Lower Extremity Functional Scale (LEFS)
Original Editor - Emily Hanson
Top Contributors - Emily Hanson, Naomi O'Reilly, Kim Jackson, Evan Thomas, Nehal Shah, Admin, Disha Rupareliya, Vidya Acharya, Lucinda hampton, WikiSysop, Mandeepa Kumawat, Rishika Babburu and Shaimaa Eldib
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] like THR, TKR, OA of Hip etc. The scale is originally developed in English language and according to western culture.
The scale consist of 4 groups with 20 questions. The questions in these group focus on activities with increasing physical demands like questions from walking between rooms to running on uneven ground[2]. The scoring of this scale varies from 0 (extreme difficulty/unable to perform activity) to 4 (no difficulty). The total score can be obtained by summing the scores of the individual items. The maximum score of 80 indicates no functional limitations and the minimum score of 0 indicates extreme limitations.
Studies have shown that LEFS is a reliable tool in clinical practice to assess impact of the conditions on lower extremity functions[3]
Purpose[edit | edit source]
In patients undergoing Orthopedic /trauma surgery, due to pre-existing conditions, at times it becomes difficult to assess pre-disease physical function. This is because questionnaires pertaining to pre-disorder physical functions are affected by recall bias. This poses a challenge for the physicians to measure the treatment effects. If Normative data of PROMs are available, they pose as reference data for healthy population[4]
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]
Intended Population[edit | edit source]
The LEFS is intended for use with adults, with lower extremity conditions like Hip OA, THR, TKR, Trauma surgery for lower extremity etc.[1]
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]
Patients select an answer from the following scale for each activity listed:
- Extreme Difficulty or Unable to Perform Activity
- Quite a Bit of Difficulty
- Moderate Difficulty
- A Little Bit of Difficulty
- 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.
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. [6]
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]
- ↑ 1.0 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.
- ↑ Backes M, Dingemans SA, Schep NW, Bloemers FW, Van Dijkman B, Garssen FP, Haverlag R, Hoogendoorn JM, Joosse P, Mirck B, Postma V. Wound Infections Following Implant removal below the knee: the effect of antibiotic prophylaxis; the WIFI-trial, a multi-centre randomized controlled trial. BMC surgery. 2015 Dec;15:1-6.
- ↑ Mehta SP, Fulton A, Quach C, Thistle M, Toledo C, Evans NA. Measurement properties of the lower extremity functional scale: a systematic review. journal of orthopaedic & sports physical therapy. 2016 Mar;46(3):200-16.
- ↑ Aasheim T, Finsen V. The DASH and the QuickDASH instruments. Normative values in the general population in Norway. Journal of Hand Surgery (European Volume). 2014 Feb;39(2):140-4.
- ↑ Fillechaud. Scoring the LEFS. Available from: https://www.youtube.com/watch?v=4CDhRMZCWQ4 [last accessed 24/03/2015]
- ↑ 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.
