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Functional rating index scoring

Functional rating index 2026

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The document is a Functional Rating Index designed to assess the impact of neck and/or back problems on a patient's daily activities. It includes a series of questions regarding pain intensity, sleep quality, personal care, work capability, and physical activities, with patients rating their condition on a scale from 0 to 4. The purpose is to quantify the severity of symptoms and their effect on everyday functioning.

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Click ‘Get Form’ to open the functional rating index in the editor.
Begin with the 'Pain Intensity' section. Circle the number that best describes your current pain level, ranging from 0 (no pain) to 4 (worst possible pain).
Proceed to the 'Sleeping' section. Indicate your sleep quality by circling a number from 0 (perfect sleep) to 4 (totally disturbed sleep).
In the 'Personal Care' section, assess how your condition affects daily activities like washing and dressing. Choose a number from 0 (no pain; no restrictions) to 4 (severe pain; need 100% assistance).
Continue through each section, including 'Work', 'Lifting', and 'Walking', circling the appropriate numbers based on your experiences.
Once all sections are completed, review your selections for accuracy before signing and dating at the bottom of the form.

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