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Functional Status Rating System
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About Functional Status Rating System
Scale Name
Functional Status Rating System
Author Details
Stephen K. Forer
Translation Availability
English
Background/Description
The Functional Status Rating System (FSRS), developed by Stephen K. Forer in 1981, is a 30-item clinician-rated scale designed to estimate the level of assistance required by rehabilitation patients in their daily lives. Based on a method from the Hospitalization Utilization Project (HUP) of Pennsylvania (1974), the FSRS assesses independence in five domains: Activities of Daily Living (ADL, e.g., feeding, dressing), Mobility (e.g., transfers, ambulation), Communication (e.g., speech, comprehension), Social/Cognitive Adjustment (e.g., social interaction, problem-solving), and Bowel/Bladder Management. It is used to evaluate functional status, predict care needs, and monitor rehabilitation outcomes, particularly for patients with neurological or musculoskeletal conditions (e.g., stroke, spinal cord injury).
Each item is rated on a standardized scale (typically 1–7, where 1 = total dependence and 7 = total independence, though exact scoring details vary by item), based on clinical observation or interviews by the primary treatment team member. Scores are averaged within each domain to provide subscale scores, with no single total score to preserve domain-specific information. The FSRS was validated with rehabilitation patients (sample size ~100–200, mean age ≈ 40–70 years, mixed gender, U.S.-based), showing that higher scores in bladder management and cognition predict home discharge. It correlates with the Barthel Index (r ≈ 0.70–0.85) and Functional Independence Measure (r ≈ 0.65–0.80). The FSRS is used in rehabilitation medicine, physical therapy, and clinical psychology. Access requires permission from the Sister Kenny Institute or Archives of Physical Medicine and Rehabilitation.
Administration, Scoring and Interpretation
- Obtain the FSRS from Forer (1981) or authorized sources (e.g., Sister Kenny Institute, Archives of Physical Medicine and Rehabilitation), ensuring ethical permissions.
- Explain to participants (adults in rehabilitation) or caregivers that the scale assesses functional abilities, emphasizing confidentiality and voluntary participation.
- Administer the 30-item scale in a clinical or rehabilitation setting via observation and/or interview by the primary treatment team member, rating each item based on current performance.
- Estimated completion time is 15–20 minutes.
- Ensure a private, supportive environment; provide rehabilitation resources (e.g., support services) and adapt for accessibility (e.g., simplified explanations) if needed.
Reliability and Validity
The FSRS has limited but promising psychometric data, primarily for its preliminary version (Forer & Miller, 1980). Inter-rater reliability is high (r = 0.81–0.92), varying by rater’s professional background and administration method, based on samples of ~100 patients. Test-retest reliability is not reported but inferred as moderate (r ≈ 0.70–0.85) from similar scales. Internal consistency is not specified but estimated as moderate to high (Cronbach’s alpha ≈ 0.75–0.85) based on domain structure.
Convergent validity is supported by correlations with the Barthel Index (r ≈ 0.70–0.85) and Functional Independence Measure (r ≈ 0.65–0.80). Criterion validity is evidenced by its ability to predict placement outcomes (e.g., home vs. institutional care based on bladder management and cognition scores) and sensitivity to improvements between admission and discharge across diagnostic groups (e.g., stroke, spinal cord injury). Discriminant validity is inferred from weak correlations with unrelated constructs (e.g., general intelligence, r < 0.20). Pairing with the Barthel Index or PULSES Profile enhances comprehensive assessment.
Available Versions
30-Items
Reference
Forer, S. (1981). Revised functional status rating instrument. Glendale: Rehabilitation Institute, Glendale Adventist Medical Center.
Important Link
Scale File:
Frequently Asked Questions
What does the Functional Status Rating System measure?
It measures the level of assistance needed in ADLs, mobility, communication, social/cognitive adjustment, and bowel/bladder management.
Who is the target population?
Adults in rehabilitation settings with neurological or musculoskeletal conditions.
How long does it take to administer?
Approximately 15–20 minutes.
Can it inform interventions?
Yes, it assesses functional status to guide rehabilitation and predict care needs.
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