The lower extremity functional scale LEFS is a well-known and validated instrument for measurement of lower extremity function. The LEFS was developed in a group of patients with various musculoskeletal disorders, and no reference data for the healthy population are available. Here we provide normative data for the LEFS. Healthy visitors and staff at 4 hospitals were requested to participate.
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The lower extremity functional scale LEFS is a well-known and validated instrument for measurement of lower extremity function. The LEFS was developed in a group of patients with various musculoskeletal disorders, and no reference data for the healthy population are available.
Here we provide normative data for the LEFS. Healthy visitors and staff at 4 hospitals were requested to participate. A minimum of volunteers had to be included at each hospital.
Participants were excluded if they had undergone lower extremity surgery within 1 year of filling out the questionnaire, or were scheduled for lower extremity surgery. Normative values for the LEFS for the population as a whole were calculated. Furthermore, the influence of sex, age, type of employment, socioeconomic status, and history of lower extremity surgery on the LEFS were investigated. The median score for the LEFS for the whole population was 77 out of a maximum of Men and women had similar median scores 78 and 76, respectively , and younger individuals had better scores.
Participants who were unfit for work had worse scores. There were no statistically significant correlations between socioeconomic status and type of employment on the one hand and LEFS score on the other. A history of lower extremity surgery was associated with a lower LEFS score. High scores were observed for the LEFS throughout the whole population, although they did decrease with age. Men had a slightly higher score than women. There was no statistically significant correlation between socioeconomic status and LEFS score, but people who were unfit for work had a significantly worse LEFS score.
The lower extremity functional scale LEFS is a well-known and validated patient-rated outcome measure PROM that can be used to measure lower extremity function. The score consists of 20 questions, which are subdivided into 4 groups. These groups consist of activities with increasing physical demands. Questions on activity vary from walking between rooms to running on uneven ground.
This makes it impossible to assess pre-disease physical function, as questionnaires regarding pre-disorder physical functioning are affected by recall bias Last For this reason, it is challenging for physicians to reliably measure the effect of their treatment regarding return to pre-disorder physical functioning.
Normative data for PROMs can aid in this problem by acting as reference data for a healthy population. For the LEFS, however, no such data are available. Therefore we provide normative data for the lower extremity function scale. In addition, we wanted to investigate the influence of sex, age, type of employment, socioeconomic status, and history of lower extremity surgery on the LEFS score. Adult visitors to the outpatient clinic of the Department of Surgery and also staff at 4 different Dutch hospitals were asked to participate in this study.
The 4 hospitals were located in different regions both rural and urban and consisted of 1 university hospital and 3 teaching hospitals. Since it was not possible to perform a prospective sample size calculation, we chose to include a minimum of individuals at each hospital.
We considered this to be a large enough population to be representative of the whole population. We constantly monitored the age and sex of the respondents in order to obtain comparable group sizes. As data collection took several days at each hospital, after each day we checked the numbers of men and women and the distribution across different age categories.
The study consisted of a short questionnaire in which the postal code, age as a continuous variable and subdivided into 3 categories 18—39, 40—64, and over 64 years , sex, and work status student, working, retired, unemployed, unfit for work, or other of the subjects were recorded. When participants were actively employed at the time of filling out the questionnaire, they were requested to report whether they considered their employment to be blue-, pink-, or white-collar i.
After this, they were asked whether they had a history of lower extremity surgery and—if this was the case—how long ago. In addition, they were asked whether they were currently scheduled for lower extremity surgery. Individuals were excluded if they had had lower extremity surgery within 1 year of filling out the questionnaire.
Participants who were scheduled for lower extremity surgery were also excluded. For all postal codes, a number is available that reflects the SES of that particular area. Normal distribution was assessed using histograms and plots. Continuous variables are presented as mean with standard deviation SD or median with interquartile range IQR , as appropriate. Categorical variables are given as frequencies and percentages. The mean and SD are also provided, to show the variability of the whole population and to allow comparison with other studies.
The Mann-Whitney U-test and Kruskal-Wallis test were used to check for differences in non-parametric outcome variables. All analyses were performed using SPSS version For this study, the need to obtain informed consent was waived by the local Medical Ethics Committee.
The questionnaire was filled out by 1, individuals. For 9 questionnaires, there were no more than 4 questions missing or 3 within one domain. Men had a statistically significant better score than women.
The level of physical demand of employment was not statistically significantly related to LEFS score. In healthcare studies, outcomes are often measured through patient-rated outcome measures PROMs. This means that it is unknown what normal scores for a healthy individual should be.
Earlier research has shown that a healthy population does not necessarily score a maximum amount of points on a PROM Schneider and Jurenitsch The latter study showed that mean score for the foot function index FFI was 10 out of points, where 0 points means no foot disability , and only one-third of the respondents achieved the maximum score of 0 points. These figures indicate that it is of importance to be aware of the normative data of a PROM.
Presenting the results of a study in the light of normative values is far more informative than presenting outcome scores alone. Several studies have used the LEFS to evaluate treatment effect.
They found a median score of 44 for both ankle arthrodesis and ankle arthroplasty, which was considerably lower than in a healthy population. They found a mean LEFS score of 71, indicating a good result of their treatment. In addition, since the LEFS was designed for use in individuals with lower extremity conditions, the fact that a ceiling effect was found for healthy individuals is notable, but it should not limit the validity of the test in the population that it was designed for.
As expected, the LEFS score showed a negative correlation with age; i. We observed a gradual decrease in function from the age of This finding is of importance for future studies, as the results for a population as a whole should be interpreted with care. It would be more appropriate to do a separate analysis of the results for different age categories, particularly young patients and elderly patients.
Men had a statistically significantly better LEFS score than women; however, the difference was only 2 points. Furthermore, we found that participants who were unfit for work had significantly worse scores.
Compared to the working population, this difference was of clinical importance 29 points. This suggests that function may be independent of SES in a normal population, but in posttraumatic patients SES may negatively influence treatment outcome.
A possible weakness of our study was that our sample was not representative of the population as a whole. However, we tried to balance the numbers of females and males. Furthermore, we constantly monitored the distribution of the responses in the different age categories.
When necessary, we requested that more males than females or vice versa should fill out the questionnaire, and we did the same for the 3 age categories used. For other subpopulations e. SES and heaviness of employment , this was unfortunately not possible and may have biased our results. We do feel, however, that with our study population of over 1, individuals, we were able to make an accurate estimate of normative values for the LEFS—especially as we had individuals from different regions and different types of hospitals.
Using the results of the present study will help researchers to interpret their data and physicians to set goals for treatment results. High scores were observed for the LEFS throughout the whole population, although it did decrease with age.
There was no statistically correlation between socioeconomic status and LEFS score, but people who were unfit for work had significantly poorer LEFS scores.
National Center for Biotechnology Information , U. Journal List Acta Orthop v. Acta Orthop. Published online Mar Find articles by Niels W L Schep. Author information Article notes Copyright and License information Disclaimer.
Correspondence: ln. Received Dec 21; Accepted Feb This article has been cited by other articles in PMC.
Abstract ackground and purpose The lower extremity functional scale LEFS is a well-known and validated instrument for measurement of lower extremity function. Methods Healthy visitors and staff at 4 hospitals were requested to participate. Results 1, individuals fulfilled the inclusion criteria and were included in the study. Interpretation High scores were observed for the LEFS throughout the whole population, although they did decrease with age.
Methods Adult visitors to the outpatient clinic of the Department of Surgery and also staff at 4 different Dutch hospitals were asked to participate in this study. Statistics Normal distribution was assessed using histograms and plots. Results Demographics Table 1 Table 1. Demographic data. Open in a separate window. Sex-specific median LEFS scores for each age category. Table 2. LEFS scores related to percentiles.
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.
Lower Extremity Functional Scale
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?