The Lower Extremity Functional Scale asks how hard 20 everyday activities are because of a hip, knee, ankle, or foot problem. Each scores 0 to 4, and the total, from 0 to 80, measures lower limb function: higher is better, and a change of 9 points is real. See how to read a score, work out percent of maximal function, set goals in LEFS points, and record the result with the free template.
LEFS result template
FreeLEFS RESULT Date: [Date] Patient: [Name or ID, age] Visit: [Initial evaluation, re-assessment, progress report, or discharge] Form: [Official LEFS form and language; completed alone, with help, or read aloud] LOWER LIMB PROBLEM Condition: [Diagnosis or injury, and any surgery with its date] Side: [Left, right, or both] Time since onset or surgery: [Weeks] Work, sport, or daily role: [What the patient needs the limb for] SCORE TODAY LEFS: [Total out of 80; all 20 items answered, or how many were blank] Percent of maximal function: [Total divided by 80, as a percent] Reading: [Severe, moderate, mild, or minimal limitation] Hardest activities: [Where most points were lost, as the patient describes them] CHANGE Baseline: [Date and score] Change from baseline: [Points up or down; real change if 9 points or more] Since the last score: [Date, score, and points changed] GOALS Short-term: [Target score and the activity it stands for, with a date] Long-term: [Target score and the return to work, sport, or daily role, with a date] Status: [Met, on track, or not met, for each goal] PLAN Treatment: [Exercise, manual therapy, gait training, home program, or other] Next LEFS: [Date or visit number] Discharge or referral: [The criteria for discharge, or why the patient is referred back] Clinician: [Name, credentials]
Use it for
The patient completes the official form alone, rating how much difficulty their lower limb problem causes with each activity at present. It takes about 5 minutes.
Avoid: Filling it in for the patient from what you saw in the session. The LEFS records the patient’s own view of their function.
Each of the 20 activities scores from 0, extremely hard or not possible, to 4, no difficulty. Add them for a total from 0 to 80.
Avoid: Reading a falling score as progress. On the LEFS, higher is better.
The total shows how much the problem limits daily life; the item scores show where.
Avoid: Treating one score as exact. A single LEFS score carries an error of about 5 points either way.
Score it at the evaluation, every 2 to 4 weeks or at each progress report, and at discharge.
Write goals as a target score tied to an activity that matters to the patient, with a date.
Avoid: Discharging on the score alone when the patient can’t yet do the activity the goal stands for.
Each one follows the recording template. Use them to judge how much to write.
Outpatient physical therapy, progress report at visit 14
58-year-old school librarian. Right total knee replacement for osteoarthritis 10 weeks ago; first seen here at week 2. Back at work 3 days a week, where she is on her feet most of the day and shelves books from floor to head height.
LEFS 52 out of 80, all 20 items answered: 65% of maximal function, mild limitation. Most points lost on the demanding activities: a full flight of stairs without the rail, getting down to the floor, and walking more than about 20 minutes. Knee bends to 112° and straightens to 3° short of full. Walks without a cane.
Baseline 24 at week 2: 30%, moderate limitation. Up 28 points, three times the 9-point minimal clinically important difference: real, meaningful improvement. 41 at week 6, so up 11 since the last score.
Short-term, set at week 2: LEFS 40 and walking indoors without the cane by week 6. Met at week 6. Long-term: LEFS 65 and full shifts at work, with stairs foot over foot, by week 16. On track.
Twice weekly for 4 more weeks: quadriceps strengthening, step-ups and step-downs, floor transfers, and walking endurance, with the home program progressed. LEFS again at week 14. Discharge to the home program when she reaches 65 and works full shifts.
Sports physical therapy clinic, discharge visit 7 weeks after the injury
29-year-old woman who runs about 30 km (19 mi) a week, half of it on trails. Left lateral ankle sprain, grade II, from rolling the ankle on a descent 7 weeks ago; X-ray showed no fracture. First seen 1 week after the injury.
LEFS 76 out of 80, all 20 items answered: 95% of maximal function, minimal limitation. The only points lost are on the most demanding sport-level activities. Single-leg hop for distance 94% of the right side; single-leg balance with eyes closed 30 seconds on both sides; no giving way.
Baseline 58 at week 1: 73%, mild limitation. Up 18 points, twice the 9-point minimal clinically important difference. 70 at the week 4 re-assessment.
Short-term: walk without a limp and jog 10 minutes pain-free by week 4. Met. Long-term: LEFS 75 and back to 30 km a week, trails included, by week 8. Score met; running 20 km a week on roads, with trails starting this week.
Discharged to a home program: balance and hop drills 3 times a week, and trail distance built up over 3 weeks. Lace-up brace for trail runs for the rest of the season. She is near the top of the scale, so the return to trails rests on the hop and balance tests as well as the score. Come back if the ankle gives way or swells again.
On the LEFS, higher is better. On the QuickDASH, the WOMAC, and the Oswestry, higher is worse. Write “improved” only when the LEFS rises.
A rise of 4 or 5 points can be measurement error. Report 9 points or more as real change, and look at the trend across scores.
The developers set no severity bands. Read the total, the change from baseline, and the activities still lost, not only which quarter of the range it falls in.
A runner can score 76 and still not be ready to race. Near the top of the range, add hop, strength, and running tests.
The LEFS gives one score for the person. When both legs are affected, record both sides, and give the form once.
Reworded versions circulate online and aren’t validated. Use the official form and its translations, so scores compare across visits and clinics.
Vero Scribe records the LEFS result in your template from the session, with the patient’s consent, or from your dictation: the score and percent, the change from baseline, and the goals and plan. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
Each of the 20 activities scores from 0, extremely hard or not possible, to 4, no difficulty. Add them for a total from 0 to 80. Higher means better function. Check that every item is answered before the patient leaves.
Divide the total by 80 and multiply by 100. That gives percent of maximal function: a score of 52 is 65%, and a score of 24 is 30%. Some clinics also report percent limitation, which is 100 minus that figure; say which one you recorded.
The higher the score, the less the lower limb problem limits daily life. The developers set no official bands; a common descriptive reading is 0 to 20 severe, 21 to 40 moderate, 41 to 60 mild, and 61 to 80 minimal or no limitation. Healthy adults usually score in the high 70s, with a median of about 77 in one large study.
About 9 points. In the original study, both the minimal detectable change and the minimal clinically important difference were 9 points, and studies after joint replacement and ACL reconstruction found much the same. The error around a single score is about 5 points either way.
The LEFS covers the whole lower limb, so one form works for a hip, knee, ankle, or foot problem, and higher is better. The KOOS is knee-specific, with five subscales scored 0 to 100. The WOMAC is built for hip and knee osteoarthritis, with pain, stiffness, and function scores where higher is worse. Many clinics use the LEFS across all lower limb patients and a joint-specific measure alongside it.
Yes. The Upper Extremity Functional Index, from the same research group, uses the same format: 20 activities, scored 0 to 80, higher is better. Many clinics use the DASH or the shorter QuickDASH instead, scored 0 to 100, where higher means more disability.
The patient completes it themselves, in about 5 minutes, and no training is needed to give or score it. Physical therapists use it most, but any clinician can hand it out, score it, and read it alongside the exam.
Twenty everyday activities, from tasks around the home and getting around to higher-demand ones such as sport. The exact wording, with its translations, is on the official form from Mapi Research Trust’s ePROVIDE site. Use that form rather than a retyped copy, as altered versions aren’t validated.
The Shirley Ryan AbilityLab’s RehabMeasures database lists the LEFS as free to use, and the copyright is held by the American Physical Therapy Association. The official form and 19 translations are listed on Mapi Research Trust’s ePROVIDE site, with the conditions of use, after a free sign-up. Check them before using it in research, a publication, or software. The recording template on this page is free to copy or download.
Patient-reported measures of symptoms and function, scored as T-scores with 50 as the average: short forms, CATs, and the PROMIS-29.
Six basic self-care activities rated independent or dependent, scored 0 to 6, for function and care needs in older adults.
Eight independent living tasks, from shopping to finances, each scored 0 or 1: a total from 0, dependent, to 8, independent.
Eleven questions on arm, shoulder, and hand function over the past week, scored 0 to 100: the higher, the more disability.
Forty-two questions on one knee over the past week: five subscales, each scored 0 to 100, where 100 means no knee problems.
Where the baseline LEFS goes, with the exam, goals, and plan of care.
Measures beside baseline, goal status, and the case to continue.
The final LEFS, goals met, and the home program.
Evaluations, daily notes, and progress reports from the session.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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