The Functional Status Questionnaire (FSQ) (Jette 1980) can be used as a self-administered functional assessment for primary care patients that provides information on physical, psychological, and social and role functions. There are five sections of the FSQ: (1) physical function in the activities of daily living (ADLs), (2) mental health function, (3) social role function, (4) social activity, and (5) other performance measures. The physical function section consists of measures of basic (three items) and intermediate ADLs (six items); mental health function includes measures of feelings of anxiousness and downheartedness (five items); and social and role functions include three groups of items including a six-item measure of work performance (for those employed during the previous month), a three-item measure of social function, and a five-item measure of social interaction. Single questions assess work status, bed disability days, days on which the.
