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Lower Extremity Functional Scale – Method and Interpretation

By Dr Arun Pal Singh

In this article
    • Method of Evaluating the Patient – the Questionnaire
    • Scoring and Interpretation
    • References
      • Related

Lower extremity functional scale is a test that consists of a questionnaire to evaluate the function of the lower limb in case of musculoskeletal condition or disorder. The test can be used to measure initial function, ongoing progress, and outcome.

The lower extremity functional scale was developed in 1999 by Binkley et al. when they were evaluating a group of patients with musculoskeletal disorders.

The areas of assessment include

  • Activities of daily living
  • Balance – non-vestibular coordnination
  • Functional mobility
  • Life participation
  • Occupational performance
  • Quality of life
  • Range of motion and strength.

The scale is used for measuring lower extremity function in a wide variety of disorders and treatments. It can also be used in cases of the stroke where lower limb functions are affected.

It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention.

The range of possible scores is 0-80, with 4 being the maximum score for each question.

Method of Evaluating the Patient – the Questionnaire

lower extremity functional scale
Lower extremity functional scale questionnaire

The patient is given a paper containing questions with an option to mark one of the following choices for each question.

The questionnaire contains 20 questions about a person’s ability to perform everyday tasks which include

  1. Any of your usual work, housework or school activities.
  2. Your usual hobbies, recreational or sporting activities.
  3. Getting into or out of the bath.
  4. Walking between rooms.
  5. Putting on your shoes or socks
  6. Squatting
  7. Lifting an object, like a bag of groceries from the floor.
  8. Performing heavy activities around your home
  9. Performing light activities around your home
  10. Getting into or out of a car
  11. Walking 2 blocks
  12. Walking a mile
  13. Going up or down 10 stairs (about 1 flight of stairs)
  14. Standing for 1 hour
  15. Sitting for 1 hour
  16. Running on even ground
  17. Running on uneven ground
  18. Making sharp turns while running fast
  19. Hopping
  20. Rolling over in bed

A sample questionnaire is provided in the image.

For each question, there are five possible answers with scores given accordingly

  • Extreme Difficulty or Unable to Perform Activity- Score Zero
  • Quite a Bit of Difficulty – Score 1
  • Moderate Difficulty- Score 2
  • A Little Bit of Difficulty- Score 3
  • No Difficulty- Score 4

Scoring and Interpretation

A total is calculated by adding the score for individual questions.

The maximum score is 80.

The score from the individual questionnaire is calculated as a percentage

A fully functional lower limb will have score 80 and thus in % the score would be

Lower Extremity Function Score: [80 / 80]X100 = 100.0 %

In another example, a patient having score 64 would have a score as follows

[64 / 80]X100 = 80%

Thus, the higher the score, the better is the patient activity.

The lower the score the greater the disability

When doing sequentially, a minimal detectable change of  9 scale points is considered significant

The  Test-retest reliability of the score has been found to be was 0.94.

The limitation of the scale is that it is not possible to assess the status of pre-disease physical function. Because the answers to the questions that pertain to past status are based on the recall and it brings in recall bias.

References

  • Binkley J M, Stratford P W, Lott S A, Riddle D L. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 1999; 79(4): 371–83.
  • Stratford P, Hart D, Binkley J, Kennedy D, Alcock G, Hanna S. Interpreting lower extremity functional status scores. Physiother Can 2005; (57): 154–62.

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Filed Under: Lower Limb

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

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