up 3 or 4 points, so all three are beyond the 3-point change for a single activity. Active elevation 165°, up from 120°; painful arc gone; external rotation strength 4+/5 on the right.
Ladder carry 8 and overhead nailing 8 by week 12, for full days on the roof. Side-sleeping 8: met.
Graded return to roof work over 4 weeks: half days for 2 weeks, carrying half bundles at first. Loaded rotator cuff and overhead strengthening, once a week here with the home program. Rate the same three activities at week 12; discharge to the home program when both work targets are met.
Family practice, knee osteoarthritis review 8 weeks after starting an exercise class
67-year-old retired bookkeeper. Left knee osteoarthritis, mostly the inner side, with moderate joint-space narrowing on an X-ray two years ago; pain worse over the past year. Started a supervised exercise class twice a week 8 weeks ago, with topical diclofenac. She cares for her grandson two afternoons a week and keeps a large vegetable garden.
Going down the basement stairs carrying the laundry basket: 4 at baseline, 5 today. Kneeling to weed the vegetable beds: 3, now 4. Walking the dog around the park, about 30 minutes: 5, now 9.
PSFS 6.0 today, 18 divided by 3: moderate limitation. Baseline 8 weeks ago: 4.0, also moderate.
Average up 2.0, just at the detectable change, and nearly all of it is the dog walk: up 4, a real change. Stairs and kneeling up 1 each, within measurement error. No effusion; knee bends to 115°; stepping down from a 20 cm (8 in) step is painful, with the knee drifting inward.
Dog walk 8: met. Basement stairs 7 and kneeling in the garden 6 by the spring.
The class is working for walking but not for stairs or kneeling. Keep the class; referral to physical therapy for step-down training and quadriceps strengthening, 4 to 6 visits. A kneeler with handles and one raised bed for the garden. Steroid injection offered; she would rather try therapy first. Rate the same three activities in 8 weeks.
An average of 5 means one thing for a roofer on a ladder and another for someone walking to the mailbox. Compare each patient only with their own earlier ratings.
If the patient rated “stairs” at the first visit and rates “stairs at work” later, the two numbers don’t compare. Read back the first-visit wording each time.
“Housework” and “sport” are hard to rate the same way twice. Ask which part is hard: vacuuming the stairs, or serving at tennis.
One point on one activity is within measurement error. Look for 3 points on an activity or 2 on the average, and for a trend across reviews.
The average hides the activity that’s stuck. Record each activity and its rating, so the plan targets the lowest one.
Vero Scribe records the PSFS in your template from the session, with the patient’s consent, or from your dictation: each activity in the patient’s words, today’s rating beside the first one, the average, and the plan. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
The patient rates each activity they named from 0, unable to do it, to 10, able to do it at the level before the problem. Add the ratings and divide by the number of activities: ratings of 2, 3, and 5 give an average of 3.3. Record each rating as well as the average.
The higher the average, the closer the patient is to how they managed before the problem; 10 means fully back to that level. There are no official bands. This page describes 0 to 3.9 as severe limitation, 4 to 6.9 as moderate, and 7 to 10 as mild or none, as a guide only. Because the activities are the patient’s own, read the score against their earlier ratings, not against other patients.
In the developers’ first study, a change of 2 points in the average, or 3 points on a single activity, was beyond measurement error at 90% confidence. Studies of the smallest change that matters to patients found about 1.2 to 2.2 points on the average, depending on the condition. Many clinics count 2 points on the average, or 3 on one activity, as real change.
Up to five, and three is common. With fewer activities, each rating counts for more in the average, so record how many were named and rate the same ones at every review.
Keep the first-visit activities and read them back each time, in the same words. If a new activity comes up, such as a return to a sport, add it with its own first rating and track it from there. Work out change from baseline on the original activities, so the number stays comparable.
Those measures ask every patient the same questions about one body region, so scores compare across patients. The PSFS asks about the activities this patient chose, for any region or condition: it picks up what matters to them, but compares only with itself. Many clinics use both, a region-specific measure and the PSFS.
Any clinician. The clinician asks for the activities at the end of the history, before the exam, and the patient rates them; it takes a few minutes and needs no training. Physical therapists use it most, along with chiropractors, occupational therapists, and physicians.
The Shirley Ryan AbilityLab’s RehabMeasures database lists the PSFS as free to use, and the copyright is held by P. Stratford. Mapi Research Trust’s ePROVIDE site lists the official form and 27 translations, with the conditions of use, after a free sign-up. Check them before using it in research, a publication, or software. The recording template on this page is free to copy or download.
Patient-reported measures of symptoms and function, scored as T-scores with 50 as the average: short forms, CATs, and the PROMIS-29.
Six basic self-care activities rated independent or dependent, scored 0 to 6, for function and care needs in older adults.
Eight independent living tasks, from shopping to finances, each scored 0 or 1: a total from 0, dependent, to 8, independent.
Eleven questions on arm, shoulder, and hand function over the past week, scored 0 to 100: the higher, the more disability.
Twenty everyday activities rated for difficulty: lower limb function scored 0 to 80, higher is better, and 9 points is a real change.
Where the first PSFS ratings go, with the exam, goals, and plan of care.
Ratings beside baseline, goal status, and the case to continue.
Daily activities, roles, and goals from the first session.
Evaluations, daily notes, and progress reports from the session.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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