Lower Extremity Functional Scale

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* 1. Please type your name. Surname, First Name

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* 2. Who is your Physiotherapist?

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* 3. We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please rate your function from 0 (extreme difficulty or unable to perform activity) to 4 (no difficulty) and provide an answer for each activity.

Today, do you or would you have any difficulty at all with:

  0 Extreme Difficulty or Unable to Perform Activity 1 Quite a Bit of Difficulty 2 Moderate Difficulty 3 A Little Bit of Difficulty 4 No Difficulty
Any of your usual work, housework, or school activities.
Your usual hobbies, re creational or sporting activities.
Getting into or out of the bath.
Walking between rooms.
Putting on your shoes or socks.
Squatting.
Lifting an object, like a bag of groceries from the floor.
Performing light activities around your home.
Performing heavy activities around your home.
Getting into or out of a car.
Walking 2 blocks.
Walking a mile.
Going up or down 10 stairs (about 1 flight of stairs).
Standing for 1 hour.
Sitting for 1 hour.
Running on even ground.
Running on uneven ground.
Making sharp turns while running fast.
Hopping.
Rolling over in bed.

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* 4. Interpretation of scores (for office use only)

Total score: (add up the total scores) = _______           MDC (90% confidence) = 9 points                    SCORE RANGE = 0 (max disability) to 80 (no disability)

This questionnaire is taken from: Binkley et al (1999): The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. Physical Therapy. 79:371-383.

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