What questions should be asked to assess a patient's functional status?

Assessing Functional Status: Key Questions to Ask

To assess functional status, ask patients if they can walk 4 blocks or climb 2 flights of stairs without stopping—this simple question identifies those with poor functional capacity (<4 METs) who are at increased risk for cardiovascular events and mortality. 1

Core Functional Capacity Questions

The most clinically validated approach centers on metabolic equivalent (MET) assessment through specific activity questions:

Primary Screening Questions (4-MET Threshold)

• "Can you walk 4 blocks without stopping?" 1
• "Can you climb 2 flights of stairs without stopping?" 1

These two questions are the most evidence-based for risk stratification. Inability to perform these activities predicts perioperative myocardial ischemia, cardiovascular events, and serious complications (P<0.006 for blocks walked; P<0.01 for stairs climbed). 1

Additional Activity-Based Questions

Ask about specific activities to further characterize functional capacity:

Activities requiring <4 METs (poor functional capacity): 1

• Can you do slow ballroom dancing?
• Can you play a musical instrument while seated?
• Can you walk at 2-3 mph on flat ground?
• Can you golf using a cart?

Activities requiring ≥4 METs (adequate functional capacity): 1

• Can you do moderate cycling?
• Can you climb hills?
• Can you play singles tennis?
• Can you jog?
• Can you ice skate or rollerblade?

Structured Assessment Tools

Duke Activity Status Index

Use the Duke Activity Status Index for systematic functional capacity estimation—it provides a standardized set of questions that correlate with MET levels and is recommended by ACC/AHA guidelines. 1

Activities of Daily Living Assessment

For comprehensive functional evaluation, particularly in heart failure, stroke, or geriatric patients, ask about:

Basic Activities of Daily Living (BADLs): 1, 2

• Bathing independently
• Dressing yourself
• Toileting without assistance
• Eating without help
• Transferring (getting in/out of bed, chair)
• Maintaining continence

Instrumental Activities of Daily Living (IADLs): 1, 3

• Shopping for groceries
• Preparing meals
• Managing finances
• Using technology/telephone
• Traveling to unfamiliar areas
• Managing medications

Symptom-Specific Questions

For Cardiovascular Patients

Ask these targeted questions to assess heart failure functional status: 1

• Dyspnea assessment:

  • "Do you get short of breath at rest?"
  • "What activities make you short of breath?" (specify distance/activity level)
  • "Do you need to sleep propped up on pillows?"
  • "Do you wake up suddenly at night gasping for air?"

• Exercise tolerance:

  • "Do you experience unusual tiredness?"
  • "Can you perform your usual activities?"

• Volume status:

  • "Have you noticed swelling in your legs or abdomen?"
  • "How much weight have you gained/lost recently?"

For Stroke Patients

Three essential questions for stroke survivors: 1

1. "What could you do before the stroke that you cannot do now?"
2. "What do you want to be able to do?"
3. "Have you reached your full potential for recovery?"

These questions identify rehabilitation gaps and unmet needs. 1

Objective Functional Tests

Six-Minute Walk Test

Ask: "How many flights of stairs can you climb or how many blocks can you walk?" 1

While patient self-reports are useful for screening, they may overestimate or underestimate true capacity. The American Thoracic Society notes that objective measurements are superior to self-reports alone. 1

Clinical Application Algorithm

Step 1: Start with the 4-block/2-stair question 1

Step 2: If unable to perform these activities, classify as poor functional capacity (<4 METs) and assess for:

• Cardiac risk factors
• Need for further cardiovascular evaluation
• Rehabilitation potential 1

Step 3: If functional capacity is adequate (≥4 METs), document specific activity level using Duke Activity Status Index or similar tool 1

Step 4: For all patients, assess BADLs and IADLs to identify specific deficits requiring intervention 1, 2

Step 5: Reassess periodically, as functional status changes over time with disease progression, treatment, or rehabilitation 1

Critical Pitfalls to Avoid

• Don't rely solely on patient self-report without specific activity questions—patients vary significantly in their recollection and may over- or underestimate capacity. 1

• Don't assume functional status remains stable—reassessment is essential, particularly after hospitalization, acute events, or changes in chronic conditions. 1

• Don't overlook non-physical domains—social, leisure, and productive activities provide important information about overall functioning and quality of life. 3

• Don't forget to ask about patient goals—understanding what patients want to be able to do guides rehabilitation and treatment priorities. 1