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.