Primary Image

RehabMeasures Instrument

Continuous Scale Physical Functional Performance; Short Form: Continuous Scale Physical Functional Performance 10; Wheel Chair Users: Wheel Chair Physical Functional Performance

Last Updated

Purpose

The Continuous Scale-Physical Functional Performance assesses a person’s ability to perform a variety of functional activities by having them actually perform, and not simulate, those activities. Sixteen tasks are performed sequentially, progressing from easy to more difficult. These tasks contribute to a CS-PFP total score, but also to 5 separate domain scores including upper extremity strength, upper extremity flexibility, lower extremity strength, balance and coordination, and endurance.

Acronym CS-PFP; Short form: CS-PFP10; Wheel chair users: WC-PFP

Area of Assessment

Activities of Daily Living
Balance – Non-vestibular
Coordination
Functional Mobility
Gait
General Health
Strength
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Computer

Cost

Not Free

Actual Cost

$325.00

Cost Description

Cost of Training: CS-PFP10
$325/participant
$475/ set of pre-workshop materials
$1500 Data reduction software and license

Diagnosis/Conditions

  • Cardiac Dysfunction
  • Parkinson's Disease & Movement Disorders
  • Stroke Recovery

Key Descriptions

  • Original CS-PFP test battery validated in 1996 (Cress et al.)

    CS-PFP composed of 16 tasks requiring persons to perform various activities of daily living, including:

    Low difficulty
    1) Carrying a weighted pot
    2) Pouring water from a jug to a cup
    3) Donning/removing a jacket
    4) Placing and removing a sponge from a shelf

    Moderate difficulty
    1) Sweeping floor with broom and dustpan
    2) Door pull
    3) Transferring clothes from washer to dryer & dryer to basket
    4) Making a bed
    5) Vacuuming
    6) Placing a strap over shoe
    7) Picking up scarves from the floor

    High difficulty
    1) Carrying weighted bag up and down simulated bus stop
    2) Sitting and standing up from floor
    3) Climbing stairs
    4) Carrying groceries
    5) Six minute walk

    Tests are scored by time to completion and/or by weight carried or height reached.

    Raw scores are converted to percentage scores for each task: Adjusted score = [(observed score - lower limit) / (upper limit - lower limit)] * 100. The upper and lower limits used are from Cress et al, 1996 validation study and based on data from older adults, ages 65 to 85 years.

    The scores range from 0 to 100, with higher scores indicating better function.
  • CS-PFP10 is the short form that was developed in 2005 (Cress, Petrella, Moore, & Schenkman).

    The CS-PFP10 includes ten of the items from the CS-PFP including the following:
    1) Carrying a weighted pot
    2) Donning/removing a jacket
    3) Placing and removing a sponge from a shelf
    4) Transferring cloths
    5) Vacuuming
    6) Sweeping the floor
    7) Picking scarves off the floor
    8) Sitting and standing up from floor
    9) Climbing stairs
    10) Carrying groceries
    11) Six-minute walk
  • The WC-PFP was developed for wheelchair users in 2002 (Cress et al.).

    The WC-PFP retains some tasks from the original CS-PFP, removes others, and adds two tasks specific to manual wheelchair users.

    CS-PFP tasks included in the WC-PFP:
    1) Carrying a weighted pot
    2) Pouring water from a jug to a cup
    3) Donning/removing a jacket
    4) Placing and removing a sponge from a shelf
    5) Door pull
    6) Transferring clothes from washer to dryer & dryer to basket
    7) Placing a strap over shoe
    8) Picking up scarves from the floor
    9) Carrying groceries

    New Tasks included in the WC-PFP:
    1) Transfer from W/C to standard chair
    2) 6-minute wheel

    Tasks in the WC-PFP are divided across 4 domains:
    1) Upper body strength
    2) Upper body flexibility
    3) Balance and coordination
    4) Endurance

    The scoring uses the same ranges for older adults used by the CS-PFP.

Number of Items

16
Short form: 10

Equipment Required

  • Two counters of specific dimensions
  • Weights: 9 x 1-lb sandbags, 18 x 2-lb sandbags, 9 x 5-lb sandbags, 8 x 10-lb sandbags
  • Two pots
  • Masking tape
  • Digital scale capable of measuring kilograms and punds
  • Jug
  • Cup
  • Spring scale
  • Men’s light-weight broad cloth jackets in sizes S, M, L, XL, 3XL
  • Lab jacket in sizes S(38), M(42), L(46), XL(50), 3XL(58)
  • Surface that is seat to waist height
  • 4 scarves
  • Footstool
  • Stadiometer
  • Sponge
  • Tile floor area
  • 1 short handled home size dustpan
  • (Modification for pts post-hip fracture) long handled dustpan
  • 1 broom with synthetic fibers
  • Kitty Litter
  • Measuring cup
  • Plastic shoe box to store kitty litter
  • 6 articles adult size clothing weighing ~4lb dry (no towels, robes, sheets)
  • Web netting/tube socks to cover vinyl sand bags
  • Laundry Basket
  • Washer machine (top loading)(specific dimensions)
  • Dryer (front loading; hinge on right)(specific dimensions)
  • Counter to right of dryer (90 cm from floor)
  • 2 sturdy chairs with rubber stoppers on legs (specific dimensions)
  • Exercise Mat
  • Vacuum
  • Bed (specific dimensions)
  • 52.3 m of clear path that includes 4 steps, and passage through a door, and ends at a counter
  • 3- or 4- step platform with hand rails (specific dimensions) or nine to eleven steps with handrail
  • Kitchen counter/folding table (specific dimensions)
  • Grocery items of varied volume and weight
  • 2 large tote bags & 2 medium tote bags
  • 2 x 12-inch cones
  • Metric measuring wheel
  • Gait belt
  • Body weight scale
  • Drinking water and orange juice (as needed)
  • Tape, pens, sharpies, clipboard, stopwatch, PFP-10 datasheet, PFP-10 data management software, Borg RPE Scale
  • Utility cart (to transport supplies if needed)
  • Wheelchair (if needed)

Time to Administer

30-75 minutes

CS-PFP: 40 - 75 minutes
CS-PFP10: At least 30 minutes

Required Training

Training Course

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Terry Ellis, PT, PhD, NCS; Laura Savella sPT; & the PD Edge Task Force of the Neurology Section of the APTA.

Body Part

Upper Extremity
Lower Extremity

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
General Health
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

R

R

R

LS/UR

LS/UR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

Yes

Not reported

Considerations

Psychometric properties for the CS-PFP were tested on populations of patients in H&Y Stages 1-3. No studies have tested its validity and reliability in H&Y stages 4 and 5.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Stroke

back to Populations

Construct Validity

Post-stroke:

(Manns et al, 2009; = 10 stroke survivors with hemiparesis; mean age = 54(10) time since stroke = 7.5(8.3) years; = 10 age and sex matched controls; mean age = 54(11))

  • Convergent validity of CS-PFP10 total score with:
    • VO2 peak: Excellent (r = 0.755)
    • Impairment (CMSA aggregate scores): Excellent (r = 0.667)

Floor/Ceiling Effects

Stroke survivors:

(Manns et al, 2009)

  • Short form CS-PFP10 No floor effects

Wheelchair Usage

back to Populations

Normative Data

Manual Wheelchair Users:

(Cress et al, 2002; = 18, mean age = 49.4(10.6); manual w/c users)

WC-PFP Descriptive Statistics: Mean Score (SD)

  • Upper Body Strength = 39.40(26.9)
  • Upper Body Flexibility = 43.34(19.2)
  • Balance &Coordination = 38.32(23.3)
  • Endurance = 41.36(30.1)
  • Total = 41.39(23.8)

Test/Retest Reliability

Manual Wheelchair users

(Cress et al, 2002)

WC-PFP: Test-Retest Reliability for Domain & Total Scores (= 13;mean age = 52.8(7.0)): Excellent

  • Upper Body Strength: (ICC = 0.95)
  • Upper Body Flexibility: (ICC = 0.87)
  • Balance &Coordination: (ICC = 0.88)
  • Endurance: (ICC = 0.96)
  • Total: (ICC = 0.96)

Internal Consistency

Manual Wheelchair users:

(Cress et al, 2002)

WC-PFP: Internal Consistency for Domain & Total Scores (n = 18)

  • Upper Body Strength: Excellent (Chronbach’s a = 0.85)
  • Upper Body Flexibility: Poor (Chronbach’s a = 0.58)
  • Balance &Coordination: Excellent (Chronbach’s a = 0.83)
  • Endurance: Excellent (Chronbach’s a = 0.90)
  • Total: Excellent (Chronbach’s a = 0.93)

Construct Validity

Manual Wheelchair Users:

(Cress et al, 2002)

  • No significant correlations between WC-PFP domain and total scores and Sickness Impact Profile (SIP) domain and total scores
  • This may be due to the amount of questions on the SIP related to ambulation

Floor/Ceiling Effects

Manual Wheelchair Users: WC-PFP

(Cress et al, 2002)

  • No floor or ceiling effects

Older Adults and Geriatric Care

back to Populations

Normative Data

Older adults

(Hearty et al 2007; CS-PFP Total score and domain scores of Non-disabled (ND) adults and adults with Parkinson’s disease (PD))

Age/Population

35-44 ND

45-54 ND

45-54 PD

55-64 ND

55-64 PD

65-74 ND

75-85 ND

N=

26

23

17

21

19

33

39

Total Score

73.9 (11.5)

70.9 (11.4)

60.5 (13.9)

63.2 (10.4)

56.0 (14.7)

58.7 (12.5)

48.2 (11.2)

UBS

74.7 (15.0)

73.6 (14.2)

62.5 (12.5)

64.0 (13.3)

59.9 (17.5)

56.5 (13.2)

46.9 (9.8)

UBF

84.8 (7.1)

82.7 (6.6)

74.2 (11.5)

74.1 (14.1)

69.1 (15.1)

58.9 (14.4)

51.8 (12.9)

LBS

72.7 (15.9)

67.6 (13.4)

56.6 (13.8)

59.2 (13.3)

51.3 (16.7)

58.1 (14.2)

45.1 (13.3)

BALC

67.5 (11.9)

63.8 (12.8)

57.2 (16.1)

58.7 (12.0)

52.0 (14.2)

54.7 (14.9)

44.7 (13.3)

END

75.7 (10.1)

72.7 (12.3)

62.1 (15.5)

65.0 (10.5)

57.5 (15.0)

65.1 (15.7)

52.2 (14.3)

RPE

10.8 (1.6)

10.5

(1.6)

10.9 (1.4)

11.8 (1.3)

11.9 (1.4)

10.9 (1.8)

11.2 (1.8)

Test/Retest Reliability

Older adults:

(Cress et al, 1996; = 148 total; n = 39 long term are facility residents with some dependence, mean age = 84.65(6.17); = 31 long term care facility residence living Independently, mean age = 80.51(6.09); n = 48 community dwelling older adults, mean age = 72.29(5.17))

  • CS-PFP Test-retest reliability
    • Upper body strength (UBS) = 0.95
    • Upper body flexibility (UBF) = 0.85
    • Lower body strength (LBS) = 0.94
    • Balance and coordination (BALC) = 0.96
    • Endurance (END) = 0.93
    • CS-PFP Total = 0.97
    • The strength of the test-retest reliability data suggests this measure is adequate for individual decision making in all but upper body flexibility domain

(Cress et al 2005, = 31, mean age = 73.5(6.7); 100% community dwelling older adults)

  • CS-PFP10 Community based test-retest reliability: Excellent (r = 0.93 - 0.98) for domain and total scores

Interrater/Intrarater Reliability

Older adults:

(Cress et al, 1996)

  • Excellent Inter-rater reliability
    • Upper body strength = 0.92
    • Upper body flexibility = 0.97
    • Lower body strength = 0.98
    • Balance and coordination = 0.99
    • Endurance = 0.95
    • CS-PFP Total = 0.98

(Hearty et al, 2007)

  • = 37 adults with PD
    • Age group 45-54 years old, = 17, mean age (males) = 49.8(1.5), mean age (females) = 51.0(1.8); years with diagnosis = 4.3(3.5); H&Y score = 2.1(0.5)
    • Age group: 55-64 years old; = 19; mean age(males) = 60.8(2.1), mean age (females) = 60.2(1.9); years with diagnosis = 4.5(3.5); H&Y score = 2.1(0.2)
  • n = 70 non-disabled adults
    • Age group 35-44 years old, = 26, mean age (males) = 39.2(2.4), mean age (females) = 38.6(3.2);
    • Age group 45-54 years old, = 23, mean age (males) = 47.3(3.9), mean age (females) = 47.7(2.8)
    • Age group 55-64 years old, = 21, mean age (males) = 58.8(2.5), mean age (females) = 58.3(2.8)
  • = 72 non-disabled older adults
    • Age group 55-64 years old, = 33, mean age (males) = 72.5(1.2), mean age (females) = 69.6(2.6)
    • Age group 55-64 years old, = 39, mean age (males) = 78.7(3.1), mean age (females) = 78.3(2.8)
  • Excellent Inter-rater reliability: ICC = 0.97 - 0.99

Internal Consistency

Older adults:

(Cress et al, 1996)

  • Excellent for all but upper body flexibility
    • Upper body strength = 0.87
    • Upper body flexibility = 0.74
    • Lower body strength = 0.83
    • Balance and coordination = 0.91
    • Endurance = 0.86
    • CS-PFP total = 0.9

(Cress et al, 2005; prospective data: = 40; mean age = 77.2(6.4); 50% community dwellers)

  • Excellent for all but upper body flexibility
    • Upper body strength: a = 0.83
    • Upper body flexibility: a = 0.69
    • Lower body strength: a = 0.87
    • Balance and coordination: a = 0.90
    • Endurance: a = 0.91

Criterion Validity (Predictive/Concurrent)

Older adults:

(Cress et al, 2005)

Retrospective date : = 228 subjects total; mean age = 76(7.1): = 134 independent community dwellers, = 48 Independent residents in a congregate housing facility, = 45 Dependent residents in a congregate housing facility

  • Concurrent validity of CS-PFP and short form CS-PFP10:
  • Excellent
    • Upper body strength = 0.967
    • Upper body flexibility = 1.00
    • Lower body strength = 0.98
    • Balance and coordination = 0.97
    • Endurance = 0.98
    • Total score = 0.99

Prospective data : = 40; mean age = 77.2(6.4); 50% community dwellers

  • Concurrent validity of CS-PFP and short form CS-PFP 10:
  • Excellent
  • Pearson correlation coefficient domain scores CS-PFP and CS-PFP 10:
    • Upper body strength = 0.95
    • Upper body flexibility = 0.86
    • Lower body strength = 0.94
    • Balance and coordination = 0.95
    • Endurance = 0.93
    • Total score = 0.95

 

Older adults:

C-PFP10 administered in a lab verses community setting had excellent correlations (Cress et al 2005, n = 20; mean age = 69.3(7.1), community dwellers)

Construct Validity

Older Adults:

(Cress et al, 1996)

  • Convergent Validity of CS-PFP Total Score with:
    • SF-36 Total: Excellent (r = 0.75)
    • Sickness Impact Profile total: Adequate (r = -0.58)
  • Discriminate Validity: SF-36 Mental Health domain and SIP Mood domain have poor correlation (both, r = -0.15) with the CS-PFP; this is expected as the CS-PFP is not intended to address mental health or emotion

(Cress et al, 1997)

  • Convergent validity (by domain):
    • Upper body strength & isometric elbow flexion: at 90 degrees/s: Excellent (r = 0.63)
    • Upper body flexibility & shoulder flexion: Poor (r = 0.26)
    • Lower body strength & isokinetic knee extension at 60 degree/second: Excellent (r = 0.69)
    • Balance and coordination & step reaction time: Adequate (r = -0.57)
    • Endurance & maximal O2 consumption: Excellent (r = 0.65)

(Arnett et al, 2008; n=29 older adults; mean age = 76.2(6.2))

  • Convergent validity:
    • CS-PFP total and living status: Adequate (r = 0.52)
    • CS-PFP total and Age: Adequate (r = -0.50)

 

Nonagenarians:

(Frisard et al, 2007; n = 22 nonagenarians; mean age = 93(1)years and = 32 aged 60–74 years; mean age = 70(1) years)

  • Convergent validity of CS-PFP10 with: 
    • Physical activity level: Excellent (r = 0.68) for combined populations
    • Physical activity level: Excellent (r = 0.78) for nonagenarians
    • Physical activity level: Adequate (r = 0.52) for 60-74 year old group 
    • Total Energy Expenditure (adjusted by sex, fat free mass, and fat mass): Adequate (r = 0.35)

Floor/Ceiling Effects

Older adults:

(Cress et al, 1996)

  • No floor effects; No zeros scores on any domain

(Hearty et al 2007; No ceiling effects in middle-aged subjects)

  • CS-PFP designed so that a raw score outside of the range on one task does not result in ceiling or floor effects on domain or total scores
  • CS-PFP developed using participants ranging from frail to vigorous and healthy older adults

Responsiveness

Older adults:

  • The CS-PFP (Cress et al, 1999, Brochu M et al, 2002) and CS-PFP10 (Cress et al, 2005) are more sensitive to change than the SF-36PF

Cress et al, 1997; Exercise Intervention in healthy elders; mean age = 73(5); Trained groups using endurance, strength, or combined: 60 min, 3x/week for 6 months.

  • CS-PFP sensitivity to change: Large effect sizes for change following exercise intervention

CS-PFP Total and Domains

Strength Training, = 9

Endurance Training, = 9

Combined training, n = 13

CS-PFP total

0.78

1.00

1.30

UBS

1.17

1.31

1.06

LBS

1.15

2.00

1.60

Endurance

0.39

0.60

0.93

Cress et al, 1999; n = 49 Community dwelling older adults; mean age 76(4); Control n = 26; Exercise group = 23

  • Exercise group showed significant improvement with large effect sizes for CS-PFP total and Upper body strength, lower body strength and endurance domains
    • CS-PFP Total score effect size = 0.80
    • Upper body strength ES = 0.94
    • Lower body strength ES = 0.74
    • Endurance ES = 0.64

Parkinson's Disease

back to Populations

Normative Data

Parkinson’s Disease:

(Schenkman et al, 2002; = 42; mean age = 63.7(11.5); mean H&Y Stage = 2.07(0.79); community dwelling people with Parkinson’s disease)

  • Normative Data
    • Upper body strength = 55.7(19.9)
    • Upper body flexibility = 54.7(16.8)
    • Lower body strength = 39.3(19.7)
    • Balance/coordination = 38.5(16.8)
    • Endurance = 44.1(18.4)
    • CS-PFP Total = 44.3(17.6)
  • Mean CS-PFP total score by PD H&Y stage
    • Stage 1, n = 13: 55.75(12.06)
    • Stage 2, n = 10: 50.90(13.18)
    • Stage 2.5, n = 8: 41.75(13.28)
    • Stage 3, n = 11: 25.36(12.68)

Test/Retest Reliability

Parkinson’s disease: CS-PFP

(Schenkman et al, 2002: Excellent (Kappa = -0.95))

Construct Validity

Parkinson’s disease:

(Schenkman et al, 2002)

  • Convergent validity of CS-PFP Total score with:
    • UPDRS: Excellent (r = -0.62)
    • Northwestern University Disability Scale: Adequate (r = 0.43)
    • Functional reach: Excellent (r = 0.70)
    • TUG: Excellent (r = -0.69)
    • 360 turn (steps): Adequate (r = -0.54)
    • 360 (time): Adequate (r = -0.53)

Responsiveness

Parkinson’s Disease:

(Schenkman et al, 2012 indicates that the CS-PFP is responsive to an exercise program consisting of functional and flexibility training)

  • At 4 months post-intervention, the flexibility and functional training intervention group improved more than the control group on the CS-PFP (mean difference 4.3, [1.2-7.3 95%CI]) and the Aerobic exercise group (mean difference 3.1, [0-6.2 95% CI]). The aerobic conditioning group did not improve more than the control group (mean difference 1.2, [-2.0-4.3 95%CI]).

(Schenkman et al, 2011)

  • CS-PFP was able to detect differences from age appropriate norms in participants in the earliest stage of PD, unlike other measures

Chronic Pain

back to Populations

Test/Retest Reliability

Fibromyalgia:CS-PFP

(Panton et al, 2006; n = 29 women with FM, mean age = 46(7), FM duration 8(6) years)

  • Excellent (r = 0.90)

Non-Specific Patient Population

back to Populations

Construct Validity

Chronic Heart failure:

(Savage et al, 2011; = 10 subjects with chronic heart failure, mean age = 73.4(2.4); = 11 control group; mean age = 72.1(2.1))

  • Convergent validity of CS-PFP10 with:
    • Peak VO2: Excellent (r = 0.78)
    • Composite 1RM (7 exercises): Excellent (r = 0.64)
    • Mental component score (MPS SF-36): Adequate (r = 0.44)
    • Ejection fraction: Adequate (r = 0.38)

(Brochu et al, 2002; = 30 women with CHD > 6 month divided into 2 groups: n = 13 Resistance exercise group (3x / week for 6 months), mean age = 70.5(4.0); = 12 control group (3x/week for 30-40 min for 6 months: yoga, breathing, stretching, calisthenics); mean age = 70.7(5.3))

  • Convergent validity of the CS-PFP with:
    • Hand-grip strength: Excellent (r = 0.67)
    •  Peak VO2: Adequate (r = 0.59)
  • Discriminate validity of the CS-PFP with:
    • SF-36: Poor (r = 0.24) indicating the two assess different concepts

Face Validity

Excellent

  • CS-PFP is a measure of functional performance with activities of daily living and each of its individual components actually tests these activities of daily living.
  • The 5 domain scores (upper body strength, upper body flexibility, lower body strength, balance and coordination, and endurance) are all collections of tasks that appear to, at face value, represent those domains

Responsiveness

Chronic Heart Disease:

(Brochu et al, 2002)

  • Significant change in total CS-PFP score between exercise and control group (24% vs. 3%)
  • Changes in total CS-PFP physical performance score were correlated with changes in maximal strength for the bench press (r = 0.71, P = 0.001) and for leg extension (r = 0.53, P = 0.01)

Mixed Populations

back to Populations

Cut-Off Scores

Community Dwellers (Independent) & Congregate Care Facility Residents (Dependent & Independent)

(Cress et al, 2003; 3 groups: Community dwellers, Independent: n = 98, Mean age CD/I = 74(3); Congregate care facility residents, Independent: = 49 Mean age CCF/I = 79(6); Congregate care facility residents, Dependent: n = 45 Mean age CCF/D = 84(7); Well-educated Caucasians of middle and higher socioeconomic status)

  • CS-PFP Score? 57 units = independent, (All were living independently; 79% community dwellers, 21% congregate care facility residents)
  • CS-PFP score < 57 = not independent (57% living independently; 30% community dwellers, and the remaining 27% congregate care facility residents not reporting functional limitations)

(The maximum score is a 100 with higher scores indicating better function)

Bibliography

Arnett, S. W., Laity, J. H., et al. (2008). "Aerobic reserve and physical functional performance in older adults." Age Ageing 37(4): 384-389.   

Brochu, M., Savage, P., et al. (2002). "Effects of resistance training on physical function in older disabled women with coronary heart disease." J Appl Physiol (1985) 92(2): 672-678. 

Cress, M. E. (1997). "Quantifying physical functional performance in older adults." Muscle Nerve Suppl 5(S5): S17-20. 

Cress, M. E., Buchner, D. M., et al. (1996). "Continuous-scale physical functional performance in healthy older adults: a validation study." Arch Phys Med Rehabil 77(12): 1243-1250. 

Cress, M. E., Buchner, D. M., et al. (1999). "Exercise: effects on physical functional performance in independent older adults." J Gerontol A Biol Sci Med Sci 54(5): M242-248. 

Cress, M. E., Kinne, S., et al. (2002). "Physical functional performance in persons using a manual wheelchair." The Journal of orthopaedic and sports physical therapy 32(3): 104-113. 

Cress, M. E. and Meyer, M. (2003). "Maximal voluntary and functional performance levels needed for independence in adults aged 65 to 97 years." Phys Ther 83(1): 37-48. 

Cress, M. E., Petrella, J. K., et al. (2005). "Continuous-scale physical functional performance test: validity, reliability, and sensitivity of data for the short version." Phys Ther 85(4): 323-335. 

Frisard, M. I., Fabre, J. M., et al. (2007). "Physical activity level and physical functionality in nonagenarians compared to individuals aged 60-74 years." J Gerontol A Biol Sci Med Sci 62(7): 783-788. 

Hearty, T. M., Schenkman, M. L., et al. (2007). "Continuous scale physical functional performance test: appropriateness for middle-aged adults with and without Parkinson's disease." Journal of Neurologic Physical Therapy 31(2): 64. 

Manns, P. J., Tomczak, C. R., et al. (2009). "Use of the continuous scale physical functional performance test in stroke survivors." Archives of physical medicine and rehabilitation 90(3): 488-493. 

Panton, L. B., Kingsley, J. D., et al. (2006). "A comparison of physical functional performance and strength in women with fibromyalgia, age- and weight-matched controls, and older women who are healthy." Phys Ther 86(11): 1479-1488. 

Savage, P. A., Shaw, A. O., et al. (2011). "Effect of resistance training on physical disability in chronic heart failure." Med Sci Sports Exerc 43(8): 1379-1386. 

Schenkman, M., Cutson, T. M., et al. (2002). "Application of the continuous scale physical functional performance test to people with Parkinson disease." Journal of Neurologic Physical Therapy 26(3): 130-138. 

Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early- and middle-stage Parkinson disease." Phys Ther 91(9): 1339-1354. 

Schenkman, M., Hall, D., et al. (2008). "Endurance exercise training to improve economy of movement of people with Parkinson disease: three case reports." Phys Ther 88(1): 63-76. 

Schenkman, M., Hall, D. A., et al. (2012). "Exercise for people in early- or mid-stage Parkinson disease: a 16-month randomized controlled trial." Phys Ther 92(11): 1395-1410.