Lower Extremity Functional Scale

Please fill out the following scale form as accurately as possible and upload with your new client form. If you would prefer to download the PDF of this form, please click the button below and upload it on our New Client Form page.

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LEFS - INITIAL VISIT

Please rate your pain level with activity:

Selected Value: 0

0 = NO PAIN, 10 = VERY SEVERE PAIN

	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTY	NO DIFFICULTY
Any of your usual work, housework or school activities	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYAny of your usual work, housework or school activities EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYAny of your usual work, housework or school activities QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYAny of your usual work, housework or school activities MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYAny of your usual work, housework or school activities A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYAny of your usual work, housework or school activities NO DIFFICULTY
Your usual hobbies, recreational or sporting activities	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYYour usual hobbies, recreational or sporting activities EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYYour usual hobbies, recreational or sporting activities QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYYour usual hobbies, recreational or sporting activities MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYYour usual hobbies, recreational or sporting activities A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYYour usual hobbies, recreational or sporting activities NO DIFFICULTY
Getting into or out of the bath	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYGetting into or out of the bath EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYGetting into or out of the bath QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYGetting into or out of the bath MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYGetting into or out of the bath A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYGetting into or out of the bath NO DIFFICULTY
Walking between rooms	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYWalking between rooms EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYWalking between rooms QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYWalking between rooms MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYWalking between rooms A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYWalking between rooms NO DIFFICULTY
Putting on your shoes or socks	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYPutting on your shoes or socks EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYPutting on your shoes or socks QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYPutting on your shoes or socks MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYPutting on your shoes or socks A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYPutting on your shoes or socks NO DIFFICULTY
Squatting	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYSquatting EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYSquatting QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYSquatting MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYSquatting A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYSquatting NO DIFFICULTY
Lifting an object, like a bag of groceries from the floor	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYLifting an object, like a bag of groceries from the floor EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYLifting an object, like a bag of groceries from the floor QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYLifting an object, like a bag of groceries from the floor MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYLifting an object, like a bag of groceries from the floor A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYLifting an object, like a bag of groceries from the floor NO DIFFICULTY
Performing light activities around your home	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYPerforming light activities around your home EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYPerforming light activities around your home QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYPerforming light activities around your home MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYPerforming light activities around your home A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYPerforming light activities around your home NO DIFFICULTY
Performing heavy activities around your home	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYPerforming heavy activities around your home EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYPerforming heavy activities around your home QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYPerforming heavy activities around your home MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYPerforming heavy activities around your home A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYPerforming heavy activities around your home NO DIFFICULTY
Getting into or out of a car	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYGetting into or out of a car EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYGetting into or out of a car QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYGetting into or out of a car MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYGetting into or out of a car A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYGetting into or out of a car NO DIFFICULTY
Walking 2 blocks	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYWalking 2 blocks EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYWalking 2 blocks QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYWalking 2 blocks MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYWalking 2 blocks A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYWalking 2 blocks NO DIFFICULTY
Walking a mile	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYWalking a mile EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYWalking a mile QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYWalking a mile MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYWalking a mile A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYWalking a mile NO DIFFICULTY
Going up or down 10 stairs (about 1 flight of stairs)	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYGoing up or down 10 stairs (about 1 flight of stairs) EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYGoing up or down 10 stairs (about 1 flight of stairs) QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYGoing up or down 10 stairs (about 1 flight of stairs) MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYGoing up or down 10 stairs (about 1 flight of stairs) A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYGoing up or down 10 stairs (about 1 flight of stairs) NO DIFFICULTY
Standing for 1 hour	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYStanding for 1 hour EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYStanding for 1 hour QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYStanding for 1 hour MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYStanding for 1 hour A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYStanding for 1 hour NO DIFFICULTY
Sitting for 1 hour	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYSitting for 1 hour EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYSitting for 1 hour QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYSitting for 1 hour MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYSitting for 1 hour A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYSitting for 1 hour NO DIFFICULTY
Running on even ground	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYRunning on even ground EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYRunning on even ground QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYRunning on even ground MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYRunning on even ground A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYRunning on even ground NO DIFFICULTY
Running on uneven ground	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYRunning on uneven ground EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYRunning on uneven ground QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYRunning on uneven ground MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYRunning on uneven ground A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYRunning on uneven ground NO DIFFICULTY
Making sharp turns while running fast	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYMaking sharp turns while running fast EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYMaking sharp turns while running fast QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYMaking sharp turns while running fast MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYMaking sharp turns while running fast A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYMaking sharp turns while running fast NO DIFFICULTY
Hopping	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYHopping EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYHopping QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYHopping MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYHopping A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYHopping NO DIFFICULTY
Rolling over in bed	EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYRolling over in bed EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITY	QUITE A BIT OF DIFFICULTYRolling over in bed QUITE A BIT OF DIFFICULTY	MODERATE DIFFICULTYRolling over in bed MODERATE DIFFICULTY	A LITTLE BIT OF DIFFICULTYRolling over in bed A LITTLE BIT OF DIFFICULTY	NO DIFFICULTYRolling over in bed NO DIFFICULTY

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

Lower Extremity Functional Scale

LEFS - INITIAL VISIT

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