What is the Le functional scale score and how is it used in rehabilitation?

Originally developed in 1999, the Lower Extremity Functional Scale (LEFS) is a widely used patient-reported outcome measure in physical therapy and orthopedics. What is the LE functional scale score? It is a numerical value, ranging from 0 to 80, that quantifies a patient's self-perceived ability to perform daily activities, with a higher score indicating less disability and better function.

Quick Summary

The LEFS score is derived from a 20-item questionnaire that gauges a patient's functional capacity following a lower extremity disorder. Clinicians utilize this assessment to track progress, set rehabilitation goals, and evaluate treatment effectiveness for injuries ranging from sprains to post-operative recovery.

Key Points

• Assessment of Function: The LE functional scale score is derived from the Lower Extremity Functional Scale (LEFS), a 20-item self-report questionnaire used to assess functional status in patients with lower limb disorders.

• Scoring Range: The total score ranges from 0 to 80, where a higher score signifies better function and less disability.

• Clinical Application: Clinicians, particularly physical therapists and orthopedic specialists, use the LEFS to establish a baseline, monitor progress, and evaluate the effectiveness of interventions like rehabilitation or surgery.

• Categorical Interpretation: Scores are often grouped into categories such as Minimal (61-80), Mild to Moderate (41-60), Moderate to Severe (21-40), and Severe (0-20) functional limitations.

• Meaningful Change: A change of at least 9 points on the LEFS is considered the Minimal Clinically Important Difference (MCID), indicating a significant improvement from the patient's perspective.

• Versatile Use: The scale is applicable to a wide variety of lower extremity conditions, including musculoskeletal injuries, osteoarthritis, and post-surgical recovery.

What is the Lower Extremity Functional Scale (LEFS)?

Often abbreviated as the LEFS, the Lower Extremity Functional Scale is a patient-reported outcome measure (PROM) designed to assess the functional status of a patient's lower limb. It is a self-administered questionnaire that asks patients to rate the difficulty they experience with 20 everyday activities due to their lower extremity condition. The scale provides a holistic view of how a musculoskeletal issue is impacting a patient's quality of life and is widely used across various clinical settings, including physical therapy and orthopedic clinics.

The Purpose of the LEFS

The LEFS serves several critical functions in clinical practice. It allows healthcare professionals to:

• Establish a baseline: The initial score helps determine the patient's starting level of function, providing a benchmark for comparison throughout the recovery process.
• Monitor progress: By administering the scale at regular intervals, clinicians can track changes in a patient's function over time, quantifying the effectiveness of an intervention.
• Set realistic goals: The scores help guide the development of functional and measurable rehabilitation goals for the patient.
• Provide an outcome measure: It provides objective data to evaluate the overall success of a treatment, such as physical therapy or surgery.

The Scoring System of the LEFS

The LEFS consists of 20 questions covering a broad range of functional activities, from walking and climbing stairs to running and hopping. Each item is scored on a five-point Likert scale, with the options corresponding to the following scores:

• 4 points: No difficulty
• 3 points: A little bit of difficulty
• 2 points: Moderate difficulty
• 1 point: Quite a bit of difficulty
• 0 points: Extreme difficulty or unable to perform activity

The total score is calculated by summing the scores of all 20 items. This results in a final score that can range from 0 to 80.

Interpreting the LE functional scale score

A higher LEFS score indicates better function and less disability. Conversely, a lower score signifies greater functional limitation. Interpreting the score goes beyond the raw number and involves categorizing the degree of a patient's limitation.

Score Ranges and Their Meaning

• 61–80: Minimal Functional Limitation: Generally considered normal or near-normal function. These patients may have minor issues that do not significantly impact their daily activities.
• 41–60: Mild to Moderate Functional Limitation: Patients in this range experience noticeable difficulty with some daily activities. They may require some assistance or modifications to perform certain tasks.
• 21–40: Moderate to Severe Functional Limitation: This indicates a significant impact on a patient's ability to perform routine activities. This group often requires substantial intervention and support.
• 0–20: Severe Functional Limitation: Represents a high degree of disability, where patients struggle to perform most activities and may be dependent on others for assistance.

Clinical Significance

In addition to the overall score, clinicians also look at the Minimal Detectable Change (MDC) and the Minimal Clinically Important Difference (MCID) of the LEFS. For the LEFS, the MDC is 10 points and the MCID is 9 points. The MDC is the smallest change in score that is not considered due to measurement error, while the MCID is the smallest change a patient perceives as meaningful. This means that for a patient's recovery to be considered clinically significant, their score should improve by at least 9 points.

Comparison with other functional assessments

While the LEFS is a valuable tool, it is important to understand how it compares to other functional scales. The choice of assessment tool can depend on the specific patient population and clinical goals.

Assessment Tool	Focus	Type of Assessment	Key Difference from LEFS	Best Suited For
Lower Extremity Functional Scale (LEFS)	General lower extremity function	Patient-reported outcome measure (PROM)	Covers a broad range of activities from basic to high-level.	Wide range of lower extremity musculoskeletal disorders, including orthopedic injuries, osteoarthritis, and post-surgery.
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)	Pain, stiffness, and physical function related to hip and knee osteoarthritis	Patient-reported outcome measure	Highly specific to osteoarthritis symptoms and function.	Patients with osteoarthritis of the hip or knee.
Foot Function Index (FFI)	Pain, disability, and activity restriction specifically for the foot	Patient-reported outcome measure	Focuses exclusively on foot-related issues.	Foot-related conditions like plantar fasciitis or deformities.
Timed Up and Go (TUG) Test	Mobility, balance, and fall risk	Performance-based measure	Involves direct observation of a timed functional task, not patient self-report.	Fall risk assessment, especially in elderly populations.

The process of completing the LEFS questionnaire

1. Patient Instruction: The patient receives the 20-item questionnaire. They are instructed to reflect on their lower limb problem over the past week.
2. Self-Reported Responses: For each activity, the patient chooses the option that best describes their level of difficulty, from “Extreme Difficulty or Unable” to “No Difficulty”.
3. Calculation of Score: A healthcare professional, such as a physical therapist, sums the points from all 20 responses to obtain the total score out of 80.
4. Clinical Evaluation: The clinician interprets the score within the context of the patient's condition, goals, and previous scores to guide treatment decisions.

Conclusion

The LE functional scale score, derived from the Lower Extremity Functional Scale (LEFS), is a vital tool for assessing and monitoring lower limb function in patients with orthopedic conditions. By converting a patient's self-reported difficulty with daily activities into a quantifiable score, the LEFS enables clinicians to measure progress, set functional goals, and evaluate treatment effectiveness. Its broad applicability and evidence-backed psychometric properties make it a cornerstone of functional assessment in physical rehabilitation, helping both clinicians and patients understand the true impact of an injury or disorder on functional ability.

• For a comprehensive resource on the LEFS and its use in physical rehabilitation, the Shirley Ryan AbilityLab provides a detailed overview.

Frequently Asked Questions

What is a good LEFS score?

A good LEFS score is typically in the 61–80 range, indicating minimal functional limitation. For many patients, a 'good' score is also an improvement of at least 9 points, which represents a clinically significant change in function.

How is the LEFS score calculated?

The LEFS score is calculated by summing the points from each of the 20 items on the questionnaire. Each item is rated on a scale from 0 (extreme difficulty) to 4 (no difficulty), resulting in a possible total score between 0 and 80.

Who uses the Lower Extremity Functional Scale?

The Lower Extremity Functional Scale (LEFS) is primarily used by physical therapists, orthopedic surgeons, and other rehabilitation specialists to assess patients with injuries or disorders affecting the lower extremities.

What kind of activities does the LEFS questionnaire cover?

The LEFS covers a range of 20 daily and recreational activities, from basic tasks like walking and getting in or out of a car to more demanding activities like running and hopping.

Is the LEFS a reliable and valid measure?

Yes, studies have shown that the LEFS has demonstrated acceptable reliability, construct validity, and responsiveness for various lower extremity injuries and disorders, making it a dependable assessment tool.

Can the LEFS be used for different types of lower extremity injuries?

Yes, the LEFS is broadly applicable to a wide variety of lower extremity musculoskeletal disorders, including soft-tissue injuries, osteoarthritis, and fractures.

What is the Minimal Clinically Important Difference (MCID) for the LEFS?

The Minimal Clinically Important Difference (MCID) for the LEFS is 9 points. This means a change of at least 9 points is considered the smallest improvement a patient would perceive as meaningful.