The Lower Extremity Functional Test (LEFT): Normative and Epidemiologic Data in a Collegiate Female Athlete Population Jason Brumitt, PT, PhD, ATC, CSCS; Bryan Heiderscheit, PT, PhD; Rob Manske, DPT, MEd, SCS, ATC; Paul Niemuth, PT, DSc, OCS, ATC; Alma Mattocks, MS, ATC; Mitchell J Rauh, PT, PhD, MPH, FACSM INTRODUCTION MATERIALS & METHODS CONTINUED RESULTS continued Table 1. Injury Rates and Injury Severity, Female Division III Collegiate Athletes The lower extremity functional test (LEFT) is a functional performance test (FPT) that has been used as a component of a return to sport rehabilitation testing algorithm.1 Average reported times for males to complete the LEFT is 100 s (range 90 s to 125 s) and 135 s (range 120 s to 150 s) for females.1 Despite its use in clinical rehabilitation, there are few reports available providing normative data or efficacy for the LEFT in assessing athletic readiness in different sport populations.1,2 Each subject completed a 5 minute dynamic warm-up prior to testing. The LEFT consisted of 8 agility drills performed on a diamond shaped course (9.14 m by 3.05 m) (Figure 1). Subjects were provided verbal instructions during the test describing each subsequent task and the corresponding direction of movement. Time was recorded in seconds using a standard stop-watch.  Injury Category Total _________________________ No. AEs Rate  Female Athletes LEFT 118 (s) or more LEFT 117 (s) or less  Rate Ratio* (95% Confidence Interval)  Onset Initial Subsequent 24 6400 3.8 8 771 10.4 32 7171 4.5   13 2718 4.8 7 402 17.4 20 3120 6.4 11 3682 3.0 1 369 2.7 12 4051 3.0 1.6 (0.7, 3.6) 6.4 (0.9, 52.2) 2.2 (1.1, 4.4)  Severity < 8 d time loss ≥ 8 d time loss 23 7171 3.2 9 7171 1.3 19 3120 6.1 1 3120 0.3 4 4051 1.0 8 4051 2.0 6.2 (2.1, 18.1) 0.2 (0.0, 1.3) Figure 1. Lower Extremity Functional Test – the 8 multidirectional skills. per 1000 AEs * LEFT 118 or more vs. LEFT 117 or less. Incidence rates for total time loss LQ injuries for female athletes who completed the LEFT in 118 seconds or more were twice as high than those who completed the LEFT in 117 seconds or less (RR = 2.2, 95% CI = 1.1, 4.4; p = 0.03) Slower female athletes (LEFT ≥ 118 seconds) experienced significantly greater subsequent LQ time-loss injuries (RR = 6.4, 95% CI = 0.9, 52.2; p = 0.05) than faster female athletes (LEFT ≤ 117 seconds) Slower female athletes (LEFT ≥ 118 seconds) experienced significantly greater minor LQ time-loss injuries (RR = 6.2, 95% CI = 2.1, 18.1; p ≤ 0.0001) than faster female athletes PURPOSE The purpose of this study was to provide normative data for the LEFT and to examine its ability to discriminate sport-related lower quadrant (LQ) injury occurrence among Division III collegiate student-athletes. Figure 2. Kaplan-Meier Survival Curve, Female D III Athletes CONCLUSION MATERIALS & METHODS LEFT scores are associated with LQ injury in Division III collegiate female athletes. We suggest that the LEFT could be used as a preseason functional test to identify female athletes who may be at an increased risk for thigh or knee injury. One-hundred and six Division III female collegiate athletes were prospectively followed during their sport season. Each athlete performed the LEFT during the preseason. The university’s athletic training team recorded injury location and time-loss from sport in athletes who sustained a low back or lower extremity injury. RESULTS Mean score (s) 117 ± 10 Females who completed the LEFT in 118 s or more were 6 times more likely to incur a thigh or knee injury than female athletes who completed the LEFT in 117 seconds or less3 OR= 6.4, 95% CI: 1.3, 31.7; p = 0.01 LITERATURE CITED 1. Davies GJ, Zillmer DA. Functional progression of a patient through a rehabilitation program. Orthop Phys Ther Clin North Am. 2000; 9: 103-118. 2. Tabor MA, Davies GJ, Kernozek TW, Negrete RJ, Hudson V. A multicenter study of the test-retest reliability of the lower extremity functional test. J Sport Rehabil. 2002; 11: 190-201.   3. Brumitt J, Heiderscheit BC, Manske RC, Niemuth PE, Rauh MJ. Lower extremity functional tests and risk of injury in division iii collegiate athletes. Int J Sports Phys Ther. 2013; 8: 216-227. Faster female athletes were more apt to LQ injury early in the season (AEs = 25, 95% CI: 14.5, 35.5) than slower female athletes.