LEFS calculator — Lower Extremity Functional Scale
Twenty everyday and athletic activities, each rated 0 to 4, summed to a 0–80 function score for the hip, knee, ankle or foot. Higher is better — the reverse of DASH, ODI and NDI.
Twenty activities, each scored 0 (unable or extreme difficulty) to 4 (no difficulty). Pre-filled with a knee patient at the re-exam; tap a selected number again to clear it.
- 1Usual work, housework or school
- 2Usual hobbies or sport
- 3Bath — in and out
- 4Walking room to room
- 5Shoes and socks on
- 6Squatting
- 7Grocery-weight lift off the floor
- 8Light jobs around the house
- 9Heavy jobs around the house
- 10Car — in and out
- 11Short walk (a couple of blocks)
- 12Long walk (about a mile)
- 13One flight of stairs, up or down
- 14Standing for an hour
- 15Sitting for an hour
- 16Running on level ground
- 17Running on uneven ground
- 18Sharp turns at speed
- 19Hopping
- 20Rolling over in bed
LEFS score, 0–80 · higher = better
39 / 80
49% of the maximum. A single reading carries about ±5.3 points of error (90% CI), so the true score most likely sits between 34 and 44.
Healthy adults aged 40–64 had a median of 77 (middle half 64–80). This patient is 38 points short of it.
Change since the last form: +12 points — at or past the 9-point MDC and MCID: a real, meaningful gain.
Higher is better — the opposite of DASH
Most of the questionnaires in a PT chart count disability: on the DASH, the Oswestry and the NDI, a falling number is the goal. The LEFS counts function, so the number has to rise. Anyone who flips between a shoulder caseload and a knee caseload in one afternoon has written “improved” beside a score that moved the wrong way at least once.
Write the goal with an arrow that points up
A LEFS goal reads “increase from 27 to at least 36”, never “reduce”. Put the baseline, the target and the date straight into the plan of care so whoever covers the re-exam reads it the right way round.
One scale for hip, knee, ankle and foot
Binkley and colleagues built the LEFS for any lower-limb musculoskeletal problem, testing it on 107 patients referred to 12 outpatient physical therapy clinics. Test-retest reliability came out at R = .94. The activities climb in demand, from walking between rooms to running on uneven ground, so the same form follows a patient from the first week after a fracture to the return-to-sport block.
It answers “what can this leg do?”, not “how far does this joint bend?”. Pair it with the joint numbers: the hip, knee and ankle range-of-motion norms give the impairment, the LEFS gives the activity limit, and a payer reviewing the chart wants both.
How to score it
Hand over the official form at the evaluation and ask about today, not the worst day this month.
Rate each of the 20 activities 0 to 4: 0 for unable or extreme difficulty, 4 for no difficulty at all.
Add the twenty numbers. That sum, out of 80, is the score — no averaging and no conversion.
Repeat at the re-exam and at discharge, and judge the change against the 9-point line before calling it progress.
Blank items
This calculator scores complete forms only. The developers publish a procedure for a few missing answers; in the normative study below, forms with more than four blanks, or three within one domain, were excluded under it. If you need to score an incomplete form, use the official instructions rather than guessing a value.
Worked example: evaluation to re-exam
The calculator opens on this patient: a knee case who could not manage a flight of stairs or a floor-level lift at the evaluation. At the re-exam the low-demand items have caught up, but every running and hopping item is still zero — which is where the next block of the home program should aim.
| Visit | LEFS | % of max | What moved |
|---|---|---|---|
| Evaluation | 27 / 80 | 34% | Stairs and floor lifts the main complaints |
| Re-exam | 39 / 80 | 49% | Indoor walking, sitting and bed mobility at no difficulty; running and hopping still 0 |
| Change | +12 | line: 9 | Past the 9-point line, so the gain is real and clinically meaningful |
The 9-point line
In the development study a single LEFS reading carried about ±5.3 points of error, and both the minimal detectable change and the minimal clinically important difference came out at 9 points (90% confidence). A later multicentre cohort of 1,708 patients across 5 PT clinics put the minimum important difference at 9 to 16 points, depending on how large a change the patient reported feeling.
A five-point gain feels like progress in the room. On the LEFS it is still inside the noise.
So set re-exam goals at least nine points above baseline, and treat a smaller move as “not yet shown” rather than “no change”. Log the pain rating beside it: function up with pain flat is a good week; pain down with the LEFS flat is often a patient avoiding the hard items.
What healthy legs score
Eighty is the ceiling, not the norm. In a Dutch study of 1,014 adults with no lower-limb surgery in the past year, the median was 77, and it fell with age. Use the age band in the calculator to set a realistic discharge target.
| Healthy group | Median | Middle half (IQR) |
|---|---|---|
| All 1,014 | 77 | 63–80 |
| Age 18–39 | 80 | 75–80 |
| Age 40–64 | 77 | 64–80 |
| Age 65 and over | 66 | 52.5–78 |
| Women | 76 | 62–80 |
| Men | 78 | 64–80 |
1,014 Dutch hospital visitors and staff with no lower-limb surgery in the past year; Dingemans et al., 2017.
38% of those healthy adults scored the full 80. The scale tops out early, so a field athlete at 80 can still have a deficit the LEFS cannot see; that is the point to switch to performance testing.
Where it goes in the note
The score belongs in the objective section with its date and the previous value, and the change belongs in the assessment — the calculator’s Copy button produces that line. The SOAP note example shows where an outcome measure sits beside the measured findings.
Red flag — refer out
A questionnaire does not screen. Calf swelling and tenderness after surgery or a cast, night pain that does not ease with position, a hot swollen joint with fever, or a leg that will not take weight after a fall go to a physician whatever the LEFS says.
The LEFS was developed by Binkley, Stratford, Lott and Riddle (1999). Item wording is paraphrased here for reference; use the official form for clinical use and observe its licence.
Sources
- 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(4):371–383 — 107 patients, 12 outpatient PT clinics; test-retest R = .94; error ±5.3 points, MDC 9 and MCID 9 points (90% CI) · read 2026-10-18
- Dingemans SA, Kleipool SC, Mulders MAM, et al. Normative data for the lower extremity functional scale (LEFS). Acta Orthop. 2017;88(4):422–426 — full text (PMC5499335): 20 items scored 0–4, 80 = maximal function; healthy medians by age and sex, n = 1,014 · read 2026-10-18
- Abbott JH, Schmitt J. Minimum important differences for the patient-specific functional scale, 4 region-specific outcome measures, and the numeric pain rating scale. J Orthop Sports Phys Ther. 2014;44(8):560–564 — 1,708 patients, 5 PT clinics; LEFS minimum important difference 9 to 16 points (small to large change) · read 2026-10-18
Keep reading
Cervical range of motion norms
Normal cervical flexion, extension, rotation and side-bending in degrees.
Hip range of motion norms
Hip flexion, extension, abduction and rotation norms, and how to measure them.
Lumbar range of motion norms
Lumbar flexion, extension and lateral bending, plus the Schober alternative.
Occupational therapy vs physical therapy
What each treats, the degree each needs, pay, and how Medicare bills them apart.