Research ArticleOriginal Research

Developing and Validating a Novel Tool to Enhance Functional Status Assessment: The Tennessee Functional Status Questionnaire (TFSQ)

Stephanie G. Vanterpool, Robert E. Heidel, Kyle Snyder, Tara Keil, Cecilia Contreras, Alexa Hartman, Rebecca Higdon and Julie Jeter
The Journal of the American Board of Family Medicine January 2023, jabfm.2022.220261R1; DOI: https://doi.org/10.3122/jabfm.2022.220261R1

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Graphical depiction of the components of functional status. Functional status is composed of both functional performance and functional capacity. Functional performance reflects usual physical activity level. Functional capacity is the maximal attainable physical activity level. Functional reserve is the difference between functional performance and functional capacity.

  • Figure 2.
    Figure 2.

    Distribution of mean Duke Activity Status Index (DASI) metabolic equivalents (METs) per corresponding Tennessee Functional Status Questionnaire (TFSQ) response. TFSQ 2 assesses functional capacity; that is, a patient's maximal attainable level of physical activity. Standard deviation (SD) represented by error bars. Statistically significant positive correlations between the TFSQ 2-reported METs (functional capacity) and DASI-calculated METs. Pearson's r correlation r = 0.690, P < .001.

  • Figure 3
    Figure 3

    A: Frequency distributions for Tennessee Functional Status Questionnaire (TFSQ) 1—functional performance. Patients selected their usual activity level from 1 of 5 columns of activities (A–E) grouped according to Metabolic Equivalents (METs) (<3 METs to >6 METs). B: Frequency distributions for TFSQ 2—functional capacity. Patients selected their best activity level from 1 of 5 columns of activities (A–E) grouped according to METs (<3 METs to >6 METs).

  • Appendix.
    Appendix.

    Tennessee Functional Status Questionnaire Instrument

Tables

  • Table 1.

    Columns of Activities, Grouped by Metabolic Equivalents (METs), for Tennessee Functional Status Questionnaire (TFSQ) Questions 1 and 2

    Columns for TFSQ 1 and 2
    A (<3 METs)B (3 to <4 METs)C (4 to <5 METs)D (5 to <6 METs)E (>= 6 METs)

    • Self-care—shower/wash, dress, use bathroom, eat

    • Activities in column A, and at least 1 activity below:

    • Activities in column B, and at least 1 activity below:

    • Activities in column C and at least one activity below:1

    • Activities in column D and at least 1 activity below:

    • Shop at store, make food

    • Child care—lift a child

    • Elder care, care for disabled adult

    • Walk/run—play with children—vigorous only active periods

    • Move furniture, household items, carry boxes

    • Walk around house

    • Sweep/vacuum/clean inside house

    • Sweep outside house, sidewalk, or garage

    • Carry 1-pound to 15-pound pound load upstairs

    • Walk 3.5 mph (very fast) up hill

    • Sit at computer

    • Walk the dog/walk on flat firm surface

    • Push a wheelchair/walk fast while holding less than 25 pounds

    • Walk fast on a flat surface (4 mph) (walk a mile in 15 minutes)

    • Jog, singles tennis, basketball game, hard workout (high-impact aerobics)

    • Ride mower, water grass

    • Trim shrubs or trees, use leaf blower

    • Push a power mower, rake lawn, play golf (walk and pull clubs)

    • Softball or baseball; tennis, doubles; health club/gym workout

    		 

    • Activities in each column are grouped by intensity level, reported as multiples of the patient’s baseline metabolic rate. 1 MET = a patient’s baseline metabolic rate (amount of oxygen consumed at rest). For example: 3 METs = physical activity intensity equal to approximately 3 times the patient’s baseline metabolic rate.

    • Abbreviation: METs, metabolic equivalents.

  • Table 2.

    Tennessee Functional Status Questionnaire (TFSQ): TFSQ Questions 1–5 Ask Details about Functional Performance, Capacity, Activity, and Acute Care. Questions 1 and 2 Refer to Columns A–E Listed in Table 1. (See Appendix for the Complete Instrument)

    ItemCategoryQuestion
    TFSQ 1Performance1) Choose the column that best matches what you usually do in a day (your usual activity level) (circle one)
      Column: A B C D E
    TFSQ 2Capacity2) Choose the column that best matches what you can do on your best day (circle one)
      Column: A B C D E
    TFSQ 3Activity level3) In the past 60 days has your usual activity level changed?
      a. I am now more active than I was 60 days ago.
      b. I am now less active than I was 60 days ago.
      c. My activity level is the same as it was 60 days ago.
    TFSQ 4Pain4) In the past 60 days have you had pain that affects your activity level?
      a. Yes
      b. No
    TFSQ 5Acute care5) In the past 60 days have you gone to the ER/hospital or had a surgery?
      a. Yes
      b. No

    • Note: Columns of activities for TFSQ 1 and 2 are shown in Table 1.

  • Table 3.

    Characteristics of Sample and Responses to Tennessee Functional Status Questionnaire (TFSQ) Questions (Study Participants, Demographics, and Descriptive Statistics)

    VariableResponseM (SD) or Frequency (%)
    Age (n = 120)-58.52 (14.93)
    Height (n = 115)-65.93 (4.11)
    Weight (n = 117)-189.49 (53.29)
    Site (n = 120)
    Pain clinic56 (46.7%)
    University Family Physicians (UFP)63 (52.5%)
    Missing1 (0.8%)
    Gender
    Man41 (34.25%)
    Woman77 (64.2%)
    Missing2 (1.7%)
    Race
    Caucasian106 (92.2%)
    African American6 (5.0%)
    Asian2 (1.75)
    Other1 (0.8%)
    Missing5 (4.2%)
    Ethnicity
    Non-Hispanic102 (85.0%)
    Hispanic3 (2.5%)
    Missing15 (12.5%)
    Performance
    (TFSQ 1)
    A (<3 METs)48 (40.0%)
    B (3 to <4 METs)18 (15.0%)
    C (4 to <5 METs)12 (10.0%)
    D 5 to < 6 METs)22 (18.3%)
    E (>= 6 METs)6 (5.0%)
    Missing14 (11.7%)
    Capacity
    (TFSQ 2)
    A (<3 METs)30 (25.0%)
    B (3 to <4 METs)14 (11.7%)
    C (4 to <5 METs)12 (10.0%)
    D 5 to < 6 METs)21 (17.5%)
    E (>= 6 METs)27 (22.5%)
    Missing16 (13.3%)
    Activity
    (TFSQ 3)
    More active14 (11.7%)
    Less active41 (34.7%)
    No change63 (52.5%)
    Missing2 (1.7%)
    Pain
    (TFSQ 4)
    No39 (32.5%)
    Yes78 (65.0%)
    Missing3 (2.5%)
    Acute care
    (TFSQ 5)
    No95 (79.2%)
    Yes23 (19.2%)
    Missing2 (1.6%)

    • Abbreviations: METs, metabolic equivalents; SD, standard deviation.

  • Table 4.

    Tennessee Functional Status Questionnaire (TFSQ) Internal Consistency: Functional Performance (TFSQ 1) and Capacity (TFSQ 2), Associations with Activity (TFSQ 3), Pain (TFSQ 4), and Acute Care (TFSQ 5) (and Corresponding Duke Activity Status Index [DASI] Metabolic Equivalents [METs] for Pain and Acute Care).

    TFSQ QuestionResponsePerformance (TFSQ 1)
    M (SD)    		P ValueCapacity (TFSQ 2)
    M (SD)    		P ValueDASI METs
    M (SD)    		P Value
    Activity
    (TFSQ 3)    		No change or more active2.44 (1.44)3.24 (1.59)
    Less active1.89 (1.16)0.0482.58 (1.54)0.047
    Pain
    (TFSQ 4)    		No2.74 (1.34)3.73 (1.39)8.25 (1.57)
    Yes2.01 (1.32)0.002.62 (1.59)<0.0015.74 (2.10)<0.001
    Acute care
    (TFSQ 5)    		No2.34 (1.34)3.19 (1.60)6.86 (2.24)
    Yes1.86 (1.42)0.152.25 (1.37)0.0175.31 (1.92)0.003

    • Abbreviations: METs, Metabolic Equivalents; SD, Standard deviation.

    • Means and standard deviations for the TFSQ question comparisons were reported and interpreted using numerical values 1–5 to associate with the TFSQ ordinal activity columns A through E. Participants who answered “less active” to Activity (TFSQ 3) reported significantly lower functional Performance (TFSQ 1) and Capacity (TFSQ 2) than those who answered “no change” or “more active”. Similarly, participants who reported “yes” to Pain (TFSQ 4) also reported significantly lower functional performance and capacity and significantly lower mean DASI METs. Patients reporting “Yes” to Acute Care (TFSQ 5) reported lower performance and significantly lower capacity on the TFSQ as well as significantly lower DASI METs.

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