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Lower Extremity Function Scale LEFS Patient Name Date Current Score Last Score Therapist Clinic We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity. Today do you or would you have any difficulty at all with circle one number on each line Activities a* b. c* d. e. f* g. h. i. j. k. l* m* n* o. p* q. r. s. t. 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 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 Making sharp turns while running fast Hopping Rolling over in bed Extreme Difficulty or Unable to Perform Activity Quite a Bit of Moderate A little Bit of No Column Totals Over the past 24 hours how bad has your pain been 3/8/01. Today do you or would you have any difficulty at all with circle one number on each line Activities a* b. c* d. e. f* g. h. i. j. k. l* m* n* o. p* q. r. s. t. 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 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 Making sharp turns while running fast Hopping Rolling over in bed Extreme Difficulty or Unable to Perform Activity Quite a Bit of Moderate A little Bit of No Column Totals Over the past 24 hours how bad has your pain been 3/8/01.

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