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write notes on "functional assessment scales used in trauma and musculoskeletal dysfunction". write common functional assessment scales used in various trauma and common musculoskeletal dysfunction in detail. in simple easy english.

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common functional outcome measures musculoskeletal trauma rehabilitation validated scales LEFS DASH WOMAC Oswestry official

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This topic can be organised into these sections:
  1. Basics of functional assessment scales
    • Meaning, purpose, types, scoring, and how to choose a scale.
  2. General scales for trauma and musculoskeletal conditions
    • SF-36/SF-12, EQ-5D, PROMIS, SMFA, Patient-Specific Functional Scale (PSFS).
  3. Upper-limb scales
    • DASH/QuickDASH, SPADI, PRWE, Constant-Murley Score, ASES, Boston Carpal Tunnel Questionnaire.
  4. Spine and low-back scales
    • Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire, Neck Disability Index (NDI), Quebec Back Pain Disability Scale.
  5. Hip and pelvic trauma/dysfunction scales
    • Harris Hip Score, HOOS, WOMAC, Merle d’Aubigné-Postel score, Hip disability and Osteoarthritis Outcome Score.
  6. Knee scales
    • KOOS, IKDC, Lysholm Knee Score, Tegner Activity Scale, WOMAC.
  7. Foot and ankle scales
    • FAAM, AOFAS scales, Foot and Ankle Ability Measure, Achilles Tendon Total Rupture Score.
  8. Lower-limb trauma and general mobility scales
    • Lower Extremity Functional Scale (LEFS), Timed Up and Go, 6-Minute Walk Test, Functional Independence Measure.
  9. Fracture and polytrauma-specific scales
    • Musculoskeletal Function Assessment (MFA), Short Musculoskeletal Function Assessment (SMFA), Iowa Pelvic Score, Majeed Pelvic Score, Nottingham Clavicle Score.
Brief overview: Functional assessment scales turn a patient’s reported difficulty and observed ability into a number. They help the clinician document the baseline problem, set rehabilitation goals, monitor change over time, and compare outcomes after treatment. They should be used with clinical examination, pain assessment, range of motion, strength, imaging when needed, and the patient’s own goals.
Scales may be generic, such as SF-36 and EQ-5D, which assess overall health and allow comparison between different illnesses. Others are region-specific, such as DASH for upper-limb disorders, LEFS for lower-limb disorders, or ODI for low-back disability. Some are condition-specific, such as WOMAC for hip and knee osteoarthritis. This progression from broad to highly specific measures is also described in Rockwood and Green’s Fractures in Adults, p. 283. Recent evidence similarly shows that pain and physical function are recurring core outcomes across musculoskeletal conditions, as reported in this 2025 systematic review.
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The full subject is best studied in parts so that the purpose, scoring, and clinical use of each scale remain clear.
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This topic can be organised into these sections:
  1. Basics of functional assessment scales
    • Meaning, purpose, types, scoring, and how to choose a scale.
  2. General scales for trauma and musculoskeletal conditions
    • SF-36/SF-12, EQ-5D, PROMIS, SMFA, Patient-Specific Functional Scale (PSFS).
  3. Upper-limb scales
    • DASH/QuickDASH, SPADI, PRWE, Constant-Murley Score, ASES, Boston Carpal Tunnel Questionnaire.
  4. Spine and low-back scales
    • Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire, Neck Disability Index (NDI), Quebec Back Pain Disability Scale.
  5. Hip and pelvic trauma/dysfunction scales
    • Harris Hip Score, HOOS, WOMAC, Merle d’Aubigné-Postel score, Hip disability and Osteoarthritis Outcome Score.
  6. Knee scales
    • KOOS, IKDC, Lysholm Knee Score, Tegner Activity Scale, WOMAC.
  7. Foot and ankle scales
    • FAAM, AOFAS scales, Foot and Ankle Ability Measure, Achilles Tendon Total Rupture Score.
  8. Lower-limb trauma and general mobility scales
    • Lower Extremity Functional Scale (LEFS), Timed Up and Go, 6-Minute Walk Test, Functional Independence Measure.
  9. Fracture and polytrauma-specific scales
    • Musculoskeletal Function Assessment (MFA), Short Musculoskeletal Function Assessment (SMFA), Iowa Pelvic Score, Majeed Pelvic Score, Nottingham Clavicle Score.
Brief overview: Functional assessment scales turn a patient’s reported difficulty and observed ability into a number. They help the clinician document the baseline problem, set rehabilitation goals, monitor change over time, and compare outcomes after treatment. They should be used with clinical examination, pain assessment, range of motion, strength, imaging when needed, and the patient’s own goals.
Scales may be generic, such as SF-36 and EQ-5D, which assess overall health and allow comparison between different illnesses. Others are region-specific, such as DASH for upper-limb disorders, LEFS for lower-limb disorders, or ODI for low-back disability. Some are condition-specific, such as WOMAC for hip and knee osteoarthritis. This progression from broad to highly specific measures is also described in Rockwood and Green’s Fractures in Adults, p. 283. Recent evidence similarly shows that pain and physical function are recurring core outcomes across musculoskeletal conditions, as reported in this 2025 systematic review.
Which section should I write in full notes first?The full subject is best studied in parts so that the purpose, scoring, and clinical use of each scale remain clear.To keep the notes clear and useful, study this large topic in sections:
  1. Basics and general functional scales
  2. Upper-limb scales
  3. Spine and low-back scales
  4. Hip and knee scales
  5. Foot, ankle, fracture, and polytrauma scales
Functional assessment scales measure how much a trauma or musculoskeletal problem affects a person’s daily activities, work, walking, self-care, sport, and quality of life. They are used at the first visit and repeated during follow-up to show improvement or deterioration.
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Reading File
This is a large topic. The scales are easiest to learn when grouped by body region and purpose.
Asking for Preferences

Which topic should I write in full, simple-English notes next?

This topic can be organised into these sections:
  1. Basics of functional assessment scales
    • Meaning, purpose, types, scoring, and how to choose a scale.
  2. General scales for trauma and musculoskeletal conditions
    • SF-36/SF-12, EQ-5D, PROMIS, SMFA, Patient-Specific Functional Scale (PSFS).
  3. Upper-limb scales
    • DASH/QuickDASH, SPADI, PRWE, Constant-Murley Score, ASES, Boston Carpal Tunnel Questionnaire.
  4. Spine and low-back scales
    • Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire, Neck Disability Index (NDI), Quebec Back Pain Disability Scale.
  5. Hip and pelvic trauma/dysfunction scales
    • Harris Hip Score, HOOS, WOMAC, Merle d’Aubigné-Postel score, Hip disability and Osteoarthritis Outcome Score.
  6. Knee scales
    • KOOS, IKDC, Lysholm Knee Score, Tegner Activity Scale, WOMAC.
  7. Foot and ankle scales
    • FAAM, AOFAS scales, Foot and Ankle Ability Measure, Achilles Tendon Total Rupture Score.
  8. Lower-limb trauma and general mobility scales
    • Lower Extremity Functional Scale (LEFS), Timed Up and Go, 6-Minute Walk Test, Functional Independence Measure.
  9. Fracture and polytrauma-specific scales
    • Musculoskeletal Function Assessment (MFA), Short Musculoskeletal Function Assessment (SMFA), Iowa Pelvic Score, Majeed Pelvic Score, Nottingham Clavicle Score.
Brief overview: Functional assessment scales turn a patient’s reported difficulty and observed ability into a number. They help the clinician document the baseline problem, set rehabilitation goals, monitor change over time, and compare outcomes after treatment. They should be used with clinical examination, pain assessment, range of motion, strength, imaging when needed, and the patient’s own goals.
Scales may be generic, such as SF-36 and EQ-5D, which assess overall health and allow comparison between different illnesses. Others are region-specific, such as DASH for upper-limb disorders, LEFS for lower-limb disorders, or ODI for low-back disability. Some are condition-specific, such as WOMAC for hip and knee osteoarthritis. This progression from broad to highly specific measures is also described in Rockwood and Green’s Fractures in Adults, p. 283. Recent evidence similarly shows that pain and physical function are recurring core outcomes across musculoskeletal conditions, as reported in this 2025 systematic review.
Which section should I write in full notes first?The full subject is best studied in parts so that the purpose, scoring, and clinical use of each scale remain clear.To keep the notes clear and useful, study this large topic in sections:
  1. Basics and general functional scales
  2. Upper-limb scales
  3. Spine and low-back scales
  4. Hip and knee scales
  5. Foot, ankle, fracture, and polytrauma scales
Functional assessment scales measure how much a trauma or musculoskeletal problem affects a person’s daily activities, work, walking, self-care, sport, and quality of life. They are used at the first visit and repeated during follow-up to show improvement or deterioration.
Please reply with one section number, and I will write detailed, simple-English notes for that section first.This is a large topic. The scales are easiest to learn when grouped by body region and purpose.
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RehabMeasures Database DASH LEFS WOMAC Oswestry functional outcome measures

Functional Assessment Scales Used in Trauma and Musculoskeletal Dysfunction

1. Introduction

A functional assessment scale is a questionnaire or test used to find out how an injury or musculoskeletal problem affects a person’s daily life.
It measures activities such as:
  • Walking
  • Climbing stairs
  • Dressing and bathing
  • Sitting, standing, lifting, and carrying
  • Working
  • Playing sports
  • Using the hand and arm
  • Sleeping
  • Social participation
These scales are used in trauma, orthopaedics, physiotherapy, rehabilitation, rheumatology, and sports medicine.
They help the health professional to:
  1. Measure the patient’s problem at the first visit.
  2. Set realistic treatment goals.
  3. Monitor recovery after fracture, surgery, injury, or rehabilitation.
  4. Compare function before and after treatment.
  5. Decide if the patient can return to work, daily activities, or sport.
  6. Document treatment outcome in a standard way.
Most scales are patient-reported outcome measures (PROMs). This means the patient answers questions about their own pain, difficulty, and ability. Some are performance tests, where the clinician measures how well the patient walks, stands, or performs a task.
A good scale should be:
  • Valid: it measures what it claims to measure.
  • Reliable: it gives similar results when the patient’s condition has not changed.
  • Responsive: it can detect important improvement or worsening.
  • Easy to understand and administer.
  • Suitable for the patient’s injury and body region.
In trauma care, outcome measures can be generic, musculoskeletal-specific, limb or joint-specific, or condition-specific. Rockwood and Green’s Fractures in Adults lists EQ-5D and SF-36 as widely used generic measures, and DASH, Harris Hip Score, KOOS, ASES, AOFAS, and WOMAC as more region- or condition-specific measures. Rockwood and Green’s Fractures in Adults, p. 283.

2. Types of Functional Assessment Scales

A. Generic health scales

These measure the person’s overall health, not only the injured body part.
They are useful when trauma has affected many areas of life, such as in polytrauma, multiple fractures, chronic pain, or after major surgery.
Examples:
  • SF-36 or SF-12
  • EQ-5D
  • PROMIS Physical Function

B. Musculoskeletal-specific scales

These assess general musculoskeletal disability and physical function.
Examples:
  • Musculoskeletal Function Assessment (MFA)
  • Short Musculoskeletal Function Assessment (SMFA)
  • Patient-Specific Functional Scale (PSFS)
  • Lower Extremity Functional Scale (LEFS)

C. Region-specific scales

These assess a particular body region.
Examples:
  • DASH for upper limb
  • Oswestry Disability Index for low back
  • Neck Disability Index for neck
  • LEFS for lower limb

D. Joint-specific or disease-specific scales

These are designed for a particular joint or condition.
Examples:
  • WOMAC for hip and knee osteoarthritis
  • KOOS for knee injury and knee osteoarthritis
  • HOOS for hip disorders and hip osteoarthritis
  • Harris Hip Score for hip function
  • Lysholm score for knee ligament injury
  • PRWE for wrist injury

E. Performance-based tests

These are physical tests observed or timed by a clinician.
Examples:
  • Timed Up and Go test
  • 6-Minute Walk Test
  • 10-Metre Walk Test
  • Five Times Sit-to-Stand Test
  • Stair-Climb Test
  • Single-Leg Hop Tests

3. General Functional Scales

3.1 SF-36 and SF-12

Full name

Short Form-36 Health Survey and Short Form-12 Health Survey

Purpose

These scales measure general health-related quality of life. They are useful in major trauma, multiple injuries, chronic musculoskeletal conditions, joint replacement, spinal conditions, and rehabilitation.

Areas assessed by SF-36

SF-36 has 36 questions and covers eight areas:
  1. Physical functioning
  2. Role limitation due to physical health
  3. Bodily pain
  4. General health
  5. Vitality or energy
  6. Social functioning
  7. Role limitation due to emotional problems
  8. Mental health

Scoring

  • Scores are commonly changed to a 0 to 100 scale.
  • Higher score generally means better health and better function.
  • SF-12 is a shorter version and is useful when time is limited.

Advantages

  • Measures both physical and mental effects of injury.
  • Useful for comparing different diseases and injuries.
  • Common in research and trauma outcome studies.

Limitations

  • It is not focused on one joint.
  • It may miss small but important changes in a specific body part, such as the wrist or ankle.
  • It is longer than a simple joint-specific scale.

3.2 EQ-5D

Full name

EuroQol 5-Dimension Questionnaire

Purpose

EQ-5D measures general health status and quality of life. It is commonly used in trauma outcome studies, health economics, and cost-effectiveness studies.

Five dimensions

The patient reports problems in:
  1. Mobility
  2. Self-care
  3. Usual activities
  4. Pain or discomfort
  5. Anxiety or depression
It also includes a visual analogue scale, usually from 0 to 100, where the patient rates their health today.

Scoring

  • Each domain has levels of severity, such as no problem, slight problem, moderate problem, severe problem, or extreme problem.
  • A health index score can be calculated.
  • Higher score means better health status.

Uses

  • Multiple trauma
  • Hip fracture
  • Lower-limb fracture
  • Joint replacement
  • Chronic musculoskeletal disability

Advantages

  • Very short and easy to complete.
  • Includes mental and social effects, not only physical ability.
  • Useful for comparing outcomes between different conditions.

Limitation

It is broad. It may not describe specific knee, shoulder, wrist, or spine problems in detail.

3.3 PROMIS Physical Function

Full name

Patient-Reported Outcomes Measurement Information System Physical Function

Purpose

PROMIS measures how well a person can perform physical activities.
It can assess:
  • Walking
  • Climbing stairs
  • Getting out of bed
  • Carrying objects
  • Housework
  • Daily self-care
  • More demanding physical activities

Scoring

  • Usually reported as a T-score.
  • The average score in the reference population is 50.
  • Higher score means better physical function.

Advantages

  • Short forms are available.
  • Can be used for many different musculoskeletal problems.
  • Useful for repeated follow-up.

Limitation

It may be less detailed than a scale made specifically for a certain joint.

3.4 Patient-Specific Functional Scale (PSFS)

Purpose

The PSFS lets the patient identify activities that are personally important but difficult because of their injury or condition.

Method

The patient chooses about 3 to 5 activities that they cannot do or find difficult.
Examples:
  • Walking to school
  • Carrying a child
  • Squatting for prayer
  • Lifting at work
  • Playing cricket
  • Reaching overhead
  • Climbing stairs
Each activity is rated from:
  • 0 = unable to perform the activity
  • 10 = able to perform the activity at the previous normal level
The average of the activity scores is calculated.

Uses

  • Any musculoskeletal dysfunction
  • Low back pain
  • Neck pain
  • Shoulder disorders
  • Lower-limb injury
  • Sports injury
  • Rehabilitation after fracture

Advantages

  • Patient-centred.
  • Quick and easy.
  • Measures activities that matter to that individual.
  • Useful for setting treatment goals.

Limitation

Different patients choose different activities, so comparison between patients is difficult.

3.5 Musculoskeletal Function Assessment and Short Musculoskeletal Function Assessment

Full names

  • MFA: Musculoskeletal Function Assessment
  • SMFA: Short Musculoskeletal Function Assessment

Purpose

These measure disability caused by musculoskeletal injury or disease. They are especially useful in serious fractures, multiple limb injuries, and orthopaedic trauma.

Areas assessed

They may include:
  • Mobility
  • Daily activities
  • Hand and arm function
  • Emotional effect of injury
  • Sleep and rest
  • Work
  • Social participation

Scoring

  • The SMFA commonly gives separate scores for:
    • Dysfunction
    • Bother
  • A higher score usually means more disability or more difficulty.

Uses

  • Major fractures
  • Pelvic fractures
  • Multiple limb trauma
  • Long-term orthopaedic follow-up
  • Chronic musculoskeletal disability

Advantages

  • Broader than a single-joint score.
  • Useful when injury affects more than one body part.

Limitation

  • Longer than simple scales.
  • May be difficult for patients with low literacy unless assistance is provided.

4. Upper-Limb Functional Assessment Scales

4.1 DASH and QuickDASH

Full name

Disabilities of the Arm, Shoulder and Hand Questionnaire

Purpose

DASH measures disability and symptoms in the entire upper limb, including the shoulder, arm, elbow, forearm, wrist, and hand.

Items assessed

It asks about difficulty with activities such as:
  • Opening a jar
  • Writing
  • Turning a key
  • Carrying a shopping bag
  • Using a knife
  • Washing hair
  • Recreational activities
  • Work activities
  • Sleep
  • Pain, weakness, tingling, and stiffness

Scoring

  • DASH has 30 items.
  • Each item is usually rated from 1 to 5.
  • Final score is converted to 0 to 100.
  • 0 = no disability
  • 100 = maximum disability
QuickDASH is a shorter form, commonly with 11 items.

Uses

  • Upper-limb fractures
  • Shoulder disorders
  • Elbow injury
  • Wrist and hand injury
  • Tendon injury
  • Nerve injury
  • Carpal tunnel syndrome
  • Postoperative upper-limb rehabilitation

Advantages

  • Covers the whole upper limb.
  • Useful when more than one upper-limb joint is involved.
  • QuickDASH is convenient in a busy clinic.

Limitation

It is not specific to one joint. For example, it may not identify the exact problem in a patient with only wrist dysfunction. The DASH description notes that it is a 30-item self-report measure for upper-limb musculoskeletal disorders, with higher scores indicating greater difficulty.

4.2 SPADI

Full name

Shoulder Pain and Disability Index

Purpose

SPADI is used for shoulder pain and shoulder dysfunction.

Components

It has two sections:
  1. Pain section
  2. Disability section
The disability section asks about activities such as:
  • Washing hair
  • Putting on a shirt
  • Reaching for an object on a high shelf
  • Carrying a heavy object
  • Reaching behind the back

Scoring

  • Each item is usually rated from 0 to 10.
  • Higher score means greater shoulder pain and disability.
  • Total score is commonly expressed as a percentage.

Uses

  • Rotator cuff disorder
  • Frozen shoulder
  • Shoulder impingement
  • Shoulder fracture rehabilitation
  • Shoulder surgery
  • Shoulder pain after trauma

Advantage

Simple, focused, and sensitive to functional change in shoulder rehabilitation.

4.3 Constant-Murley Score

Purpose

This is a clinician-administered shoulder score.

Components

It assesses:
  • Pain
  • Ability to perform daily activities
  • Range of motion
  • Strength

Scoring

  • Total score is generally out of 100.
  • Higher score means better shoulder function.

Uses

  • Proximal humerus fracture
  • Rotator cuff tear
  • Shoulder instability
  • Shoulder arthroplasty
  • Postoperative shoulder assessment

Advantage

It includes both the patient’s experience and objective clinical findings.

Limitation

Strength measurement and range-of-motion measurement must be done correctly. Results can vary between examiners.

4.4 ASES Score

Full name

American Shoulder and Elbow Surgeons Score

Purpose

Used mainly for shoulder disorders.

Components

  • Pain
  • Activities of daily living

Scoring

  • Usually out of 100.
  • Higher score means better shoulder function.

Uses

  • Rotator cuff tear
  • Shoulder instability
  • Shoulder arthritis
  • Shoulder surgery
  • Fracture rehabilitation

4.5 PRWE or PRWHE

Full name

  • PRWE: Patient-Rated Wrist Evaluation
  • PRWHE: Patient-Rated Wrist and Hand Evaluation

Purpose

Used for wrist and hand pain and disability.

Components

  • Pain
  • Function
    • Specific activities
    • Usual activities

Scoring

  • Usually scored out of 100.
  • Higher score means more pain and disability.

Uses

  • Distal radius fracture
  • Wrist ligament injury
  • Scaphoid fracture
  • Wrist arthritis
  • Hand injury
  • Wrist surgery

Advantage

Very useful for patients whose main problem is wrist or hand function.

4.6 Boston Carpal Tunnel Questionnaire

Other name

Boston Questionnaire

Purpose

Used specifically for carpal tunnel syndrome.

Components

  1. Symptom Severity Scale
  2. Functional Status Scale

Areas assessed

  • Numbness
  • Tingling
  • Night pain
  • Weakness
  • Difficulty with writing, buttons, holding a book, or gripping objects

Uses

  • Carpal tunnel syndrome
  • Before and after carpal tunnel release surgery

5. Spine and Neck Functional Assessment Scales

5.1 Oswestry Disability Index

Short name

ODI

Purpose

ODI is one of the most common measures of disability due to low back pain.

Areas assessed

It asks about:
  • Pain intensity
  • Personal care
  • Lifting
  • Walking
  • Sitting
  • Standing
  • Sleeping
  • Sexual activity
  • Social life
  • Travelling

Scoring

  • Ten sections are commonly used.
  • Each section is scored from 0 to 5.
  • Score is converted into a percentage.

Interpretation

ODI scoreUsual interpretation
0-20%Minimal disability
21-40%Moderate disability
41-60%Severe disability
61-80%Very severe disability
81-100%Bed-bound or severe symptom exaggeration may be considered

Uses

  • Mechanical low back pain
  • Lumbar disc prolapse
  • Lumbar spinal stenosis
  • Lumbar fracture
  • Spondylolisthesis
  • Postoperative lumbar spine rehabilitation

Important point

Higher ODI percentage means greater disability. The ODI overview describes its assessment of pain and activity limitations such as self-care, walking, sitting, standing, sleeping, social activity, and travel.

5.2 Roland-Morris Disability Questionnaire

Short name

RMDQ

Purpose

Measures disability due to low back pain.

Method

  • Contains 24 statements.
  • The patient ticks statements that apply to them on that day.
Examples include statements related to:
  • Staying at home
  • Walking slowly
  • Avoiding bending
  • Difficulty getting dressed
  • Difficulty sleeping
  • Avoiding heavy work

Scoring

  • Score ranges from 0 to 24.
  • Higher score means greater disability.

Uses

  • Acute low back pain
  • Subacute low back pain
  • Mild to moderate low back disability
  • Physiotherapy follow-up

Difference from ODI

  • RMDQ is short and simple.
  • ODI is more detailed and is often preferred in more severe or chronic disability.

5.3 Neck Disability Index

Short name

NDI

Purpose

Measures disability due to neck pain.

Areas assessed

  • Pain intensity
  • Personal care
  • Lifting
  • Reading
  • Headache
  • Concentration
  • Work
  • Driving
  • Sleeping
  • Recreation

Scoring

  • Ten items, usually scored from 0 to 5.
  • Converted to a percentage.
  • Higher score means greater neck disability.

Uses

  • Whiplash injury
  • Cervical spondylosis
  • Cervical radiculopathy
  • Neck muscle strain
  • Cervical fracture rehabilitation
  • Postoperative cervical spine conditions

5.4 Quebec Back Pain Disability Scale

Purpose

Measures difficulty in daily physical activities because of low back pain.

Activities assessed

  • Walking
  • Sitting
  • Standing
  • Bending
  • Reaching
  • Lifting
  • Turning in bed
  • Getting in and out of a car

Use

Useful for monitoring activity limitation in low back pain rehabilitation.

6. Hip Functional Assessment Scales

6.1 Harris Hip Score

Purpose

Harris Hip Score is a common hip outcome scale.

Components

  • Pain
  • Function
    • Walking distance
    • Use of walking aid
    • Stairs
    • Sitting
    • Putting on shoes and socks
  • Absence of deformity
  • Range of motion

Scoring

  • Total score is out of 100.
  • Higher score means better hip function.

Common interpretation

ScoreInterpretation
90-100Excellent
80-89Good
70-79Fair
Below 70Poor

Uses

  • Hip fracture
  • Hip dislocation
  • Femoral neck fracture
  • Intertrochanteric fracture
  • Hip osteoarthritis
  • Total hip replacement
  • Hip trauma follow-up

Limitation

It includes clinician-measured findings, so measurement technique can affect the score.

6.2 HOOS

Full name

Hip Disability and Osteoarthritis Outcome Score

Purpose

HOOS is a patient-reported scale for hip problems. It is especially useful in hip osteoarthritis and hip surgery, but may also be useful in hip trauma recovery.

Subscales

  1. Pain
  2. Symptoms
  3. Activities of daily living
  4. Sport and recreation
  5. Hip-related quality of life

Scoring

  • Each subscale is usually converted to 0 to 100.
  • Higher score means better function and fewer symptoms.

Uses

  • Hip osteoarthritis
  • Hip arthroscopy
  • Hip replacement
  • Femoroacetabular impingement
  • Long-term hip fracture rehabilitation

6.3 WOMAC

Full name

Western Ontario and McMaster Universities Osteoarthritis Index

Purpose

WOMAC is mainly used for hip and knee osteoarthritis. It can also be used to describe pain and function after hip or knee surgery.

Components

  1. Pain
  2. Stiffness
  3. Physical function

Functional activities assessed

  • Stairs
  • Walking
  • Sitting
  • Standing
  • Getting in and out of bed
  • Dressing
  • Housework

Scoring

Different versions use different scoring methods. In general:
  • Higher score may mean worse symptoms in raw scoring systems.
  • Some systems convert scores so that higher score means better outcome.
Always check the scoring method before interpreting the result.

Uses

  • Hip osteoarthritis
  • Knee osteoarthritis
  • Total hip replacement
  • Total knee replacement
  • Degenerative joint dysfunction
The WOMAC measure overview describes it as a self-administered measure of pain, stiffness, and function in hip and knee osteoarthritis.

6.4 Merle d’Aubigné-Postel Score

Purpose

Often used after hip trauma, especially acetabular fracture and hip dislocation.

Components

  • Pain
  • Mobility or walking
  • Ability to walk

Scoring

  • Each area is commonly graded from 1 to 6.
  • Total score is commonly out of 18.
  • Higher score means better hip outcome.

Uses

  • Acetabular fracture
  • Hip dislocation
  • Pelvic and hip trauma
  • Postoperative hip trauma assessment

7. Knee Functional Assessment Scales

7.1 KOOS

Full name

Knee Injury and Osteoarthritis Outcome Score

Purpose

KOOS is a patient-reported outcome scale for knee injury and knee osteoarthritis.

Subscales

  1. Pain
  2. Other symptoms
  3. Activities of daily living
  4. Sport and recreation
  5. Knee-related quality of life

Scoring

  • Each subscale is reported from 0 to 100.
  • Higher score means better knee status.

Uses

  • Knee osteoarthritis
  • Meniscus injury
  • ACL injury
  • Cartilage injury
  • Patellofemoral problems
  • Knee surgery
  • Long-term rehabilitation after knee trauma

Advantage

It includes higher-demand sport and recreation activities, so it is useful for active adults and athletes.

7.2 IKDC Subjective Knee Form

Full name

International Knee Documentation Committee Subjective Knee Evaluation Form

Purpose

Used for knee symptoms, function, and sports ability.

Areas assessed

  • Pain
  • Swelling
  • Stiffness
  • Instability
  • Ability to perform daily tasks
  • Ability to perform sports activities

Scoring

  • Usually from 0 to 100.
  • Higher score means better function.

Uses

  • ACL injury
  • Meniscal injury
  • Ligament injury
  • Cartilage injury
  • Knee surgery
  • Sports rehabilitation

7.3 Lysholm Knee Score

Purpose

Originally developed for knee ligament injury, especially ACL injury.

Components

  • Limp
  • Support needed
  • Locking
  • Instability
  • Pain
  • Swelling
  • Stair climbing
  • Squatting

Scoring

  • Total score is out of 100.
  • Higher score means better knee function.

Common interpretation

ScoreInterpretation
95-100Excellent
84-94Good
65-83Fair
Below 65Poor

Uses

  • ACL injury
  • Knee instability
  • Ligament reconstruction
  • Sports injury rehabilitation

7.4 Tegner Activity Scale

Purpose

Measures activity level rather than only pain or disability.

Scoring

  • Usually scored from 0 to 10.
  • 0 means disability because of knee problems.
  • Higher scores represent more physically demanding work and sport.
  • 10 represents elite-level competitive sport.

Uses

  • ACL injury
  • Ligament reconstruction
  • Return-to-sport assessment
  • Combination with Lysholm score

Important point

A patient may have less pain but still not return to their previous activity level. Tegner helps identify this difference.

7.5 Oxford Knee Score

Purpose

Measures pain and function in people with knee arthritis and after knee replacement.

Method

  • Contains 12 questions.
  • Focuses on pain and ability in daily activities.

Uses

  • Knee osteoarthritis
  • Total knee replacement
  • Follow-up after knee surgery

8. Lower-Limb and General Mobility Scales

8.1 Lower Extremity Functional Scale

Short name

LEFS

Purpose

LEFS measures function in people with lower-limb musculoskeletal problems.

Activities assessed

It asks about difficulty with activities such as:
  • Usual work or school activities
  • Housework
  • Walking indoors
  • Walking between rooms
  • Getting in and out of a bath
  • Running
  • Hopping
  • Squatting
  • Lifting objects
  • Climbing stairs
  • Standing for one hour

Scoring

  • Contains 20 items.
  • Each item is scored from 0 to 4.
  • Total score ranges from 0 to 80.
  • 0 = unable to perform activities
  • 80 = maximum function

Uses

  • Hip, thigh, knee, leg, ankle, and foot disorders
  • Lower-limb fracture
  • Ligament injury
  • Postoperative rehabilitation
  • Sports injury
  • Osteoarthritis

Advantage

It is easy to use and useful for many lower-limb injuries. The LEFS resource supports its use across various lower-extremity injuries and notes good ability to detect change over time.

8.2 Timed Up and Go Test

Short name

TUG

Purpose

A quick performance test for mobility, balance, and fall risk.

Method

The patient:
  1. Sits in a chair.
  2. Stands up.
  3. Walks 3 metres.
  4. Turns around.
  5. Walks back.
  6. Sits down.
The clinician records the time taken.

Interpretation

  • Less time means better mobility.
  • A longer time may indicate reduced mobility and increased fall risk.
  • Interpretation should consider age, diagnosis, walking aid use, and the clinical setting.

Uses

  • Hip fracture rehabilitation
  • Knee replacement
  • Lower-limb fracture
  • Older adults
  • Balance problems
  • General rehabilitation

8.3 6-Minute Walk Test

Short name

6MWT

Purpose

Measures walking endurance and functional exercise capacity.

Method

The patient walks as far as possible in six minutes on a flat path.

Outcome

  • Distance walked in metres.
  • Greater distance means better endurance.

Uses

  • Polytrauma rehabilitation
  • Lower-limb fracture recovery
  • Hip and knee replacement rehabilitation
  • Spinal conditions
  • General deconditioning

Limitation

Pain, breathlessness, fatigue, use of a walking aid, and motivation can affect the result.

8.4 10-Metre Walk Test

Purpose

Measures walking speed.

Outcome

  • Walking speed in metres per second.

Uses

  • Lower-limb injury
  • Neurological and musculoskeletal rehabilitation
  • Hip fracture
  • Gait training
  • Mobility assessment

Meaning

Faster walking speed usually indicates better functional mobility.

8.5 Five Times Sit-to-Stand Test

Purpose

Measures lower-limb strength, balance, and functional mobility.

Method

The patient rises from a chair and sits down five times as fast as possible, usually without using the arms if safe.

Outcome

  • Time taken to complete five repetitions.
  • Less time means better performance.

Uses

  • Knee osteoarthritis
  • Hip fracture rehabilitation
  • Lower-limb weakness
  • Older adults
  • After joint replacement

9. Foot and Ankle Functional Assessment Scales

9.1 Foot and Ankle Ability Measure

Short name

FAAM

Purpose

Measures function in people with foot and ankle disorders.

Subscales

  1. Activities of Daily Living
  2. Sports

Scoring

  • Higher percentage score means better function.

Uses

  • Ankle sprain
  • Chronic ankle instability
  • Ankle fracture
  • Achilles tendon injury
  • Foot and ankle surgery
  • Sports injury

9.2 AOFAS Scales

Full name

American Orthopaedic Foot and Ankle Society Scores

Purpose

There are different AOFAS scales for different parts of the foot and ankle, such as:
  • Ankle-hindfoot
  • Midfoot
  • Hallux
  • Lesser toes

Components

Usually include:
  • Pain
  • Function
  • Walking distance
  • Walking surface
  • Gait
  • Alignment

Scoring

  • Commonly out of 100.
  • Higher score means better result.

Uses

  • Ankle fracture
  • Hindfoot injury
  • Foot deformity
  • Achilles disorder
  • Foot and ankle surgery

Limitation

Part of the score is clinician-assessed, so standard examination is important.

9.3 Achilles Tendon Total Rupture Score

Short name

ATRS

Purpose

Used after Achilles tendon rupture.

Areas assessed

  • Weakness
  • Stiffness
  • Pain
  • Ability to walk
  • Climbing stairs
  • Running
  • Jumping
  • Sports participation

Scoring

  • Usually from 0 to 100.
  • Higher score means better recovery.

Uses

  • Surgical or non-surgical treatment of Achilles tendon rupture
  • Return-to-running and return-to-sport follow-up

10. Trauma-Specific Functional Assessment Scales

10.1 Functional Independence Measure

Short name

FIM

Purpose

Measures how independent a patient is in daily life. It is useful after severe trauma, spinal cord injury, multiple fractures, traumatic brain injury, and prolonged hospital admission.

Areas assessed

Motor areas

  • Eating
  • Grooming
  • Bathing
  • Dressing
  • Toileting
  • Transfers
  • Walking or wheelchair movement
  • Stairs

Cognitive and social areas

  • Communication
  • Social interaction
  • Memory
  • Problem-solving

Scoring

Each item is commonly scored from:
  • 1 = total assistance needed
  • 7 = complete independence

Uses

  • Polytrauma
  • Spinal injury
  • Severe lower-limb injury
  • Rehabilitation ward
  • Discharge planning

Advantage

Shows how much help a patient needs in real life.

10.2 Majeed Pelvic Score

Purpose

Used to assess outcome after pelvic ring injury.

Areas assessed

  • Pain
  • Standing
  • Sitting
  • Sexual intercourse
  • Work performance
  • Walking aids
  • Gait
  • Walking distance

Scoring

  • Usually out of 100.
  • Higher score means better functional recovery.

Uses

  • Pelvic fracture
  • Pelvic ring disruption
  • Long-term pelvic trauma follow-up

10.3 Iowa Pelvic Score

Purpose

May be used after pelvic fracture to assess pain and function.

Areas assessed

  • Pain
  • Gait
  • Work
  • Sitting
  • Social function
  • Symptoms related to pelvic injury

Uses

  • Pelvic trauma
  • Rehabilitation and research follow-up

10.4 Hospital for Special Surgery Hip Fracture Recovery Score

Short name

HSS Hip Fracture Recovery Score

Purpose

Used to assess recovery after hip fracture, especially in older adults.

Areas may include

  • Pain
  • Walking
  • Use of walking aids
  • Transfers
  • Daily activities
  • Hip movement

Use

Useful in monitoring functional recovery after hip fracture surgery and rehabilitation.

11. Choosing the Correct Scale

The scale should match the patient’s problem.
Clinical problemUseful functional scales
Multiple trauma or major fractureEQ-5D, SF-36/SF-12, SMFA, FIM
Shoulder dysfunctionSPADI, Constant-Murley, ASES, DASH
Elbow, wrist, hand, or arm injuryDASH/QuickDASH, PRWE/PRWHE
Carpal tunnel syndromeBoston Carpal Tunnel Questionnaire
Low back painODI, RMDQ, PSFS
Neck pain or whiplashNDI
Hip fracture or hip dysfunctionHarris Hip Score, HOOS, Merle d’Aubigné-Postel
Hip or knee osteoarthritisWOMAC, HOOS, KOOS
ACL, meniscus, or knee sports injuryIKDC, KOOS, Lysholm, Tegner
Lower-limb injury or fractureLEFS, TUG, 6MWT, 10MWT
Ankle and foot injuryFAAM, AOFAS
Achilles tendon ruptureATRS, FAAM
Pelvic fractureMajeed Pelvic Score, Iowa Pelvic Score
Severe injury needing help with daily livingFIM

12. Important Points While Using Functional Scales

  1. Use the same scale at every follow-up.
    This makes comparison easier.
  2. Record the baseline score before treatment.
    Without a baseline, improvement cannot be measured properly.
  3. Use a scale suitable for the body region.
    For example, use DASH for upper limb, ODI for low back, and LEFS for lower limb.
  4. Do not use only one score to judge a patient.
    Also assess pain, range of motion, muscle strength, swelling, gait, neurological findings, imaging, work demands, and the patient’s goals.
  5. Check whether high score means better or worse function.
    • DASH, ODI, NDI, PRWE, and SMFA: higher score generally means more disability.
    • LEFS, Harris Hip Score, KOOS, HOOS, Lysholm, FAAM, and ASES: higher score generally means better function.
    • WOMAC scoring may vary by version, so always check the method used.
  6. Consider literacy and language.
    Use a validated local-language version when available. Explain questions without leading the patient toward an answer.
  7. Consider floor and ceiling effects.
    • A floor effect occurs when many severely affected patients score at the lowest end, making it difficult to distinguish between them.
    • A ceiling effect occurs when many recovered or high-functioning patients score near the maximum, making further improvement difficult to detect.
      Rockwood and Green’s Fractures in Adults explains that these effects can limit the ability of an instrument to distinguish between patients, p. 283.
  8. Combine self-report and performance measures when possible.
    For example, use LEFS with a 6-Minute Walk Test, or KOOS with strength and hop testing. A patient may report feeling better but still have poor walking endurance, weakness, or poor balance.

13. Short Summary

Functional assessment scales are important tools in trauma and musculoskeletal rehabilitation. They convert the patient’s pain, disability, activity limitation, and recovery into measurable scores.
  • Use generic scales such as SF-36 or EQ-5D for overall health and major trauma.
  • Use regional scales such as DASH, ODI, NDI, and LEFS for a specific body area.
  • Use joint- or disease-specific scales such as WOMAC, KOOS, HOOS, Harris Hip Score, Lysholm, and FAAM for more detailed assessment.
  • Use performance tests such as TUG, 6MWT, and sit-to-stand tests to measure actual mobility and endurance.
  • Use the same validated scale repeatedly to show change after treatment.
A recent systematic review of core musculoskeletal outcomes found that pain and physical function are consistently important outcome domains across musculoskeletal conditions.
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