The Lower Extremity Functional Scale

* Denotes mandatory field

Client Name

First Name *

Last Name *

Date of Birth *

We are seeking to assess the level of mobility difficulty you may be experiencing with the activities listed below.

Please indicate the conditions that apply to this outcome measure *

Walking barefootWalking with shoesWalking with orthosis (AFO/brace/splint brace)

Specify *

Mobility aid (stick, crutch, walker etc)

Specify *

Additional information

Please select the most accurate response for each of the following activities. If you have any questions regarding your response to an activity, please contact clinic@orthomotion.com.au

Today, do you or would you have any difficulty at all with:

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 around your home *

Getting into or out of a car *

Walking 2 blocks *

Walking a kilometre *

Going up or down 10 stairs (about 1 flight of stairs) *

Standing for 1 hour *

Sitting for 1 hour *

Running on even ground *

Running on uneven ground *

Making sharp turns while running fast *

Hopping *

Rolling over in bed *

Minimum Level of Detectable Change (90% Confidence): 9 points

Lower Extremity Functional Score

Adapted from: Binkley, J., Stratford, P., Lott, S., Riddle, D., & The North American Orthopaedic Rehabilitation Research Network, The Lower Extremity Functional Scale: Scale development, measurement properties, and clinical application, Physical Therapy, 1999, 79, 4371-383