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Functional Status Index
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About Functional Status Index
Scale Name
Functional Status Index
Author Details
Alan M. Jette
Translation Availability
English
Background/Description
The Functional Status Index (FSI), developed by Alan M. Jette in 1978 and revised in 1980, is an 18-item interviewer-administered scale designed to assess functional status in adults with arthritis living in the community, as part of the Pilot Geriatric Arthritis Program (PGAP). Published in Arthritis & Rheumatism (1980), the FSI measures three dimensions—dependence, difficulty, and pain—across five domains: Mobility (e.g., walking, stairs), Hand Activities (e.g., grasping), Personal Care (e.g., bathing, dressing), Home Chores (e.g., cleaning), and Social/Role Activities (e.g., work, social engagement). Unlike traditional ADL scales focusing solely on independence, the FSI emphasizes pain and difficulty to capture the broader impact of arthritis on quality of life.
Each of the 18 items is rated three times (dependence, difficulty, pain) over the past seven days, using a 5-point scale for dependence (1 = independent to 5 = unable) and 4-point scales for difficulty and pain (1 = none to 4 = severe). Total scores per dimension range from 18–90 (dependence) and 18–72 (difficulty, pain), with higher scores indicating greater impairment. The FSI was validated with 95–149 elderly arthritis patients (mean age ≈ 60–75 years, mixed gender, U.S.-based). It correlates with the Barthel Index (r ≈ 0.40–0.60) and American Rheumatism Association functional class (r ≈ 0.40–0.47). The FSI is used in rehabilitation, clinical psychology, and arthritis research to assess functional status and evaluate treatment outcomes. Access requires permission from Arthritis & Rheumatism or the author.
Administration, Scoring and Interpretation
- Obtain the FSI from Jette (1980) or authorized sources (e.g., Arthritis & Rheumatism), ensuring ethical permissions.
- Explain to participants (adults with arthritis, typically 60+ years) that the scale assesses functioning, pain, and difficulty in daily activities, emphasizing confidentiality and voluntary participation.
- Administer the 18-item scale via interview in a clinical or community setting, asking about performance over the past seven days, using cue cards for response options if needed.
- Estimated completion time is 20–30 minutes.
- Ensure a private, supportive environment; provide arthritis or mental health resources (e.g., support groups) and adapt for accessibility (e.g., oral administration for low literacy) if needed.
Reliability and Validity
The FSI demonstrates acceptable psychometric properties (Jette, 1980; Jette & Deniston, 1978). For the 18-item version (N = 149), internal consistency is high (Cronbach’s alpha = 0.70–0.90 for mobility and personal care). Inter-rater reliability (N = 19) shows intraclass correlations of 0.78 (dependence), 0.61 (difficulty), and 0.75 (pain), with lower agreement as pain/difficulty increases. Test-retest reliability (N not specified) is moderate to high (r = 0.69–0.88 for dependence, 0.77 for difficulty, 0.69 for pain).
Convergent validity is supported by correlations with patient self-ratings of joint condition (r = 0.39), good days (r = 0.14–0.46), and American Rheumatism Association functional class (r = 0.40–0.47, N = 80). Factor analysis confirms five domains (58.5% variance explained). Criterion validity is evidenced by correlations with muscle strength (r = 0.49), endurance (r = 0.53), and task time (r = 0.67, N = 15), predicting 77% of change score variance. Sensitivity to change is lower than other scales (e.g., Arthritis Impact Measurement Scales). Pairing with the Barthel Index or AIMS enhances comprehensive assessment.
Available Versions
18-Items
Reference
Jette, A. M. (1980). Functional Status Index: reliability of a chronic disease evaluation instrument. Archives of Physical Medicine and Rehabilitation, 61(9), 395-401.
Important Link
Scale File:
Frequently Asked Questions
What does the Functional Status Index measure?
It measures dependence, difficulty, and pain in mobility, hand activities, personal care, home chores, and social/role activities for arthritis patients.
Who is the target population?
Adults (typically 60+) with arthritis in community settings.
How long does it take to administer?
Approximately 20–30 minutes.
Can it inform interventions?
Yes, it assesses functional status to guide arthritis treatment and rehabilitation.
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