Functional Rating Index

Functional Rating Index

In order to properly assess your condition, we must understand how much your neck and/or back problems have affected your ability to manage everyday activities. For each item below, please select the number which most closely describes your condition right now.


Your Full Name*

Your Email*


1. Pain Intensity
 0. No pain 1. Mild pain 2. Moderate pain 3. Severe pain 4. Worst possible pain


2. Sleeping
 0. Perfect sleep 1. Mildly disturbed sleep 2. Moderately disturbed sleep 3. Greatly disturbed sleep 4. Totally disturbed sleep


3. Personal Care (washing, dressing, etc.)
 0. No pain; no restrictions 1. Mild pain; no restrictions 2. Moderate pain; need to go slowly 3. Moderate pain; need some assistance 4. Severe pain; need 100% assistance


4. Travel (driving, etc.)
 0. No pain on long trips 1. Mild pain on long trips 2. Moderate pain on long trips 3. Moderate pain on short trips 4. Severe pain on short trips


5. Work
 0. Can do usual work plus unlimited extra work 1. Can do usual work; no extra work 2. Can do 50% of usual work 3. Can do 25% of usual work 4. Cannot work


6. Recreation
 0. Can do all activities 1. Can do most activities 2. Can do some activities 3. Can do a few activities 4. Cannot do any activities


7. Frequency of pain
 0. No pain 1. Occasional pain; 25% of the day 2. Intermittent pain; 50% of the day 3. Frequent pain; 75% of the day 4. Constant pain; 100% of the day


8. Lifting
 0. No pain with heavy weight 1. Increased pain with heavy weight 2. Increased pain with moderate weight 3. Increased pain with light weight 4. Increased pain with any weight


9. Walking
 0. No pain; any distance 1. Increased pain after 1 mile 2. Increased pain after 1/2 mile 3. Increased pain after 1/4 mile 4. Increased pain with all walking


10. Standing
 0. No pain after several hours 1. Increased pain after several hours 2. Increased pain after 1 hour 3. Increased pain after 1/2 hour 4. Increased pain with any standing