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.

LEFS - INITIAL VISIT

Selected Value: 0
0 = NO PAIN, 10 = VERY SEVERE PAIN
EXTREME DIFFICULTY OR UNABLE TO PERFORM ACTIVITYQUITE A BIT OF DIFFICULTYMODERATE DIFFICULTYA LITTLE BIT OF DIFFICULTYNO DIFFICULTY
Any of your usual work, housework or school activities
Your usual hobbies, recreational 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

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