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Outcome measures are standardized assessment tools used to quantify a patient’s functional status and track progress over time. StrataEMR includes a library of outcome measures with automatic scoring built in, so you don’t have to calculate results manually.

How Outcome Measures Work in StrataEMR

Each outcome measure is a standalone clinical document. You access them the same way you access other clinical templates, through the document dropdown on the Clinical Documents page. When you complete an outcome measure, StrataEMR automatically calculates the score based on your entries. This score is saved with the document and can be referenced in evaluations, progress notes, and discharge summaries.
Outcome measures cannot be embedded directly inside evaluation or progress note templates. This is because each measure runs its own scoring calculation. To include results in another document, complete the outcome measure in a separate browser tab, then copy the score into your eval or progress note manually.

Complete an Outcome Measure

  1. Open the patient’s chart and navigate to the Clinical Documents page.
  2. Select the Outcome Measures family.
  3. Select the outcome measure you want to complete from the dropdown.
  4. Answer each question in the form. StrataEMR calculates the score automatically at the end.
  5. Click Complete to save the document.
Use two browser tabs for efficiency. Open the outcome measure in one tab and your evaluation or progress note in another. Complete the measure, copy the score, and paste it into the corresponding field in your note without losing your place in either document.

Track Progress Over Time

Once you’ve completed an outcome measure, subsequent scores are recorded each time you complete a new instance of the same measure. Your document templates can include an outcome measure tracking table that displays scores visit-to-visit, giving you and your clinical team a quick view of patient progress. You can also send outcome measures to patients before their visit using the Patient Intake workflow. This allows patients to complete the form electronically, and their responses are saved directly in StrataEMR when submitted.

Available Outcome Measures

The following measures are available in StrataEMR with full automatic scoring:
  • Berg Balance Scale
  • Dizziness Handicap Inventory (DHI)
  • Foot Function Index
  • Functional Abilities Confidence Scale
  • Harris Hip Score
  • Knee Outcome Survey
  • Lysholm Knee Scoring Scale
  • Neck Disability Index (NDI)
  • OPTIMAL Data Collection Instrument
  • Oswestry Low Back Disability (Modified)
  • Penn Shoulder Score
  • Resumption of ADL Scale
  • Shoulder Pain and Disability Index
  • Simple Shoulder Test
  • Tinetti Assessment Tool
  • Upper Extremity Functional Scale
Some measures are unavailable due to copyright restrictions. The Lower Extremity Functional Scale (LEFS) and Quick DASH are examples of measures that cannot be added to StrataEMR without additional licensing. If a measure you need is not in the system, you can submit a feature request through the feedback portal.

What Each Score Means

Use this section as a quick reference for what each outcome measure captures, how StrataEMR scores it, and which direction a score needs to move to reflect improvement. The table below is for scanning; each measure has a full write-up underneath with more detail on how the score is calculated.

Berg Balance Scale

What it measures: Functional balance and fall risk, through 14 performance-based tasks the clinician observes - sitting to standing, standing unsupported, reaching forward, turning 360°, standing on one leg, and similar tasks. How it’s scored: You score each of the 14 tasks from 0–4 based on how the patient performs it. StrataEMR adds up all 14 scores for the total. Score format: Balance Score, 0–56. StrataEMR also shows a Deficit %, which reflects how far the score falls below the maximum possible score. Improvement: A higher Balance Score means better balance. A lower Deficit % means better balance.

Dizziness Handicap Inventory (DHI)

What it measures: How much a patient’s dizziness or unsteadiness affects their daily life, across three areas - Physical, Emotional, and Functional. How it’s scored: The patient answers 25 questions with Yes, Sometimes, or No. StrataEMR totals each of the three subscales, then converts each total into a percentage. Score format: Physical %, Emotional %, Functional %, and an Overall Disability %, each 0–100%. Improvement: A lower percentage means less handicap from dizziness. Watch for the percentage going down over time.

Foot Function Index

What it measures: Foot-related pain, difficulty with everyday tasks, and activity limitation, across three areas - Pain, Disability, and Activity Limitation. How it’s scored: The patient rates 23 items on a 1–10 scale. StrataEMR totals each subscale and converts it to a percentage. Score format: Pain %, Disability %, Activity Limitation %, and an Overall %, each 0–100%. Improvement: A lower percentage means less pain and difficulty with the foot. Watch for the percentage going down over time.

Functional Abilities Confidence Scale

What it measures: How confident a patient feels performing 15 everyday activities - sitting, standing, walking, stairs, transfers, reaching, lifting, and similar tasks, regardless of pain. How it’s scored: The patient rates their confidence in each activity from 0–100% in 10-point steps. StrataEMR averages all 15 ratings. Score format: Confidence Level, 0–100%, shown as a single average. Improvement: A higher percentage means more confidence in daily activities.

Harris Hip Score

What it measures: Hip pain and function after a hip condition or surgery, combining Pain, Function (gait and daily activities), Deformity, and Range of Motion. How it’s scored: You select the option that best describes the patient in each category. StrataEMR adds up the weighted points across all categories. Score format: Harris Hip Score, 0–100. StrataEMR also shows a Deficit %, which reflects how far the score falls below the maximum possible score. Improvement: A higher Harris Hip Score means better hip function. A lower Deficit % means better hip function.

Knee Outcome Survey

What it measures: Knee symptoms (pain, grinding, stiffness, swelling, slipping, buckling, weakness) and how the knee limits everyday activities like walking, stairs, standing, kneeling, and squatting. How it’s scored: The patient selects the statement that best describes them for each of 17 items. StrataEMR totals the Symptoms and Function items separately, then converts each to a percentage. Score format: Symptom Disability %, Functional Disability with ADL %, and Overall Disability %, each 0–100%. Improvement: A lower percentage means less disability from the knee. Watch for the percentage going down over time.

Lysholm Knee Scoring Scale

What it measures: Knee function and stability across 8 areas - Limp, Cane/Crutch use, Locking, Giving Way, Pain, Swelling, Stair Climbing, and Squatting. How it’s scored: You select the option that best describes the patient in each of the 8 areas. StrataEMR adds the points from all 8 areas into one total. Score format: Total score, 0–100 (a raw number, not a percentage). Improvement: A higher score means better knee function.

Neck Disability Index (NDI)

What it measures: How neck pain affects 10 areas of daily life - pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. How it’s scored: The patient rates each of the 10 sections. If Driving doesn’t apply, they can mark it Not Applicable, and StrataEMR adjusts the scoring accordingly. StrataEMR converts the total to a percentage. Score format: Disability %, 0–100%. Improvement: A lower percentage means less disability from neck pain. Watch for the percentage going down over time.

OPTIMAL Data Collection Instrument

What it measures: Broad functional Difficulty and Confidence across 21 mobility and activity tasks - lying down, rolling, sitting, squatting, bending, balancing, kneeling, walking, stairs, jumping, running, pushing, pulling, reaching, grasping, lifting, and carrying. It also collects demographic information for context, which isn’t scored. How it’s scored: The patient rates their difficulty and confidence with each task. StrataEMR adds up the ratings for Difficulty and Confidence separately. Score format: Functional Difficulty Score and Confidence Score, both raw totals (not percentages). The exact ceiling depends on how many items the patient answers, since items marked Not Applicable are excluded. Improvement: For both scores, a lower total means less difficulty and better confidence. Because these are raw totals rather than percentages, compare a patient’s score to their own prior visits rather than to another patient’s score.
Tip: Because the OPTIMAL’s Difficulty and Confidence scores aren’t normalized to a percentage, they’re best used to track one patient’s progress over time — not to compare scores between different patients.

Oswestry Low Back Disability (Modified)

What it measures: How low back pain affects 10 areas of daily life - pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, and employment/homemaking. How it’s scored: The patient rates each of the 10 sections. StrataEMR totals the ratings and converts the total to a percentage. Score format: Disability %, 0–100%. Improvement: A lower percentage means less disability from low back pain. Watch for the percentage going down over time.

Penn Shoulder Score

What it measures: Shoulder pain, patient satisfaction with shoulder function, and functional ability - covering Pain, Satisfaction, and 20 everyday shoulder activities like reaching, dressing, carrying, and overhead tasks. How it’s scored: The patient rates Pain, Satisfaction, and each Function item. StrataEMR totals each subscale and converts it to a percentage, then combines all three into an Overall Score. Score format: Pain Score %, Satisfaction Score %, Function Score %, and Overall Score %, each 0–100%.
Read the Pain Score in the opposite direction from the other three. A higher Pain Score % means more pain. A higher Satisfaction, Function, or Overall Score % means better outcomes. Don’t assume all four numbers move the same way, check which one you’re looking at before drawing a conclusion.
Improvement: Higher Satisfaction, Function, and Overall scores mean better outcomes. A lower Pain Score means less pain.

Resumption of ADL Scale

What it measures: How much a patient has resumed 12 usual activities since their injury - sleeping, sexual activity, self-care, household chores, shopping, socializing, traveling, recreation, and paid employment. How it’s scored: The patient rates how fully they’ve resumed each activity, from 0–100% in 10-point steps, or marks an activity Not Applicable if it doesn’t apply. StrataEMR averages the applicable ratings. Score format: ADL Resumption, 0–100%, shown as a single average. Improvement: A higher percentage means the patient has resumed more of their usual activities.

Shoulder Pain and Disability Index

What it measures: Shoulder pain severity and functional disability over the past week - pain with specific movements, and difficulty with tasks like washing, dressing, and carrying. How it’s scored: The patient rates 5 pain items and 8 disability items on a 0–10 scale. StrataEMR totals each subscale and converts it to a percentage, then combines both into an Overall Score. Score format: Pain Severity %, Functional Disability %, and Overall Score %, each 0–100%. Improvement: A lower percentage for Pain, Disability, and Overall means the patient is doing better. All three move in the same direction on this instrument.

Simple Shoulder Test

What it measures: Shoulder function across 12 yes/no questions - comfort at rest, sleep, reaching behind the back, overhead positioning, lifting and carrying various weights, throwing, and working full-time. How it’s scored: The patient answers Yes or No to each of the 12 questions. StrataEMR calculates the percentage of questions answered No. Score format: Functional Disability %, 0–100%.
This is the opposite of how the Simple Shoulder Test is usually reported. Most published references score the SST as the percentage of “Yes” answers, where a higher number means better shoulder function. StrataEMR instead displays the percentage of “No” answers as Functional Disability, where a higher number means worse function. Keep this in mind if you’re comparing a StrataEMR score to an outside reference or a score from another system.
Improvement: A lower Functional Disability % means better shoulder function.

Tinetti Assessment Tool

What it measures: Fall risk through clinician-observed Balance (9 items, like sitting balance, arising, and standing with eyes closed) and Gait (7 items, like step length, path, and trunk stability). How it’s scored: You score each item based on the patient’s performance. StrataEMR totals the Balance and Gait items separately, then adds them together for an Overall Score. Score format: Balance Score (0–16), Gait Score (0–12), and Overall Score (0–28) - all raw totals, not percentages. Improvement: A higher score, in any of the three, means better balance and gait, and lower fall risk.

Upper Extremity Functional Scale

What it measures: Difficulty performing 8 everyday upper-extremity tasks - sleeping, writing, opening jars, picking up small objects, driving, opening a door, carrying, and washing dishes. How it’s scored: The patient rates each task from 0 (no problem) to 10 (major problem, can’t do at all). StrataEMR totals the ratings and converts the total to a percentage. Score format: Functional Difficulty %, 0–100%. Improvement: A lower percentage means less difficulty with upper-extremity tasks. Watch for the percentage going down over time.

Pediatric Assessments

StrataEMR supports a number of pediatric assessments with meta-commentary scoring - meaning the system documents the resulting score and relevant notes rather than running a full interactive calculation. These include tools such as the PDMS, BOT-2, PLS-5, and others commonly used in pediatric PT, OT, and SLP settings. If you use pediatric assessments and do not see the form you need, submit a request through the feedback portal.

Request a Missing Outcome Measure

If you need an outcome measure that is not currently in StrataEMR, submit a feature request to the support team. The team reviews copyright clearance and implementation effort for each request. You can submit requests directly from within StrataEMR using the feedback option in the navigation bar.