• Eclipse Orthopedic Rehabilitation - Lower Extremity Functional Scale

  • We are interested in knowing whether you are having difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.

    Today, do you or would you have any difficulty at all with: (check one number on each line). 

  • 0 = Unable to Perform 1 = Severe Difficulty 2 = Moderate Difficulty 3 = Some Difficulty 4 = No Difficulty

  • Date*
     - -
  • 1. Any of your usual work, housework, or school activities:*
  • 2. Your usual hobbies, recreational r sporting activities.*
  • 3. Getting into or out of the bath.*
  • 4. Walking between rooms.*
  • 5. Putting on your shoes or socks.*
  • 6. Squatting*
  • 7. Lifting an object, like a bag of groceries from the floor.*
  • 8. Performing light activities around your home.*
  • 9. Performing heavy activities around your home.*
  • 10. Getting into or out of a car.*
  • 11. Walking 2 blocks.*
  • 12. Walking a mile.*
  • 13. Going up or down 10 stairs (about one flight).*
  • 14. Standing for 1 hour.*
  • 15. Sitting for 1 hour.*
  • 16. Running on even ground.*
  • 17. Running on uneven ground.*
  • 18. Making sharp turns while running.*
  • 19. Hopping*
  • 20. Rolling over in bed.*
  • Should be Empty: