Lower Extremity Functional Scale Form – Fill Out and Use This PDF

The Lower Extremity Functional Scale Form is an important metric for determining the physical ability of an individual. It assesses different parts of the body including their hips, knees, and ankles to understand the full extent of movement available. Due to its comprehensive implementation and reported accuracy, medical practitioners worldwide rely on this evaluation tool when analyzing a person's conditions and providing care solutions. As such, it should be filled out thoroughly and accurately to ensure maximum benefit in potential assessments and treatments.

Lower Extremity Functional Scale Form PDF Details

Do you struggle with understanding the lower extremity functional scale (LEFS) form when assessing a patient's functional status? If so, this post is designed to help demystify the LEFS and explain how it can be used to accurately assess patients. This post will discuss how the LEFS measures physical function, what evidence supports its use in clinical practice, and provide helpful tips for completing the LEFS form. By reading on, clinicians of all backgrounds and levels of experience can learn more about this important tool for measuring patient health outcomes.

Question	Answer
Form Name	Lower Extremity Functional Scale Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	lower extremity functional scale, lower limb functional scale, printable lefs form, lefs scale pdf

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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
Activities			Activity
			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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Lower Extremity Functional Scale Form – Fill Out and Use This PDF

Lower Extremity Functional Scale Form PDF Details

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