Lower Extremity Functional Scale NameDate Date Format: MM slash DD slash YYYY Please use the following scale to fill out the questions below:0 - Extreme Difficulty or Unable to Perform Activity 1 - Quite a Bit of Difficulty 2 - Moderate Difficulty 3 - A little Bit of Difficulty 4 - No DifficultyAny of your usual work, housework or school activities01234Your usual hobbies, recreational or sporting activities01234Getting into or out of the bath01234Walking between rooms01234Putting on your shoes or socks01234Squatting01234Lifting an object, like a bag of groceries, from the floor01234Performing light activities around your home01234Performing heavy activities around your home01234Getting into or out of a car01234Walking 2 blocks01234Walking a mile01234Going up or down 10 stairs (about 1 flight of stairs)01234Standing for 1 hour01234Sitting for 1 hour01234Running on even ground01234Running on uneven ground01234Making sharp turns while running fast01234Hopping01234Rolling over in bed01234Total Score: This iframe contains the logic required to handle Ajax powered Gravity Forms.
