Lymphedema Life Impact Scale (LLIS Functional Outcomes)

Lymphedema Life Impact Scale
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Today's Date

MonthDayYear
Date
Listed below are symptoms or problems reported by many individuals with lymphedema. Please indicate to what extent these problems associated with your lymphedema has affected you in the past week. Select the number which best describes your symptom level.
I. Physical Concerns (Note: If swelling and symptoms are the same in both limbs, rate them the same; otherwise, rate only the worst limb)
1. The amount of pain associated with my lymphedema is:

0

1

2

3

4

0 is no pain, 4 is severe pain
2. The amount of limb heaviness associated with my lymphedema is:

0

1

2

3

4

0 is no heaviness, 4 is extremely heavy
3. The amount of skin tightness associated with my lymphedema is:

0

1

2

3

4

0 is no tightness, 4 is extremely tight
4. The size of my swollen limb(s) seems:

0

1

2

3

4

0 is normal size, 4 is extremely large
5. Lymphedema affects the movement of my swollen limb(s):

0

1

2

3

4

0 is normal movement, 4 is extremely limited
6. The strength of my swollen limb(s) is:

0

1

2

3

4

0 is normal strength, 4 is extremely weak
II. Psychosocial Concerns
7. Lymphedema affects my body image (how I think I look):

0

1

2

3

4

0 is not at all, 4 is completely
8. Lymphedema affects my socializing with others.

0

1

2

3

4

0 is no interference, 4 is interferes completely
9. Lymphedema affects my intimate relations with spouse or partner (rate 0 if not applicable).

0

1

2

3

4

0 is no interference, 4 is interferes completely
10. Lymphedema "get me down" (i.e. I have feelings of depression, frustration, or anger due to the lymphedema).

0

1

2

3

4

0 is never, 4 is constantly
11. I must rely on others for help due to my lymphedema.

0

1

2

3

4

0 is not at all, 4 is completely
12. I know what to do to manage my lymphedema.

0

1

2

3

4

0 is good understanding, 4 is no understanding
III. Functional Concerns
13. Lymphedema affects my ability to perform self-care activities (i.e. eating, dressing, hygiene).

0

1

2

3

4

0 is no interference, 4 is interferes completely
14. Lymphedema affects my ability to perform routine home or work-related activities.

0

1

2

3

4

0 is no interference, 4 is interferes completely
15. Lymphedema affects my performance of preferred leisure activities.

0

1

2

3

4

0 is no interference, 4 is interferes completely
16. Lymphedema affects the proper fit of clothing/shoes.

0

1

2

3

4

0 is fits normally, 4 is unable to wear
17. Lymphedema affects my sleep.

0

1

2

3

4

0 is no interference, 4 is interferes completely
IV. Infection Occurrence
18. In the past year, I have become ill with infection in my swollen limb requiring oral antibiotics or hospitalization.

0

1

2

3

4

0 is 0 times, 4 is 4+ times
Should be Empty:

Lymphedema Life Impact Scale

I. Physical Concerns (Note: If swelling and symptoms are the same in both limbs, rate them the same; otherwise, rate only the worst limb)

II. Psychosocial Concerns

III. Functional Concerns

IV. Infection Occurrence