MOBL Physical Therapy
Menu
Home
How it works
Conditions Treated
About
Lower Extremity Functional Scale (LEFS)
The LEFS is a questionnaire containing 20 questions about a person's ability to perform everyday tasks. It is used by clinicians as a measure of patients' initial function, ongoing progress and outcome, as well as to set functional goals.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
INSTRUCTIONS - I am interested in knowing whether you are having any difficulty at all with the activities 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 at all with the following activities:
Any of your usual work or housework activities
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Your usual hobbies, recreational, or sporting activiteis
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Getting into or out of the bath
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Walking between rooms
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Putting on your shoes and socks
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Squatting
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Lifting an object, like a bag of groceries from the floor
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Performing light activities around your home
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Performing heavy activities around your home
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Getting into or out of a car
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Walking 2 blocks
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Walking a mile
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Going up or down 10 stairs (about 1 flight of stairs)
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Standing for 1 hour
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Sitting for 1 hour
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Running on even ground
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Running on uneven ground
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Making sharp turns while running fast
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Hopping
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Rolling over in bed
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Submit
