Lower Extremity Functional Scale (LEFS) is a useful tool for evaluating lower extremity (LE) disability, but it has not been adapted for use with Kannada or other regional languages in India.
Objective
This study aimed to perform cross-cultural adaptation and Kannada translation of the LEFS (LEFS-K) and examine its psychometric properties.
Methods
A Longitudinal study on 150 patients with hip and knee injuries. Numeric Rating Scales for Pain (NRS-P) and disability (NRS-D), and Sit-to-stand (5STS) was administered at the initial visit. LEFS-K and NRS again 2 days later and at discharge. Intraclass correlation coefficient (ICC) and Cronbach's alpha (CA) assessed test-retest reliability and internal consistency. Pearson correlation coefficients (r) examined concurrent relations. Effects size was calculated for responsiveness. Clinically important (MCID) and statistically true (MDC) were assessed for the LEFS-K.
Results
LEFS-K demonstrated excellent test-retest reliability (ICC = 0.98) and internal consistency (CA = 0.88). Low to moderate correlations (r < 0.70) were observed between the LEFS-K and other measures (NRS-P, NRS-D, and 5STS). The LEFS-K was deemed responsive to assess change for LE disability (ES = 0.84).
Conclusion
The Kannada LEFS is proved to be a reliable, valid and responsive tool for evaluating LE MSK disability in Kannada speaking individuals with hip and knee disorders.
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet2020; 396: 1204–1222.
2.
KumarAKishoreD(JLaisramN,et al.Prevalence of musculoskeletal disorders amongst adult population of India. Epidemiol Int (E-ISSN: 2455–7048)2019; 4: 22–26.
3.
LubeckDP. The costs of musculoskeletal disease: health needs assessment and health economics. Best Pract Res Clin Rheumatol2003; 17: 529–539.
4.
SinghADasSChopraA, et al.Burden of osteoarthritis in India and its states, 1990–2019: findings from the global burden of disease study 2019. Osteoarthritis Cartilage2022; 30: 1070–1078.
5.
LenaAAshokKPadmaM, et al.Health and social problems of the elderly: a cross-sectional study in udupi taluk, karnataka. Indian J Community Med2009; 34: 131–134.
6.
LitwicAEdwardsMHDennisonEM,et al.Epidemiology and burden of osteoarthritis. Br Med Bull2013; 105: 185–199.
7.
SmithEHoyDGCrossM, et al.The global burden of other musculoskeletal disorders: estimates from the global burden of disease 2010 study. Ann Rheum Dis2014; 73: 1462–1469.
8.
BlackN. Patient reported outcome measures could help transform healthcare. Br Med J2013; 346: f167–f167.
9.
BoyceMBBrowneJPGreenhalghJ. The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf2014; 23: 508–518.
10.
Lundgren-NilssonÅDenckerAPalstamA, et al. Original article: Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties. RMD Open2018; 4: e000715.
11.
WangYYinMZhuS, et al.Patient-reported outcome measures used in patients undergoing total knee arthroplasty. Bone Joint Res2021; 10: 203–217.
12.
BinkleyJMStratfordPWLottSA,et al.The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American orthopaedic rehabilitation research network. Phys Ther1999; 79: 371–383.
13.
YeungTSMWesselJStratfordP,et al.Reliability, validity, and responsiveness of the lower extremity functional scale for inpatients of an orthopaedic rehabilitation ward. J Orthop Sports Phys Ther2009; 39: 468–477.
14.
MehtaSPFultonAQuachC, et al.Measurement properties of the lower extremity functional scale: a systematic review. J Orthop Sports Phys Ther2016; 46: 200–216.
15.
Castillo-DomínguezAGarcia-RomeroJAlvero CruzJR, et al.Systematic review of patient-reported outcome measures for patients with exercise-induced leg pain. Medicina (Kaunas, Lithuania)2022; 58: 841.
16.
LinC-WCMoseleyAMRefshaugeKM,et al.The lower extremity functional scale has good clinimetric properties in people with ankle fracture. Phys Ther2009; 89: 580–588.
17.
PuaY-HCowanSMWrigleyTV,et al.The lower extremity functional scale could be an alternative to the western Ontario and McMaster universities osteoarthritis Index physical function scale. J Clin Epidemiol2009; 62: 1103–1111.
18.
ReidABirminghamTBStratfordPW, et al.Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther2007; 87: 337–349.
19.
Cruz-DíazDLomas-VegaROsuna-PérezMC, et al.The Spanish lower extremity functional scale: a reliable, valid and responsive questionnaire to assess musculoskeletal disorders in the lower extremity. Disabil Rehabil2014; 36: 2005–2011.
20.
CacchioADe BlasisENecozioneS, et al.The Italian version of the lower extremity functional scale was reliable, valid, and responsive. J Clin Epidemiol2010; 63: 550–557.
21.
HouW-HYehT-SLiangH-W. Reliability and validity of the Taiwan Chinese version of the lower extremity functional scale. J Formos Med Assoc2014; 113: 313–320.
22.
AlnahdiAHMurtadaBAZawawiAT, et al.Cross-cultural adaptation and measurement properties of the arabic version of the patient-specific functional scale in patients with lower extremity musculoskeletal disorders. Disabil Rehabil2022; 44: 4104–4110.
23.
RenéFCasimiroLTremblayM, et al.Une version canadienne française du lower extremity functional scale (LEFS) : l’Échelle fonctionnelle des membres inférieurs (ÉFMI), partie I. Physiotherapy Canada2011; 63: 242–248.
24.
RepoJPTukiainenEJRoineRP, et al.Reliability and validity of the Finnish version of the lower extremity functional scale (LEFS). Disabil Rehabil2017; 39: 1228–1234.
25.
PereiraLMDiasJMMazuquinBF, et al.Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL. Braz J Phys Ther2013; 17: 272–280.
26.
StasiSPapathanasiouGAnagnostouM, et al.Lower extremity functional scale (LEFS): cross-cultural adaption into Greek and reliability properties of the instrument. Health Sci J2012; 6: 23.
27.
NaalFDImpellizzeriFMTorkaS, et al.The German lower extremity functional scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement. Qual Life Res2015; 24: 405–410.
28.
HoogeboomTJde BieRAden BroederAA,et al.The Dutch lower extremity functional scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study. BMC Musculoskelet Disord2012 2; 13: 117.
29.
GuilleminFBombardierCBeatonD. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol1993; 46: 1417–1432.
30.
KarciogluOTopacogluHDikmeO,et al.A systematic review of the pain scales in adults: which to use?Am J Emerg Med2018; 36: 707–714.
31.
GoldbergAChavisMWatkinsJ,et al.The five-times-sit-to-stand test: validity, reliability and detectable change in older females. Aging Clin Exp Res2012; 24: 339–344.
32.
Muñoz-BermejoLAdsuarJCMendoza-MuñozM, et al.Test-Retest reliability of five times sit to stand test (FTSST) in adults: a systematic review and meta-analysis. Biology (Basel)2021; 10: 510.
33.
BuatoisSPerret-GuillaumeCGueguenR, et al.A simple clinical scale to stratify risk of recurrent falls in community-dwelling adults aged 65 years and older. Phys Ther2010; 90: 550–560.
34.
Anon. wnarifin.github.io > Sample size calculator. [cited 2025 March 19]. Available from: https://wnarifin.github.io/ssc/sssnsp.html.
35.
McHorneyCATarlovAR. Individual-patient monitoring in clinical practice: are available health status surveys adequate?Qual Life Res1995; 4: 293–307.
36.
KooTKLiMY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med2016; 15: 155–163.
37.
WeirJP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res2005; 19: 231–240.
38.
NegahbanHMazaheriMSalavatiM, et al.Reliability and validity of the foot and ankle outcome score: a validation study from Iran. Clin Rheumatol2010; 29: 479–486.
39.
SchoberPBoerCSchwarteLA. Correlation coefficients: appropriate use and interpretation. Anesth Analg2018; 126: 1763–1768.
40.
ShiH-YChangJ-KWongC-Y, et al.Responsiveness and minimal important differences after revision total hip arthroplasty. BMC Musculoskelet Disord2010; 11: 261.
41.
CohenJ. A power primer. Psychol Bull1992; 112: 155–159.
42.
MandrekarJN. Receiver operating characteristic curve in diagnostic test assessment.J Thorac Oncol2010 September; 5: 1315–1316.
43.
TerweeCBBotSDMde BoerMR, et al.Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol2007; 60: 34–42.
44.
Citaker S, Kafa N, Hazar Kanik Z. Translation, cross-cultural adaptation and validation of the Turkish version of the Lower Extremity Functional Scale on patients with knee injuries. Arch Orthop Trauma Surg 2016 March; 136: 389–395.
