LEFS: complete lower extremity functional assessment
Complete LEFS guide — 20 items, 0–80 scale, score direction (higher=better), MCID of 9 points and comparison with KOOS and IKDC.
What is the LEFS?
The LEFS (Lower Extremity Functional Scale) was developed by Binkley et al. (1999) to measure lower extremity function in patients with orthopedic conditions of the hip, knee, ankle or foot. It comprises 20 items on a 0–4 Likert scale, with a total score of 0 to 80 points.
Unlike the IKDC and KOOS, the LEFS is more anatomically comprehensive — it assesses any lower extremity condition, not just the knee. And unlike the DASH and WOMAC, higher scores indicate better function.
Knee injuries (ACL, meniscus, chondropathy), hip conditions (arthroplasty, dysplasia), ankle (sprains, fractures), foot and any lower extremity musculoskeletal condition. MCID = 9 points.
The 20 LEFS items
| Item | Activity assessed |
|---|---|
| Q1 | Any of your usual work, housework, or school activities |
| Q2 | Your usual hobbies, recreational or sporting activities |
| Q3 | Getting into or out of the bath |
| Q4 | Walking between rooms |
| Q5 | Putting on your shoes or socks |
| Q6 | Squatting |
| Q7 | Lifting an object from the floor |
| Q8 | Performing light activities around your home |
| Q9 | Performing moderate activities around your home |
| Q10 | Performing heavy activities around your home |
| Q11 | Getting into or out of a car |
| Q12 | Walking 2 blocks |
| Q13 | Walking a mile |
| Q14 | Going up or down 1 flight of stairs |
| Q15 | Standing for 1 hour |
| Q16 | Sitting for 1 hour |
| Q17 | Running on even ground |
| Q18 | Running on uneven ground |
| Q19 | Making sharp turns while running fast |
| Q20 | Jumping |
Calculate the LEFS for free
Apply the questionnaire online and get the score with exportable PDF.
Scoring formula
Total score: 0–80 | Higher = better function
No normalisation — unlike DASH and WOMAC
In the LEFS, a higher score = better function. Unlike the DASH (0=best) and similar to the KOOS (100=best, after transformation). Pay attention when comparing with other instruments.
Interpretation and clinical bands
| Score (0–80) | Classification | Interpretation |
|---|---|---|
| 64–80 | Good function | Lower extremity function well preserved. Minimal limitation. |
| 44–63 | Moderate limitation | Moderate difficulty with some activities. Follow-up recommended. |
| 0–43 | Significant limitation | Significant functional limitation. Specialist evaluation indicated. |
The LEFS MCID is 9 points (Binkley et al., 1999). An improvement of less than 9 points, even if statistically significant, may not be perceived by the patient as clinically relevant.
Clinical application and comparison with KOOS/IKDC
| LEFS | KOOS | IKDC | |
|---|---|---|---|
| Items | 20 | 42 | 18 |
| Region | Lower extremity (all) | Knee | Knee |
| Maximum score | 80 pts | 100 per subscale | 100 |
| Direction | ↑ better | ↑ better | ↑ better |
| MCID | 9 pts | 8–15 pts | 10 pts |
| Best use | Any LE condition | Knee-specific | Knee-specific |
The LEFS is the ideal choice when assessing a condition that may affect any segment of the lower extremity — such as post-hip surgery limiting walking — or when comparing patients with different anatomical conditions.
References
- 1. Binkley JM, Stratford PW, Lott SA, Riddle DL. “The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application.” Physical Therapy, 1999;79(4):371–83.
- 2. Stratford PW, Binkley JM, Stratford DM. “Development and initial validation of the upper extremity functional index.” Physiother Can, 2001;53(4):259–67.