Lower Extremity Functional Scale (LEFS)

Background[edit | edit source]

The lower extremity functional scale (LEFS) is a valid patient-rated outcome measure (PROM) for the measurement of lower extremity function. It was first developed by Binkley et al. (1999) in a group of patients with various musculoskeletal conditions.[1] The scale is originally developed in English language and according to western culture.

Objective[edit | edit source]

The objective of the Lower Extremity Functional Scale (LEFS) is to measure "patients' initial function, ongoing progress, and outcome" for a wide range of lower-extremity conditions.[1][2][3]

Lower Extremity Functional Scale.png

Intended Population[edit | edit source]

The LEFS is intended for use with adults, with lower extremity conditions.[1][2]

Method of Use[edit | edit source]

The LEFS is a self-report questionnaire. Patients answer the question "Today, do you or would you have any difficulty at all with:" in regards to twenty different everyday activities.[1][2]

Patients select an answer from the following scale for each activity listed:

  1. Extreme Difficulty or Unable to Perform Activity
  2. Quite a Bit of Difficulty
  3. Moderate Difficulty
  4. A Little Bit of Difficulty
  5. No Difficulty

The patient's score is tallied at the bottom of the page. The maximum possible score is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function.

[4]

Evidence[edit | edit source]

Reliability[edit | edit source]

Internal reliability for the LEFS is excellent (α=0.96). Test-retest reliability estimates were R=.86 (95% lower limit CI=.80) for the entire sample (n=98) and R=.94 (95% lower limit CI=.89) for the subset of patients with more chronic conditions (n=31).[1]

Validity[edit | edit source]

The LEFS is a valid tool as compared to the SF-36.[1]

Responsiveness[edit | edit source]

The minimum detectable change (MDC) for the LEFS is 9 points. That is, a change of more than 9 points represents a true change in the patient's condition.[1]

The minimum clinically important difference (MCID) for the LEFS is 9 points. That is, "Clinicians can be reasonably confident that a change of greater than 9 points is... a clinically meaningful functional change."[1]

The capacity of the LEFS to detect change in lower-extremity function appears to be superior to that of the SF-36 physical function subscale, as indicated by higher correlations with an external prognostic rating of change.[1]

The LEFS has good measurement properties--namely test-retest reliability and cross-sectional construct validity--and it could be an alternative to WOMAC-PF. [5]

Miscellaneous[edit | edit source]

The LEFS has an error of +/- 5 points. That is, the tabulated score is within 5 points of a patient's "true" score.[1]

Adaptation in different countries[edit | edit source]

LEFS has been translated and adapted in different populations like, Italian, Canadian French, Dutch, Arabic, Brazilian Portugese, Malaysian, Finnish, Persian, Turkish, Taiwan, Chinese and Dutch translated and adapted version are also tested for validity and reliability.

Resources[edit | edit source]

Lower Extremity Functional Scale

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Binkley JM, Stratford PW, Lott SA, Riddle DL. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther 1999;79:371-383.
  2. 2.0 2.1 2.2 Rehabilitation Measures Database Lower Extremity Functional Scale http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1113 (accessed 24 Mar 2015).
  3. lower extremity functional scale https://www.researchgate.net/figure/Source-originale-Binkley-JM-Stratford-PW-Lott-SA-Riddle-DL-The-Lower-Extremity_fig1_221874838 (accessed on 29 August 2018)
  4. Fillechaud. Scoring the LEFS. Available from: https://www.youtube.com/watch?v=4CDhRMZCWQ4 [last accessed 24/03/2015]
  5. Pua YH, Cowan SM, Wrigley TV, Bennell KL. The lower extremity functional scale could be an alternative to the Western Ontario and McMaster universities osteoarthritis index physical function scale. Journal of clinical epidemiology. 2009 Oct 1;62(10):1103-11.