Patient-reported outcome measures are increasingly necessary elements of good clinical practice.  By using a clinically meaningful outcome measure at the initial assessment and measuring change over time, you can track shifts in patient progress and thereby improve clinical decisions. Documenting treatment necessity (which can improve and facilitate reimbursement and decrease insurance denials) can fine-tune your treatment regime and provide a rationale for ongoing treatment. Outcome measures are useful in establishing maximum therapeutic recovery, and they can identify patients at risk for poor outcomes.

Barriers To The Implementation of Outcome Measures

Despite the benefits of using outcome measures, some practitioners resist using them in everyday practice. In a cross-sectional study of both users and non-users, more than 70% of respondents felt it takes too much time for patients to complete. Most self-reporting instruments measuring spinal pain and dysfunction are underutilized, because they require too much time for patients to answer (5-10 minutes per instrument). The Functional Rating index was created specifically to address this issue.

Functional Rating Index

The Functional Rating Index (FRI) instrument contains 10 short items that measure pain and function of the spinal musculoskeletal system: eight refer to activities of daily living that might be adversely affected by a spinal condition; two refer to different attributes of pain. Function is considered the strongest measure of severity, and pain is the most common measure. Because many spinal disabilities are a combination of loss of function and pain and/or the fear of pain, employing both pain and function allows for a wider view of a patient's disability. The FRI requires only about one minute for a patient to complete.  This instrument can be used with cervical, thoracic or lumbar conditions, which reduces the need for multiple instruments for spine-related conditions.

A Validated Spinal Outcome Measure

The FRI was originally tested, and the results were published in Spine. The initial research showed that FRI had good reliability, validity and responsiveness, and it significantly reduced administrative burden. Since its inception, nine independent research teams have tested the qualities of the FRI. A review of all FRI studies was published in Medical Science Monitor and found the measurement qualities excellent for clinical practice and research. You can download the FRI instrument at

Dr. Ron Feise is a practice consultant & coach with RJF Consulting.



Feise RJ, Menke JM. Functional Rating Index: A new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine 2001;26:78-87.

Feise RJ, Menke JM. Functional Rating Index: literature review. Med Sci Monit 2010 Feb;16:RA25-36.