LEFS SCALE PDF

Toll-Free U. From high-quality clinical care and groundbreaking research to community programs that improve quality of life, philanthropic support drives our mission and vision. The test can be used to evaluate the impairment of a patient with lower extremity musculoskeletal condition or disorders. Instrument Details. Do you see an error or have a suggestion for this instrument summary?

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Background and Purpose. Subjects and Methods. The LEFS was administered to patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks.

The SF acute version was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability. Pearson correlations and one-way analyses of variance were used to examine construct validity. Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF scores.

There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF physical function score. Conclusion and Discussion. The LEFS is efficient to administer and score and is applicable for research purposes and clinical decision making for individual patients. Proposed new measures of health status should be viewed with increasing rigor and sophistication with respect to scale development.

Generic health status measures assess overall health, including social, emotional, and physical health status, and are intended to be applicable across a broad spectrum of diseases, interventions, and demographic and cultural subgroups. Several barriers to the widespread adoption of generic and condition-specific measures in clinical practice have been identified, including 1 difficulty of administering the scales and of scoring, 2 difficulty in administering scales for different conditions and anatomical sites, 3 the practitioner's belief that there is a lack of clinical meaningfulness for the scores, and 4 inadequate measurement properties for application to individual patients.

For example, there are numerous condition-specific measures available for people with knee conditions. Measures exist for people with general conditions of the knee, 5 patellofemoral joint disorders, 6 , 7 ligamentous deficiency, 8 — 10 and joint replacement.

One approach to overcoming the need for multiple measures of health status in clinical practice is to explore whether the measurement properties of conditionspecific measures are superior to those of generic measures. Should the measurement properties be similar, a single generic measure or subscale of that measure could be used in place of a number of condition-specific measures.

Several generic measures have been applied to a variety of patients with lower-extremity musculoskeletal conditions, including the SF, 13 , 14 the SF, 15 the Functional Status Index, 16 and the Musculoskeletal Functional Assessment Questionaire. The SF has served as the principal generic measure for comparisons with condition-specific measures.

Each subscale score can vary from 0 to , with higher scores representing more desirable health states. The physical and mental component summary scores represent weighted composite scores derived from the 8 health concept scales.

Each of the component summary scores is scaled to have a mean of 50 and a standard deviation of 10 for the general population of the United States. To date, the responsiveness of several of the SF subscales and the physical component summary score have been shown to be superior or equivalent to condition-specific scales relevant to the lower extremity.

There is no strong evidence to suggest that existing condition-specific scales designed for the lower extremity are superior to the SF The SF, however, is time-consuming to administer and score in the clinic and was not designed for individual patient decision making.

It is critical that measures of health status be reliable, valid, and responsive to clinical change that occurs over time. Within Kirshner and Guyatt's taxonomy, responsiveness exists independent of validity. This position has been challenged by Hays and Hadorn, 34 who suggested that responsiveness is actually one indication of a measure's validity.

An external standard of change was introduced to examine the extent to which a health status measure truly differentiates among patients who have improved, deteriorated, or remained stable and subsequently used in our study and by other authors. Several methods have been used by us and by other researchers in an attempt to distinguish among patients' levels of change, including other clinical measures eg, spinal flexion , 29 retrospective global rating of change, 27 , 29 , 37 — 41 the achievement of treatment goals, 35 and an external prognostic rating of change.

We believe that there is a need for a functional measure that is easy to administer and score and applicable to a wide range of patients with lower-extremity orthopedic conditions. Our goal was to develop a self-report condition-specific measure that would yield reliable and valid measurements and that would be appropriate for use as a clinical and research tool.

Accordingly, the scale development process took into account the barriers identified for clinical implementation of self-report measures. The purpose of this article is to report on the development and initial validation of a newly developed condition-specific measure, the Lower Extremity Functional Scale LEFS , including the determination of internal consistency, reliability, construct validity, sensitivity to change, and clinical application.

Subjects were consecutive patients referred for physical therapy with any lower-extremity musculoskeletal condition defined as any condition of the joints, muscles, or other soft tissues of the lower extremity. Patients who did not speak English or were unable to read were excluded from the study. Data were collected over a 4-month period. A total of patients were entered into the study.

A description of the patients is presented in Table 1. Twelve of the 19 clinicians contributed data to the study Fig. Informed consent was obtained from all patients. The conceptual framework that guided the development of the LEFS included that the scale 1 be based on the World Health Organization's model of disability and handicap, 43 2 be efficient to administer, score, and record in the medical record with respect to patient and clinician time, 3 be applicable to a wide variety of patients with lower-extremity orthopedic conditions, including patients with a range of disability levels, conditions, diseases, treatments, and ages, 4 be applicable for documenting function on an individual patient basis as well as in groups, such as for clinical outcomes assessment and clinical research purposes, 5 be developed using a systematic process of item selection and item scaling, 2 6 yield reliable measurements have internal consistency and test-retest reliability , and 7 yield valid measurements at a single point in time and sensitive to valid change.

Items were generated for the LEFS by a process of reviewing existing questionnaires as well as surveying clinicians and patients. The World Health Organization's model of disability 43 served as the basis for the item generation phase of the scale development.

The terminology used to define disability and handicap was used as the basis of questions posed about functional limitations to patients. Thirty-five patients with a variety of lower-extremity orthopedic conditions were surveyed to determine important functional limitations associated with their problem. Three orthopedic physical therapists, each with at least 10 years of experience in orthopedic physical therapy practice, reviewed the 22 items and were given the opportunity to add additional items.

We surveyed existing questionnaires. No additional items were identified as important to include in the LEFS by these additional processes. The initial version of the scale consisted of 22 items.

The 5-point difficulty rating scale was selected to maximize the capacity of the scale to measure change Appendix. The initial version of the scale was administered to 57 patients who were referred for physical therapy with lower-extremity dysfunction. Total LEFS scale scores, means, and score distribution were determined for this group.

At the individual item level, mean score, median score, standard deviation, range, and frequency of endorsement of each level 0—4 of all items were determined. Interitem correlations and corrected item-item total correlations were calculated. The corrected item-item total correlation is an estimate of the degree to which a single item score correlates with the total scale score with that item removed.

The alpha coefficient, a measure of internal consistency, was determined for the scale and calculated with each of the items removed. In order to develop a measure that is applicable to a spectrum of conditions and levels of disabilities, the remaining items were selected to represent different difficulty levels, as indicated by item mean scores that were higher and lower than the midpoint. As a result of the item analysis, 2 items were removed from the original LEFS and 1 item was reworded.

A factor analysis performed on the final item questionnaire indicated that all items loaded on a single factor. The factor loadings varied from. The final version of the LEFS consists 20 items, each with a maximum score of 4. The total possible score of 80 indicates a high functional level Appendix. The scale is one page, can be filled out by most patients in less than 2 minutes, and is scored by tallying the responses for all of the items.

Scoring is performed without the use of a calculator or computer and requires approximately 20 seconds. The LEFS was administered during the initial assessment to patients with lower-extremity musculoskeletal dysfunction referred for physical therapy.

The LEFS was readministered to patients 24 to 48 hours following the initial administration in order to examine test-retest reliability. In addition, the SF acute version was administered during the initial assessment and at the weekly follow-up assessments. In the absence of an accepted measure of function, determination of the validity of functional scales has relied heavily on the concept of construct validity.

One or more theories are developed, and the extent to which a measure yields results concordant with the theory provides support for the validity of the measure. Patients who had recently undergone surgery surgery less than 2 weeks prior to initial assessment would have lower LEFS and SF physical function subscale and physical component summary scores than would patients who did not have recent surgery no surgery or surgery greater than 2 weeks prior to assessment.

Patients with acute conditions would demonstrate lower LEFS scores and SF physical function subscale and physical component summary scores than would patients with chronic conditions.

The selection of the SF was based on the literature documenting the measurement properties of the SF, including its applicability to patients with lower-extremity dysfunction. The reliability, validity, and responsiveness of measurements obtained with the SF have been documented in diverse patient groups. The physical function and pain dimensions appear to be most relevant to orthopedic outpatients.

In order to examine our argument for validity, which specified that patients with acute conditions would demonstrate more functional limitation than patients with chronic conditions, all patients were assigned a chronicity rating on a 3-point scale by 2 orthopedic physical therapists blinded to patients' functional scale scores. The ratings were performed allowing discussion of the patient profile, and a single agreed-on score was determined.

The basis for the selection of 4 weeks was the judgment of the investigators. Sensitivity to change was examined using a prognosis rating. Each patient was given a rating of prognosis using a 7-point scale Fig. Two orthopedic physical therapists who were blind to the patient's functional scale scores performed independent prognostic ratings on each patient, which were subsequently averaged.

Prognostic ratings were based on documentation review of patients' diagnoses, age, chronicity, number of comorbid conditions, and type of surgery and time since surgery, where applicable. This approach was based on clinical judgment and previous work by Westaway et al, 45 whose data suggested that experienced clinicians can make prognoses about patients.

The capacity of the LEFS and the SF physical function subscale and physical component summary scores to measure valid change was compared at 1 week and at 3 weeks using this theory for change. The interrater reliability for the prognostic ratings was determined using a type 3,2 intraclass correlation coefficient ICC. This class of ICC is appropriate when ratings are averaged and an adjustment has been applied to address a systematic difference between raters.

Because the goal of the analysis was to examine change, rather than to evaluate intervention, we made no attempt to control interventions.

We used the alpha coefficient to estimate internal consistency, a measure of homogeneity of items. Reliability of the LEFS scores was also quantified using the standard error of measurement SEM , a representation of measurement error expressed in the same units as the original measurement, in this case, LEFS points.

Two estimates of the SEM were obtained. To obtain this estimate, the SEM is multiplied by the z value for the confidence level of interest, and this quantity is multiplied by the square root of 2. One-way analyses of variance were used to examine the hypotheses about validity that specified that there would be a difference in initial LEFS scores and SF physical function subscale and physical component summary scores between: 1 patients with recent surgery and patients without recent surgery and 2 patients with acute conditions and patients with chronic conditions.

Spearman rank-order correlation coefficients were used to examine the relationship between the prognostic rating and change in the following functional status scores at 1 week and 3 weeks: LEFS score, SF physical function subscale score, SF physical component summary score, and SF mental component summary score.

The magnitudes of the correlations between the prognostic ratings and the LEFS, SF physical function subscale, and SF physical component summary scores were formally compared using the method of Williams 48 for dependent data. The minimal clinically important difference MCID , defined as the minimal amount of change on the scale required to be considered a clinically important change, was determined using 2 methods. In the first approach, we used the prognostic ratings of change to separate patients into those who were predicted to undergo important change prognostic ratings of 2, 3, and 4 and those who were predicted to undergo no important change at 3 weeks prognostic ratings of 0 and 2.

The cutpoint of change on the LEFS that maximized the area under a receiver operating characteristic ROC curve was determined as the estimate of the amount of change on the LEFS that best classified patients who had changed an important amount from those who had not.

The second approach was a survey of 5 clinicians who reported that they had used the LEFS for an minimum of 4 months and on at least 10 patients as a clinical decision-making tool.

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Normative data for the lower extremity functional scale (LEFS)

Background and Purpose. Subjects and Methods. The LEFS was administered to patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks.

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Lower Extremity Functional Scale

Background and purpose: The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale LEFS. Subjects and methods: The LEFS was administered to patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. Methods: The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks. The SF acute version was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability.

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