Validation of the Polish versions of the Lower Limb Task Questionnaire, Lower Limb Functional Index, and Lower Limb Functional Index-10

Published:October 12, 2022DOI:



      Physicians who treat patients with lower limb diseases should pay attention not only to the patients’ clinical condition but also to their individual needs and expectations. For this purpose, many different questionnaires can be employed. This study aimed to validate the Lower Limb Task Questionnaire (LLTQ), Lower Limb Functional Index (LLFI), and Lower Limb Functional Index-10 (LLFI-10) for their use in Polish conditions and to perform a mutual comparison and analysis of differences in subjective assessments by patients who undergo hip or knee arthroplasty.


      The LLTQ, LLFI, and LLFI-10 were translated into Polish. A total of 103 patients who qualified for hip or knee arthroplasty at a University Hospital in from 2019 to 2021 were included in this study. The patients were asked to complete the Polish versions of the LLTQ, LLFI, LLFI-10, Lower Extremity Functional Scale (LEFS), and Short Form-36 four times – twice before and twice after their surgeries.


      The Polish versions of the LLTQ, LLFI, and LLFI-10 had good psychometric properties. One year after surgery, the Cohen's standard response mean revealed high improvement of limb functionality and thus quality of life among all patients. We observed better treatment outcomes among patients who had hip osteoarthritis.


      The questionnaires were validated and can be used both in everyday health practice and in further research in Poland.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hoogeboom T.J.
        • De Bie R.A.
        • Den Broeder A.A.
        • Van Den Ende C.H.M.
        The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study.
        BMC Muscoskel Disord. 2012 Jul 2; 13: 117
        • Citaker S.
        • Kafa N.
        • Hazar Kanik Z.
        • Ugurlu M.
        • Kafa B.
        • Tuna 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 Mar; 136: 389-395
        • McNair P.J.
        • Prapavessis H.
        • Collier J.
        • Bassett S.
        • Bryant A.
        • Larmer P.
        The lower-limb Tasks questionnaire: an assessment of validity, reliability, responsiveness, and minimal important differences.
        Arch Phys Med Rehabil. 2007 Aug; 88: 993-1001
        • Gabel C.P.
        • Melloh M.
        • Burkett B.
        • Michener L.A.
        Lower limb functional index: development and clinimetric properties.
        Phys Ther. 2012 Jan; 92: 98-110
        • Pua Y.H.
        • Cowan S.M.
        • Wrigley T.V.
        • Bennell K.L.
        The lower extremity functional scale could be an alternative to the Western Ontario and McMaster Universities osteoarthritis index physical function scale.
        J Clin Epidemiol. 2009 Oct; 62: 1103-1111
        • Shultz S.
        • Olszewski A.
        • Ramsey O.
        • Schmitz M.
        • Wyatt V.
        • Cook C.
        A systematic review of outcome tools used to measure lower leg conditions.
        Int J Sports Phys Ther. 2013 Dec; 8: 838-848
        • Koziej M.
        • Trybus M.
        • Mydłowska A.
        • Sałapa K.
        • Gniadek M.
        • Banach M.
        • et al.
        The Polish version of the Michigan Hand Outcomes Questionnaire: cross-cultural adaptation, reliability, construct validity, and measurement error.
        J Hand Surg Eur. 2018 Feb; 43: 199-208
        • Trybus M.
        • Koziej M.
        • Belka M.
        • Bednarek M.
        • Banach M.
        The Polish version of the Boston Carpal Tunnel Questionnaire: associations between patient-rated outcome measures and nerve conduction studies.
        J Plast Reconstr Aesthetic Surg. 2019 Jun; 72: 924-932
        • Dingemans S.A.
        • Kleipool S.C.
        • Mulders M.A.M.
        • Winkelhagen J.
        • Schep N.W.L.
        • Goslings J.C.
        • et al.
        Normative data for the lower extremity functional scale (LEFS).
        Acta Orthop. 2017 Jul; 88: 422-426
        • Bejer A.
        • Podufały A.
        • Kyc S.
        • Michałek M.
        • Mataczyński P.
        • Domka-Jopek E.
        • et al.
        Polish cross-cultural adaptation of the lower limb functional index (LLFI) demonstrates a valid outcome measure for the lower limb region and joints.
        2020 Apr 29
        • Beaton D.E.
        • Bombardier C.
        • Guillemin F.
        • Ferraz M.B.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine. 2000 Dec 15; 25: 3186-3191
        • Ryland M.E.
        • Grisbrook T.L.
        • Wood F.M.
        • Phillips M.
        • Edgar D.W.
        Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index-10 as a measure of functional recovery post burn injury: a cross-sectional repeated measures study design.
        Burn Trauma. 2016 Dec 1; 4: 1-7
        • Backes M.
        • Dingemans S.A.
        • Dijkgraaf M.G.W.
        • Van den Berg H.R.
        • Van Dijkman B.
        • Hoogendoorn J.M.
        • et al.
        Effect of antibiotic prophylaxis on surgical site infections following removal of orthopedic implants used for treatment of foot, ankle, and lower leg fractures a randomized clinical trial.
        JAMA - Am Med Assoc. 2017 Dec; 318: 2438-2445
        • Binkley J.M.
        • Stratford P.W.
        • Lott S.A.
        • Riddle D.L.
        The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American orthopaedic rehabilitation research network.
        Phys Ther. 1999 Apr; 79: 371-383
        • Bravini E.
        • Giordano A.
        • Sartorio F.
        • Ferriero G.
        • Vercelli S.
        Rasch analysis of the Italian lower extremity functional scale: insights on dimensionality and suggestions for an improved 15-item version.
        Clin Rehabil. 2017; 31: 1-13
        • Cacchio A.
        • De Blasis E.
        • Necozione S.
        • Rosa F.
        • Riddle D.L.
        • di Orio F.
        • et al.
        The Italian version of the Lower Extremity Functional Scale was reliable, valid, and responsive.
        J Clin Epidemiol. 2010 May; 63: 550-557
        • Čižmář I.
        • Vlček M.
        • Ehler E.
        • Dráč P.
        Rekonstrukce paréz dolní končetiny po zlomeninách pánve svalovými transfery [Reconstruction of lower extremity Palsy after Pelvic fractures with the muscle transfers].
        Acta Chir Orthop Traumatol Cech. 2019; 86: 348-352
        • Eckenrode B.J.
        • Kietrys D.M.
        • Stackhouse S.K.
        Pain sensitivity in chronic achilles tendinopathy.
        Int J Sports Phys Ther. 2019 Dec; 14: 945-956
        • Gavaskar A.S.
        • Parthasarathy S.
        • Balamurugan J.
        • Raj R.V.
        • Chander V.S.
        • Ananthkrishnan L.K.
        A load-sharing nail - cage construct may improve outcome after induced membrane technique for segmental tibial defects.
        Injury. 2020 Feb; 51: 510-515
        • Korakakis V.
        • Saretsky M.
        • Whiteley R.
        • Azzopardi M.C.
        • Klauznicer J.
        • Itanmd A.
        • et al.
        Translation into modern standard Arabic, cross-cultural adaptation and psychometric properties' evaluation of the Lower Extremity Functional Scale (LEFS) in Arabic-speaking athletes with Anterior Cruciate Ligament (ACL) injury.
        PLoS One. 2019 Jun; 14
        • Lourduraj D.B.
        • Barnawal S.P.
        • Pattabi K.
        • Gnanasekaran V.
        • Sadhasivam A.
        • Vinmd K.S.
        • et al.
        Application of the lower extremity functional scale and its correlation with Lymphedema health-related quality of life on lower limb Filarial Lymphedema patients.
        Lymphatic Res Biol. 2020; 18: 254-260
        • Mehta S.P.
        • Fulton A.
        • Quach C.
        • Thistle M.
        • Toledo C.
        • Evans N.A.
        Measurement properties of the lower extremity functional scale: a systematic review.
        J Orthop Sports Phys Ther. 2016 Mar; 46: 200-216
        • Yeung T.S.M.
        • Wessel J.
        • Stratford P.
        • Macdermid J.
        Reliability validity, and responsiveness of the lower extremity functional scale for inpatients of an orthopaedic rehabilitation ward.
        J Orthop Sports Phys Ther. 2009; 39: 468-477
        • Hays R.D.
        • Sherbourne C.D.
        • Mazel R.M.
        The RAND 36-item health survey 1.0.
        Health Econ. 1993 Oct; 2: 217-227
        • Tylka J.
        • Piotrowicz R.
        Quality of life SF-36 questionnaire – the Polish version.
        Kardiol Pol. 2009; 67: 1166-1169
        • Terwee C.B.
        • Bot S.D.M.
        • de Boer M.R.
        • van der Windt D.A.W.M.
        • Knol D.L.
        • Dekker J.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Mokkink L.B.
        • Terwee C.B.
        • Patrick D.L.
        • Alonso J.
        • Stratford P.W.
        • Knol D.L.
        • et al.
        The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes.
        J Clin Epidemiol. 2010; 63: 737-745
        • McHorney C.A.
        • Ware J.E.
        Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study Short-Form 36-Item Heamed.
        Survey. Med Care. 1995 Jan; 33: 15-28
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        L. Erlbaum Associates, Hillsdale, N.J.1988
        • In T.S.
        • Jung J.H.
        • Jung K.S.
        • Cho H.Y.
        The reliability and validity of the Korean version of the lower limb functional index.
        J Phys Ther Sci. 2018; 30: 50-52
        • Duruturk N.
        • Tonga E.
        • Gabel C.P.
        • Acar M.
        • Takindal A.
        Cross-cultural adaptation, reliability and validity of the Turkish version of the lower limb Funcional index.
        Disabil Rehabil. 2015; 37: 2439-2444
        • Hernandez-Sanchez S.
        • Korakakis V.
        • Malliaropoulos N.
        • Moreno-Perez V.
        Validation study of the functional assessment scale for acute hamstring injuries in Spanish professional soccer players.
        Clin Rehabil. 2019; 33: 711-723