LEFS

Activity: Usual work, housework, or school activities *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Usual hobbies, recreational or sporting activities *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Getting into or out of the bath *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Walking between rooms *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Putting on shoes or socks *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Squatting *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Lifting an object, like a bag of groceries from the floor *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Performing light activities around your home *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Performing heavy activities around your home *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Getting into or out of a car *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Walking 2 blocks *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Walking a mile *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Going up or down 10 stairs *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Standing for 1 hour *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Sitting for 1 hour *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Running on even ground *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Running on uneven ground *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Making sharp turns while running fast *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Hopping *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty

Activity: Rolling over in bed *

0 Extreme difficulty or unable to perform 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty