The Spine Function Index-10, or SFI-10, is a shortened whole-spine patient-reported outcome measure used to assess functional limitation related to spine problems. It was developed from the longer Spine Functional Index and is designed to support practical monitoring across neck, thoracic and low back presentations. Higher scores indicate greater functional limitation when using the common SFI scoring direction, but users should always confirm the scoring method attached to the version being used. The SFI-10 can support progress tracking, but it does not diagnose the cause of spinal pain or clear someone for work, training or sport on its own.
Spine symptoms can affect sitting, standing, walking, bending, lifting, turning, sleep, work, training, sport and confidence with movement.
Many spine outcome measures are region-specific, such as the Neck Disability Index for neck pain or the Oswestry Disability Index for low back pain. The Spine Functional Index, and its shortened version, the Spine Function Index-10 or SFI-10, were developed to provide a more practical way to assess function across the whole spine.
The SFI-10 may be useful for:
neck pain
mid-back or thoracic symptoms
low back pain
multi-region spine symptoms
general musculoskeletal spine presentations
rehabilitation progress tracking
return-to-work monitoring
return-to-training planning
whole-spine function monitoring
The SFI-10 was developed from the longer Spine Functional Index because brief whole-spine patient-reported outcome measures can be more practical while still supporting functional status measurement. Recent research has evaluated the SFI-10 in a large musculoskeletal spine population and reported that it demonstrated reliable, responsive and practical measurement properties.
Outcome measure: Spine Function Index-10
Abbreviation: SFI-10
Related measure: Spine Functional Index / SFI-25
Body region: Whole spine
Type: Patient-reported outcome measure
Number of items: 10
Main purpose: Assess spine-related functional limitation
Common use: Neck, thoracic, low back and whole-spine musculoskeletal presentations
Score direction: Confirm the version used; common SFI scoring uses higher scores to indicate greater functional limitation
Best used for: Baseline assessment, reassessment and functional progress tracking
Key limitation: SFI-10 does not diagnose the cause of spinal pain or determine return-to-activity readiness on its own
The SFI-10 is a shortened patient-reported outcome measure designed to assess function in people with spinal musculoskeletal disorders.
It was developed from the longer whole-spine SFI. The original SFI was developed because many spine PROMs focus on separate spinal regions, which limits their usefulness when symptoms involve more than one area of the spine.
The SFI-10 is designed to be:
brief
practical
whole-spine focused
suitable for neck, thoracic and low back presentations
useful for repeated progress tracking
The official ePROVIDE listing identifies the SFI-10 as a distributed instrument and links it to the original Spine Functional Index development and validation work.
The SFI-10 is used because spine symptoms can affect function across more than one spinal region.
A client may report:
neck pain with upper back stiffness
low back pain with thoracic restriction
pain during sitting and standing
difficulty bending or lifting
reduced walking tolerance
reduced confidence with training
difficulty returning to work duties
multi-region symptoms after injury
The SFI-10 can help professionals:
establish a baseline
quantify self-reported spine-related functional limitation
monitor change over time
support client education
guide goal-setting conversations
compare self-reported progress with physical testing
track whole-spine function when symptoms are not isolated to one region
improve progress reporting in Measurz
The SFI-10 should support assessment reasoning and monitoring. It should not be used as a stand-alone diagnostic, treatment or clearance tool.
The SFI-10 measures perceived functional limitation related to spinal symptoms.
It may provide insight into:
bending tolerance
lifting tolerance
sitting tolerance
standing tolerance
walking tolerance
movement confidence
daily function
work-related function
activity participation
spine-related disability
It does not directly measure:
spinal range of motion
strength
nerve function
disc status
tissue healing
imaging findings
pain mechanism
structural pathology
readiness to return to sport
readiness to return to work
The SFI-10 may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches
workplace health professionals
allied health support teams
movement assessment professionals
students learning outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
neck pain
thoracic or mid-back pain
low back pain
multi-region spine symptoms
recurrent spinal pain
persistent spinal symptoms
spine-related work limitations
reduced confidence with bending, lifting, sitting or standing
general spine-related functional limitation
A recent SFI-10 clinimetric study included a large general musculoskeletal spine population with neck, mid-back, low back and multi-site presentations, supporting its intended use as a whole-spine measure rather than a single-region tool.
Use the SFI-10 when you want to understand how a spinal problem affects the client’s overall function.
It may be useful at:
initial assessment
onboarding
reassessment
flare-up review
return-to-work monitoring
return-to-lifting planning
return-to-training planning
progress review
discharge or long-term follow-up
The SFI-10 may be especially useful when symptoms involve more than one spine region or when a whole-spine function measure is preferred over a region-specific tool.
Use caution when:
the client cannot complete the questionnaire independently
language or literacy affects responses
the wrong language version is used
many items are missing
the score is being used as a diagnosis
the score is being used as a pass/fail activity decision
the result is interpreted without physical assessment context
a region-specific measure may be more appropriate
The SFI-10 should not be used to:
diagnose the cause of spinal pain
confirm disc injury
confirm nerve involvement
determine tissue healing
identify the exact pain source
clear someone for work, training or sport
replace professional judgement
replace medical assessment where needed
SFI-10 questionnaire
Version-specific scoring guide
Measurz recording workflow
Client-reported symptom notes
Baseline and retest dates
Optional related physical tests, such as:
cervical range of motion
thoracic range of motion
lumbar range of motion
hip range of motion
lifting assessment
walking tolerance
sit-to-stand testing
trunk endurance
pain with repeated movement
work or training exposure notes
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your spine symptoms are affecting everyday activities. It does not diagnose the cause of symptoms, but it helps us monitor your function over time.”
The SFI-10 can be completed:
on paper
digitally
independently
verbally if assistance is needed
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
answer based on their current spine problem
consider the relevant spine area or whole-spine symptoms
rate each item honestly
answer every item where possible
ask for clarification if they do not understand an item
complete the same version at each retest
Record whether the SFI-10 was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and helps interpret change over time.
If assistance is needed:
explain instructions without leading the answer
avoid telling the client which score to choose
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
For best practice:
encourage completion of all 10 items
record any missing item
avoid comparing scores if missing-item handling differs between sessions
record whether the score was calculated from a complete or incomplete form
interpret incomplete scores cautiously
The SFI-10 includes 10 items.
The exact scoring direction should be confirmed using the version and scoring guide being used.
For Measurz recording, always document:
version used
item score range
total score
transformed score if used
direction of scoring
whether higher scores indicate more limitation or better function
Some existing MAT-style summaries describe the SFI-10 as scored on a scale where higher scores indicate greater functional limitation, but official version-specific scoring should be checked before publishing or comparing results.
Retest at meaningful points, such as:
baseline
after a rehabilitation block
after a flare-up
before return to lifting
before return to work
after a change in training load
after education or graded exposure
discharge or progress review
For consistency, record:
date
current pain behaviour
current work demands
current training exposure
sitting, standing and walking exposure
recent flare-ups
region involved: neck, thoracic, low back or multi-region
any major change in activity demands
The SFI-10 is a self-report questionnaire, so it does not create physical testing risk.
However, worsening responses may support further assessment where the client reports:
severe deterioration
worsening walking tolerance
major function loss
new neurological symptoms
red flag symptoms
major quality-of-life impact
The SFI-10 produces a score that reflects spine-related functional status.
Interpretation depends on the scoring direction of the version used.
For Measurz use, state the scoring direction every time.
A higher score may suggest:
greater spine-related functional limitation
more difficulty with daily activity
lower tolerance to bending, lifting, sitting, standing or walking
greater impact on work, training or participation
A lower score may suggest:
fewer reported activity limitations
better daily function
better tolerance of spine-related activity
less impact of symptoms on function
A higher score may suggest:
better reported spine function
less limitation
better tolerance of activity
A lower score may suggest:
greater functional limitation
more difficulty with daily tasks
An SFI-10 score does not prove:
the diagnosis
the pain source
structural damage
disc injury
nerve compression
readiness to return to work or sport
whether imaging is required
whether one intervention caused the change
Example wording:
“Your SFI-10 score shows how your spine symptoms are affecting your function. This does not tell us exactly what structure is causing symptoms, but it helps us track whether your daily function is improving over time.”
For general fitness clients, the SFI-10 may help show how spine symptoms affect:
walking
bending
lifting
sitting
standing
gym participation
household activity
Interpretation cautions:
recent exercise may influence answers
fear of bending or lifting may affect responses
symptoms from the hip, shoulder or leg may also influence function
For athletes, SFI-10 can track broad spine-related function, but it may not capture sport-specific demands fully.
Interpretation should also include:
sport-specific movement testing
lifting exposure
running or jumping exposure
workload changes
confidence with training
pain response to sport tasks
A favourable SFI-10 score should not be treated as sport clearance on its own.
For older adults, SFI-10 may help monitor how spine symptoms affect:
walking
standing
bending
transfers
daily household activity
participation
Interpretation cautions:
other health conditions may influence scores
balance, strength and endurance may affect function
walking limitation may not be caused only by spine symptoms
The SFI-10 is more commonly used in adult musculoskeletal spine contexts.
For youth clients, consider:
reading level
comprehension
school and sport demands
parent or guardian assistance
whether a youth-specific measure may be more appropriate
For neck pain, SFI-10 may provide whole-spine functional context.
However, if the main concern is neck-specific disability, consider pairing it with:
Neck Disability Index
cervical range of motion
headache notes where relevant
work or driving exposure
For low back pain, SFI-10 may help track overall functional limitation.
Consider pairing it with:
Oswestry Disability Index
Roland-Morris Disability Questionnaire
Quebec Back Pain Disability Scale
lifting or walking tolerance
work exposure
For multi-region symptoms, the SFI-10 may be especially practical because it is designed as a whole-spine measure.
Record:
regions involved
primary limiting region
symptom distribution
activity exposure
related physical findings
Meaningful change helps determine whether an SFI-10 score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on method used
MDC: the amount of change likely needed to exceed measurement error
SEM: estimated measurement error around a score
Responsiveness: ability of the questionnaire to detect change over time
The 2025 SFI-10 clinimetric study assessed test-retest reliability, responsiveness, construct validity and error scores including SEM and MDC90 in a general musculoskeletal spine population.
This means SFI-10 change interpretation is developing, but values should still be matched to:
version used
scoring direction
spine region involved
population
baseline score
follow-up timeframe
clinical setting
When interpreting SFI-10 change:
compare the score with baseline
use the same version at retest
check the scoring direction
consider whether change exceeds available MDC or meaningful change values
check which activities improved
check whether activity exposure has increased
compare with pain, function and physical assessment findings
avoid over-interpreting very small changes
Reported meaningful change values may vary by:
neck versus low back versus whole-spine presentation
acute versus persistent symptoms
baseline disability
language version
clinical setting
follow-up timeframe
scoring method
When no matching MCID, MDC or SEM value exists, interpretation should rely more heavily on:
baseline comparison
repeated measurement
client-reported change
activity exposure
related physical assessment findings
professional judgement
Broad universal SFI-10 normative values appear limited.
Evidence level: Level 3 — practical comparison guidance is recommended because broad published norms are not yet clearly established for routine use.
Use:
baseline comparison
retest comparison
region involved
item-level change
client goals
activity exposure
pain and symptom response
related physical assessment findings
Practical guidance:
Interpret the score according to the version’s scoring direction.
Repeated scores are usually more useful than one isolated score.
Compare only when the same version and scoring method are used.
Avoid using one SFI-10 score as a strict return-to-work or return-to-sport threshold.
Compare with region-specific measures when more detail is needed.
Comparison should consider:
age
work demands
activity level
spine region involved
symptom duration
language version
pain irritability
comorbidities
physical capacity
psychosocial context
The SFI-10 has emerging post-2020 evidence supporting its use as a practical whole-spine functional measure.
A 2024 development study reported that the SFI-10 was developed from the longer SFI-25 because a shorter version was recommended to improve structural validity and practicality.
A 2025 longitudinal clinimetric study of 1,317 spine musculoskeletal disorder clients assessed SFI-10 psychometric characteristics, including structural validity, criterion validity, internal consistency, floor and ceiling effects, test-retest reliability, responsiveness, construct validity and error scores. The authors concluded that SFI-10 demonstrated sound measurement properties in a general physiotherapy outpatient spine population, while recommending further investigation in more culturally diverse and broader clinical settings.
Reliability and validity are stronger when:
the correct SFI-10 version is used
the correct language version is used
all 10 items are completed
the scoring direction is documented
the same scoring method is repeated
retesting occurs at meaningful time points
results are interpreted alongside physical and functional assessment
Interpret cautiously when:
multiple items are missing
symptoms are not primarily spine-related
multiple non-spine body regions affect function
the score is used as a stand-alone diagnostic or clearance decision
the language version has limited validation evidence
region-specific detail is required
Common errors include:
treating SFI-10 as a diagnosis
using SFI-10 as return-to-work or return-to-sport clearance
not recording the version used
not recording scoring direction
confusing higher-is-worse and higher-is-better interpretations
not recording completion method
ignoring missing items
over-interpreting small changes
interpreting the score without activity exposure
failing to pair it with physical testing
Limitations include:
self-report can be influenced by mood, expectations and recent activity
scores do not identify the exact physical cause of symptoms
meaningful change evidence is still developing
broad normative values are limited
sport-specific performance may require additional testing
region-specific measures may be more appropriate for some presentations
high or low scores should not be used as clearance decisions
The SFI-10 may help professionals:
document baseline spine-related function
monitor whole-spine functional change
track function across neck, thoracic and low back symptoms
support return-to-work discussions
guide goal-setting conversations
monitor progress during rehabilitation or training modification
improve client education
strengthen Measurz reports
For fitness clients, SFI-10 can show whether spine symptoms are affecting bending, lifting, walking or gym participation.
For workplace clients, it can help track sitting, standing, lifting and general task tolerance.
For persistent spine symptoms, it can help monitor whether function is improving even if pain fluctuates.
For Measurz users, SFI-10 is most useful when combined with practical measures such as:
cervical range of motion
thoracic range of motion
lumbar range of motion
hip range of motion
trunk endurance
lifting tolerance
walking tolerance
sit-to-stand performance
pain score
confidence measures
work or training exposure
Record:
outcome measure name: Spine Function Index-10 / SFI-10
related measure if relevant: Spine Functional Index / SFI
version used
date completed
completion method: paper, digital, interview or assisted
language/version used
condition or presentation being tracked
spine region involved:
neck
thoracic
low back
multi-region
total score
score range used
direction of scoring:
higher score means greater limitation, or
higher score means better function
missing items, if any
assistance provided, if any
current pain score, if relevant
current symptoms
current sitting, standing, walking, bending and lifting tolerance
current work or training exposure
key functional limitations
confidence or participation goals
baseline comparison
MCID/MDC/SEM comparison where supported
item-level activities that improved or worsened
related physical assessment findings
interpretation notes
retest date
referral or further assessment notes where appropriate
Record whether the main limitation appears to be:
neck-related limitation
thoracic-related limitation
low back-related limitation
multi-region spine limitation
sitting limitation
standing or walking limitation
bending or lifting limitation
work or training limitation
mixed limitation
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
The SFI-10 measures self-reported functional limitation related to spine symptoms. It is designed as a brief whole-spine outcome measure.
The SFI-10 has 10 items.
No. The SFI-10 is intended as a whole-spine measure and may be used across neck, thoracic, low back and multi-region spine presentations.
Use the version-specific scoring guide. Record the total score, score range and scoring direction every time, because interpretation depends on whether the version is higher-is-worse or higher-is-better.
No. It measures functional impact. It does not diagnose the cause of pain or identify the tissue source of symptoms.
Meaningful change evidence is developing. A 2025 clinimetric study assessed error scores, SEM and MDC90, but interpretation should be matched to the version, population and setting.
Yes, it can support broad spine function monitoring, but it may not capture sport-specific performance fully. It should be paired with sport-specific testing and workload information.
It can be repeated at baseline, reassessment, after a rehabilitation phase, after a flare-up, during return-to-work or return-to-training planning, and at progress review.
The SFI-10 is a brief whole-spine patient-reported outcome measure.
It was developed from the longer Spine Functional Index.
It can be used across neck, thoracic, low back and multi-region spine presentations.
Scoring direction must be recorded clearly.
SFI-10 does not diagnose the cause of spine pain or clear a client for activity.
Recent evidence supports its reliability, responsiveness and practicality in musculoskeletal spine populations.
Broad norms are limited, so baseline comparison is usually most useful.
Measurz should record version, score range, scoring direction, region involved, completion method, missing items, activity exposure, baseline comparison and related physical findings.
Gabel, C. P., Cuesta-Vargas, A., Qian, M., & Melloh, M. (2013). The Spine Functional Index: Development and clinimetric validation of a new whole-spine functional outcome measure. The Spine Journal. https://doi.org/10.1016/j.spinee.2013.10.032
Mapi Research Trust. (2026). Spine Functional Index-10. ePROVIDE. https://eprovide.mapi-trust.org/instruments/spine-functional-index-10
Mokhtarinia, H. R., Cuesta-Vargas, A., Dibai-Filho, A. V., Melloh, M., Bejer, A., & Gabel, C. P. (2024). Developing a shortened Spine Functional Index (SFI-10) for patients with spine disorders. BMC Musculoskeletal Disorders, 25, Article 312. https://doi.org/10.1186/s12891-024-07352-x
Mokhtarinia, H. R., Cuesta-Vargas, A., Dibai-Filho, A. V., Melloh, M., Bejer, A., & Gabel, C. P. (2025). A shortened 10-item Spine Functional Index: Clinimetric properties indicate a reliable, responsive and practical measure. BMC Musculoskeletal Disorders, 26, Article 408. https://doi.org/10.1186/s12891-025-08604-0
