Quality of Life Concepts

Secondary Health Conditions

Sarno Functional Life Scale (SFLS)

Description: An objective measure that estimates an individual’s ability to participate in all of the basic activities customary to a human being. The five elements comprising the scale include: cognition, activities of daily living (ADL), activities inside the home, outside activities, and social interaction.

Format: 44 items designed to measure the five elements of performance on four qualities of performance (self-initiation, frequency, speed, and overall efficiency) that are ranked on a five point scale:

0 = Does not perform the activity at all
1 = Very poor
2 = Deficient
3 = Approaches normal
4 = Normal

Scoring: The scoring of the SFLS is a matter of finding the proportion of the patient’s scores with respect to his/her maximum score (see details below on where to obtain). Scores are obtained for each category and each quality of performance being measured.  The overall score obtained is the proportion of the patient’s total score in all five categories compared to his/her maximum possible total.

Administration and Burden: Interviewer-administered (Observational); Approximately 15-20 minutes.

Psychometrics for SCI: Not available.

Language(s):  English.

QoL Concept: The SFLS is a measure of Activities of Daily Living, which corresponds to Boxes B (societal standards and priorities) and C (achievements; activities of daily living) of Dijker’s Model.

Permissions/Where to Obtain: Public Domain; The SFLS and scoring information can be obtained from the article:

Sarno JE, Sarno MT, Levita E. The Functional Life Scale. Arch Phys Med Rehabil 1973;59:330-7.



Pressure Ulcer SCI Studies: One cross-sectional observational study:

  1. Sapountzi-Krepia D, Soumilas A, Papadakis N, Sapkas G, Nomicos J, Theodossopoulou E, Dimitriadou A. Post traumatic paraplegics living in Athens: the impact of pressure sores and UTIs on everyday life activities. Spinal Cord 1998;36:432-7.

Sensitivity to Impact: Sapountzi-Krepia and colleagues (1998) used the Sarno Life Function Scale (SFLS) (excluding the cognition sub-scale) to assess the impact of pressure ulcers in a sample of community-dwelling persons with paraplegia in Athens (N = 98). Significant associations between the SFLS everyday life activities and social relations sub-scores with the presence of pressure ulcers were detected.

Suggestions for Use: Although the SFLS everyday life activities and social relations sub-scores with the presence of pressure ulcers, the use of the SFLS is extremely limited in persons with spinal cord injury (SCI), and has not been validated for this population. As well, the SFLS appears to be closer to that of a functional status measure that is generic in nature despite having items that assess social relations and everyday life activities, which arguably could be used to assess participation/community integration from an objective ‘societal’ viewpoint.  Further work validating this measure for use in SCI is recommended.

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