Lower Extremity Functional Scale (LEFS) We are interested in knowing whether you are having any difficulty at all with 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: Name* First Last Date* Date Format: MM slash DD slash YYYY Any of your usual work, housework, or school activities.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyAny of your usual work, housework, or school activities.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyYour usual hobbies, recreational or sporting activities.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyGetting in or out of the bath.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyWalking between rooms.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyPutting on your shoes or socks.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultySquatting.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyLifting an object, like a bag of groceries from the floor.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyPerforming light activities around your home.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyPerforming heavy activities around your home.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyGetting in or out of a car.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyWalking 2 blocks.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyWalking a mile.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyGoing up or down 10 stairs (about 1 flight of stairs).*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyStanding for 1 hour.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyRunning on even ground.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyRunning on uneven ground.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyMaking sharp turns while running fast.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyHopping.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyRolling over in bed.*Extreme Difficulty or Unable to Perform ActivityQuite a Bit of DifficultyModerate DifficultyA Little Bit of DifficultyNo DifficultyCAPTCHA
