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Today, do you or would you have any difficulty at all with:
1. Any of your usual work, housework, or school activities.
11. Walking 2 blocks
2. Your usual hobbies, re creational or sporting activities.
12. Walking a mile.
3. Getting into or out of the bath.
13. Going up or down 10 stairs (about 1 flight of stairs).
4. Walking between rooms.
14. Standing for 1 hour.
5. Putting on your shoes or socks.
15. Sitting for 1 hour.
6. Squatting.
16. Running on even ground.
7. Lifting an object, like a bag of groceries from the floor.
17. Running on uneven ground.
8. Performing light activities around your home.
18. Making sharp turns while running fast.
9. Performing heavy activities around your home.
19. Hopping.
10. Getting into or out of a car.
20. Rolling over in bed
Subtotal (1 through 10)
Subtotal (11 through 20)
LEFS Comments:
LEFS Score (Total 1 through 20)
CLICK HERE FOR SCORING DIRECTIONS
Higher scores correlate with better function.
Minimum Level of Detectable Change (90% Confidence): 9 points

DrChrono Physical Therapy | FOS Lower Extremity Functional Index (LEFS) Medical Form

Physical Therapist

DrChrono's FOS lower extremity functional index form, customizable for your Physical Therapy practice.

There are 3 copies in use.
Published: Dec. 11, 2018, 6:22 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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Sunnyvale, CA 94089

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