LEFS (Responses)
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1
TimestampPatientTherapist
Today, do you or would you have any difficulty at all with: [Any of your usual work, housework, or school activities.]
Today, do you or would you have any difficulty at all with: [Your usual hobbies, re creational or sporting activities.]
Today, do you or would you have any difficulty at all with: [Getting into or out of the bath.]
Today, do you or would you have any difficulty at all with: [Walking between rooms.]
Today, do you or would you have any difficulty at all with: [Putting on your shoes or socks.]
Today, do you or would you have any difficulty at all with: [Squatting.]
Today, do you or would you have any difficulty at all with: [Lifting an object, like a bag of groceries from the floor.]
Today, do you or would you have any difficulty at all with: [Performing light activities around your home.]
Today, do you or would you have any difficulty at all with: [Performing heavy activities around your home.]
Today, do you or would you have any difficulty at all with: [Getting into or out of a car.]
Today, do you or would you have any difficulty at all with: [Walking 2 blocks.]
Today, do you or would you have any difficulty at all with: [Walking a mile.]
Today, do you or would you have any difficulty at all with: [Going up or down 10 stairs (about 1 flight of stairs).]
Today, do you or would you have any difficulty at all with: [Standing for 1 hour.]
Today, do you or would you have any difficulty at all with: [Sitting for 1 hour.]
Today, do you or would you have any difficulty at all with: [Running on even ground.]
Today, do you or would you have any difficulty at all with: [Running on uneven ground.]
Today, do you or would you have any difficulty at all with: [Making sharp turns while running fast.]
Today, do you or would you have any difficulty at all with: [Hopping.]
Today, do you or would you have any difficulty at all with: [Rolling over in bed.]
2
1/14/2019 10:56:23Patient 1Therapist 1Quite a Bit of Difficulty
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of Difficulty
Extreme Difficulty or Unable to Perform Activity
A Little Bit of DifficultyQuite a Bit of DifficultyModerate DifficultyQuite a Bit of Difficulty
Extreme Difficulty or Unable to Perform Activity
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of DifficultyQuite a Bit of Difficulty
Extreme Difficulty or Unable to Perform Activity
No DifficultyNo Difficulty
Extreme Difficulty or Unable to Perform Activity
Extreme Difficulty or Unable to Perform Activity
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of DifficultyA Little Bit of Difficulty
3
1/14/2019 11:01:33Patient 2Therapist 2
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of DifficultyNo DifficultyModerate DifficultyA Little Bit of DifficultyModerate DifficultyQuite a Bit of DifficultyQuite a Bit of DifficultyModerate DifficultyModerate DifficultyQuite a Bit of DifficultyA Little Bit of DifficultyModerate DifficultyQuite a Bit of DifficultyQuite a Bit of DifficultyQuite a Bit of DifficultyQuite a Bit of DifficultyQuite a Bit of Difficulty
Extreme Difficulty or Unable to Perform Activity
A Little Bit of Difficulty
4
1/20/2019 16:17:01Patient 1Therapist 2
Extreme Difficulty or Unable to Perform Activity
Extreme Difficulty or Unable to Perform Activity
Moderate Difficulty
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of DifficultyA Little Bit of DifficultyQuite a Bit of DifficultyModerate DifficultyQuite a Bit of DifficultyModerate Difficulty
Extreme Difficulty or Unable to Perform Activity
Moderate DifficultyModerate DifficultyModerate DifficultyModerate DifficultyModerate DifficultyModerate DifficultyQuite a Bit of DifficultyModerate DifficultyModerate Difficulty
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