Lower extremity functional scale pdf 2026

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  1. Click ‘Get Form’ to open the lower extremity functional scale PDF in the editor.
  2. Begin by entering your Patient Label neatly inside the designated box at the top of the form.
  3. Fill in your Patient Age and select whether this is your First, Intermediate, or Last Visit.
  4. For each activity listed, indicate your level of difficulty by selecting a number from 0 (No Difficulty) to 4 (Extreme Difficulty).
  5. Once you have completed all activities, calculate your total score and write it in the SCORE section provided.
  6. If applicable, complete any additional fields for therapist use only, such as Employee ID and ICD-9 Code.

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The maximum score of 80 indicates no functional limitations and the minimum score of 0 indicates extreme limitations.
Documentation of a basic, normal extremity exam should look something along the lines of the following: Extremities are atraumatic in appearance without tenderness or deformity. Extremities are without swelling or erythema. Full range of motion is noted to all joints.
Upper Extremity Functional Scale (UEFS) Each item is scored from 1 (no problem) to 10 (major problem), for a total score ranging from 8 (best state) to 80 (worst state).
However, scores in the range of 61-80 are generally considered normal or indicative of minimal functional limitation. Scores in the range of 41-60 may indicate mild to moderate functional limitation, while scores in the range of 20-40 may indicate moderate to severe functional limitation.
The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. The columns on the scale are summed to get a total score. The maximum score is 80.

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