FIST Scoring

The scoring criteria on the FIST are the same for each item.  The FIST was designed this way to make learning and using the scoring scale easy and to decrease the need to constantly refer to written directions when scoring each item.  The items are scored on a 5 point ordinal scale ranging from 0 to 4, with 0 representing the lowest ability and 4 representing normal ability. 

                0  Dependent

                1  Needs assistance

                2  Upper extremity support

                3  Verbal cues/increased time

                4  Independent

 Let's take a look at each point on the scale.       

0  Dependent:  Patient requires complete physical assistance to perform task successfully, patient is unable to complete task successfully even with physical assistance, or dependent

  • Without complete assistance, cannot complete the task successfully or safely

1  Physical Assistance:  Patient is unable to complete task successfully without physical assistance

  • Cannot complete the task safely or completely without physical assistance of the therapist
  • Documentation of level of physical assistance needed by the patient is also required for this score
    • minimal assistance or min A (25% or less effort provided by therapist)
    • moderate assistance or mod A (26-74% of the effort provided by the therapist)
    • maximal assistance or max A (75% or more of the effort provided by the therapist)

2  Upper Extremity Support:   If the patient requires the use of one or both of their upper extremities to support themselves or to maintain their balance during the performance of the task, they score a 2.  Items involving grasping or picking up items should be scored a 2 if the patient uses their upper extremity for support or balance, not as a score of how they pick up the item.  Items that involve a movement and require the patient return to the starting position should be scored a 2 if the patient requires the use of their hands for any part of the task.  You may prompt the patient to try again without using their hands to see if they are able to successfully complete the task without their hands.

  • Must use hands for successful completion of task or to maintain balance during task

3  Verbal Cues/ Increased Time:  A score of 3 indicates the patient required verbal cueing or an increased amount of time to complete the task.  Otherwise, their performance was complete and they successfully completed the task. If a patient is unsafe but can otherwise complete the task, and providing verbal cueing would improve safety (i.e.,"slow down"), the patient is scored as a 3.

  • Performance is normal but cues are needed or longer than normal time is needed

4  Independent: 4 is the highest score attainable for any individual item and represents performance that is normal.  It also accounts for speed and safety.

  • Reaction and performance you would expect as normal
  • Speed and safety also normal


Now you should be familiar with the scoring scale used for all the FIST items.

Next, the 14 FIST items

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