Pain, Function, and Mental Health Tests used by CMS
Physical Function Outcomes

General/Global Function
  Patient Questionnaire for Lumbar Spinal Stenosis                                  
  Oswestry Low Back Pain Disability Questionnaire  
  Functional Rating Scale (FRS)  
  Low Back Pain Rating Scale (RS)  
  Roland and Morris Disability Questionnaire  
  Quebec Back Pain Disability Scale  
  SF-36  
  Sickness Impact Profile  
  Functional Independence Measure (FIM)  
  Restricted Activity Days  
  Bed Days  
  Nottingham Health Profile  
  Duke Health Profile  
  Million Instrument  

Self Care  
  Oswestry Low Back Pain Disability Questionnaire  
  Neck Disability Index (revised form of Oswestry)  
  Dallas Pain Questionnaire (DPQ)  
  Functional Rating Scale (FRS)  
  Revised Oswestry Disability Index  
  Revised Oswestry Pain Questionnaire  
  Northwick Park Neck Pain Questionnaire  
  Million Instrument  
  Functional Status Questionnaire (Jette)  
  6 Item Activities of Daily Living (ADL) (Katz)  
  Weighted 7 Item ADL (Kane)  
  5 Item ADL Recovery (Kramer)  
  Bristol ADL (for persons with dementia) Barthel Index  
  Lawton Instrumental Activities of Daily Living (IADLs)  
  OARS (Older American Resources and Services) Multidemensional  
  Physical Performance Test (Reuben)  

Ambulation/Mobility  
  Limp  
  Walking  
  Discharge with assistive devices for ambulation  
  Oswestry Low Back Pain Disability Questionnaire  
  Gait speed  
  Walking distance  
  Tinetti Gait and Balance  
Mental Health Outcome Measures

Anxiety-Depression   Dallas Pain Questionnaire (DPQ)  

Depression  
  Geriatric Depression Scale (GDS)  
  DSM IV  
  CES-D  
  HAM-D  
  Life Satisfaction Index K  
  Zung Self-Rating Depression Scale  

Cognition  
  MMSE  
  Short Portable (Pfiefer)  
  Blessed Dementia Scale  
  Abbreviated Mental Test  
  Clock Drawing Test  
  Neuropsychological Testing  

Delirium     

Anxiety  
  DSM IV  
Quality of Life Indicators

Social Life   Oswestry Low Back Pain Disability Questionnaire  
Social Interest   Dallas Pain Questionnaire (DPQ)  
Travel   Oswestry Low Back Pain Disability Questionnaire  
Work Activities   Dallas Pain Questionnaire (DPQ), Functional Rating     
 Scale (FRS)

Leisure Activities:   Dallas Pain Questionnaire (DPQ)  

Time Spent in Bed:   Functional Rating Scale (FRS)  

Health-Related Quality of Life  
  SF-36 (mental health score)  
  Sickness Impact Profile (SIP)  
  Quality of Well-Being Scale (QWB)  
  Reintegration to Normal Living Scale  

Self-Perceived Ability to Participate in Social/Recreational Activities  
  Activity Pattern Indicator  
Subjective Well-Being     
Days of Work Absenteeism : Health Interview Survey Items  
Days in Bed: Health Interview Survey Items  
Days of Limited Activity: Health Interview Survey Items  
Work Status:   NASS Questionnaire  
Compensation Status: NASS Questionnaire  
Job Description: NASS Questionnaire  
Vocational Outcomes     
Social Function  
  Sickness Impact Profile (SIP)  
  Oswestry Disability Questionnaire  
  Nottingham Health Profile  
Household Activities  
  Sickness Impact Profile (SIP)  
Recreation  
  Sickness Impact Profile (SIP)
Pain Assessment

Symptom Severity   Patient Questionnaire for Lumbar Spinal Stenosis  
Pain Intensity  
  Oswestry Low Back Pain Disability Questionnaire  
  Low Back Pain Rating Scale (RS)  
  Revised Oswestry Pain Questionnaire  
  Revised Oswestry Disability Index  
  NASS Questionnaire  
Pain  
  Patient Pain Scale 1-10  
  Dallas Pain Score  
  Chronic Pain Grade (VonKorff)  
  Visual Analog Scale  
  Hospice QI  
  Pain and Impairment Relationship Scale (PAIRS)  
  Pain Disability Index  
  Functional Interference Estimate  
  McGill Pain Questionnaire  
  The Modified Somatic Perception Questionnaire (MSPQ)