Lower Extremity Functional Scale Form PDF Details

When health professionals seek to understand the challenges faced by individuals with lower limb problems, the Lower Extremity Functional Scale (LEFS) form becomes a critical tool in their assessment toolkit. This form, designed to be filled out by patients, asks about difficulties encountered in daily activities due to lower limb issues. From basic tasks like getting out of the bath or walking between rooms, to more strenuous activities such as running on uneven ground or hopping, the LEFS covers a wide range of physical functions. Patients rate their difficulty level on a scale from 'Extreme Difficulty or Unable to Perform' to 'No Difficulty,' allowing healthcare providers to quantify and evaluate the impact of lower limb problems on patients' lives. The scoring, derived from patients' responses, ranges from 0 to 80 and offers a numeric representation of a patient’s functional status. This information is invaluable not only in diagnosing the extent of impairment but also in crafting a targeted treatment and rehabilitation plan to address the specific functional deficits identified through the form. Thus, the LEFS serves as both a diagnostic tool and a guide for patient care, emphasizing patient-reported outcomes to steer therapeutic strategies.

QuestionAnswer
Form NameLower Extremity Functional Scale Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslower extremity functional scale, lower limb functional scale, printable lefs form, lefs scale pdf

Form Preview Example

NAME ____________________________________ DATE ________________ PATIENT ID#_______________

Lower Extremity Functional Scale

We are interested in knowing whether you are having any difficulty with the activities listed below because of your lower limb problem for which you are currently seeking attention. Provide an answer for each activity.

 

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

(Circle one number on each line)

 

 

 

 

 

Extreme

 

 

 

 

 

 

 

 

Difficulty

Quite a

 

A Little

 

 

 

 

 

or Unable

Bit of

Moderate

Bit of

No

 

Activities

 

to Perform

Difficulty

Difficulty

Difficulty

Difficulty

 

 

Activity

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Any of your usual work, household, or

 

0

1

2

3

4

 

 

school activities.

 

 

 

 

 

 

 

b. Your usual hobbies, recreational or

0

1

2

3

4

 

 

sporting activities.

 

 

 

 

 

 

 

c.

Getting into or out of the bath.

 

0

1

2

3

4

 

 

 

 

 

 

 

 

 

 

d.

Walking between rooms.

0

1

2

3

4

 

 

 

 

 

 

 

 

 

e.

Putting on your shoes or socks.

 

0

1

2

3

4

 

 

 

 

 

 

 

 

 

 

f.

Squatting.

0

1

2

3

4

 

 

 

 

 

 

 

 

g. Lifting an object, like a bag of groceries

 

0

1

2

3

4

 

 

from the floor.

 

 

 

 

 

 

 

h. Performing light activities around your

0

1

2

3

4

 

 

home.

 

 

 

 

 

 

 

i.

Performing heavy activities around your

 

0

1

2

3

4

 

 

home.

 

 

 

 

 

 

 

j.

Getting into or out of a car.

0

1

2

3

4

 

 

 

 

 

 

 

 

 

k.

Walking 2 blocks.

 

0

1

2

3

4

 

 

 

 

 

 

 

 

 

 

l.

Walking a mile.

0

1

2

3

4

 

 

 

 

 

 

 

 

m. Going up or down 10 stairs (about 1 flight

 

0

1

2

3

4

 

 

of stairs).

 

 

 

 

 

 

 

n. Standing for 1 hour.

0

1

2

3

4

 

 

 

 

 

 

 

 

o. Sitting for 1 hour.

 

0

1

2

3

4

 

 

 

 

 

 

 

 

 

 

p. Running on even ground.

0

1

2

3

4

 

 

 

 

 

 

 

 

q. Running on uneven ground

 

0

1

2

3

4

 

 

 

 

 

 

 

 

 

 

r.

Making sharp turns while running fast

0

1

2

3

4

 

 

 

 

 

 

 

 

 

s.

Hopping

 

0

1

2

3

4

 

 

 

 

 

 

 

 

 

 

t.

Rolling over in bed

0

1

2

3

4

COLUMN TOTALS (for physical therapist use)

Score is the sum of all circled items. (range = 0-80)

SCORE: _/80

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