Table 2.
Modified Salisbury score completed by referring GP/physiotherapist and interface-clinician
| Please rate your assessment of the patient's current pain/problems: | ||
| 1. How do you rate the progress of the problem? | 2. How do you rate the pain that the patient is experiencing? | 3. How do you rate the distress that the patient is experiencing (psychosocial)? |
| Stable/improving (0) | No pain (0) | None (no worry) (0) |
| Slowly worsening (months) (1) | Occasional pain (1) | Mild (occasional worry) (1) |
| Worsening steadily (weeks) (2) | Frequent pain (2) | Moderate (frequently worried (2) |
| Rapidly worsening (days) (3) | Constant pain (night & day) (3) | Severe (constant distraction) (3) |
| 4. How do you rate the loss of physical function? | 5. How do you rate the patient's dependence on others? | 6. How do you rate the specific effect on the patient's ability to perform normal activities during the last week (ie social, housework, educational, recreational)? |
| 0-25% loss of function (0) | No dependence (0) | Not affected (0) |
| 26-50% loss of function (1) | Occasional help needed (1) | Coping but affected (1) |
| 51-75% loss of function (2) | Regular help needed (2) | Not coping some days (<3 days) (2) |
| 76-100% loss of function (3) | Substantial dependence (3) | Total incapacity (3) |