Development of an index of physical functional health status in rehabilitation

Arch Phys Med Rehabil. 2002 May;83(5):655-65. doi: 10.1053/apmr.2002.31178.


Objective: To describe (1) the development of an index of physical functional health status (FHS) and (2) its hierarchical structure, unidimensionality, reproducibility of item calibrations, and practical application.

Design: Rasch analysis of existing data sets.

Setting: A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities in 41 states participating with Focus On Therapeutic Outcomes, Inc.

Patients: A convenience sample of 92,343 patients (40% male; mean age +/- standard deviation [SD], 48+/-17y; range, 14-99y) seeking rehabilitation between 1993 and 1999.

Interventions: Not applicable.

Main outcome measures: Patients completed self-report health status surveys at admission and discharge. The Medical Outcomes Study 36-Item Short-Form Health Survey's physical functioning scale (PF-10) is the foundation of the physical FHS. The Oswestry Low Back Pain Disability Questionnaire, Neck Disability Index, Lysholm Knee Questionnaire, items pertinent to patients with upper-extremity impairments, and items pertinent to patients with more involved neuromusculoskeletal impairments were cocalibrated into the PF-10.

Results: The final FHS item bank contained 36 items (patient separation, 2.3; root mean square measurement error, 5.9; mean square +/- SD infit, 0.9+/-0.5; outfit, 0.9+/-0.9). Analyses supported empirical item hierarchy, unidimensionality, reproducibility of item calibrations, and content and construct validity of the FHS-36.

Conclusions: Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Health Status Indicators*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / physiopathology*
  • Musculoskeletal Diseases / rehabilitation*
  • Nervous System Diseases / physiopathology*
  • Nervous System Diseases / rehabilitation*
  • Physical Fitness / physiology*
  • Recovery of Function / physiology
  • Rehabilitation Centers*
  • Reproducibility of Results
  • Retrospective Studies