COMBI >> Scales >> Level of Cognitive Functioning Scale >> Properties


Tamara Bushnik , PhD, Santa Clara Valley Medical Center at

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Bushnik, T. (2000). The Level of Cognitive Functioning Scale. The Center for Outcome Measurement in Brain Injury.
combi/lcfs ( accessed ).*

*Note: This citation is for the COMBI web material. Dr. Bushnik is not the scale author for the LCFS.





LCFS Properties

Reliability of the LCFS
Inter-rater reliability for the LCFS was assessed among three raters in 40 TBI patients admitted to an acute rehabilitation facility (Gouvier et al, 1987). An average Spearman rho correlation coefficient of 0.89 was obtained. Test-retest reliability of the LCFS was established in the same sample by Gouvier et al, 1987. In tests administered on sequential days, a Spearman rho correlation coefficient of 0.82 was obtained.

Validity of the LCFS
Predictive and concurrent validity was established in 40 TBI patients admitted to an acute rehabilitation facility (Gouvier et al, 1987). Predictive validity of the LCFS at admission was assessed by correlations with discharge Stover Zeiger (r=0.59), discharge Glasgow Outcome Scale (r=0.57), and discharge Expanded Glasgow Outcome Scale (r=0.68). Discharge concurrent validity was measured by correlating the discharge ratings on the LCFS and Stover Zeiger scale (r=0.73), Glasgow Outcome Scale (r=0.76), and Expanded Glasgow Outcome Scale (r=0.79). Admission concurrent validity between the LCFS and the Stover Zeiger Scale was established as r=0.92.

Use of the LCFS to predict employment
Successful return to work one year after a TBI was assessed in a sample of 132 individuals who had been employed prior to the TBI and had been admitted to an acute rehabilitation facility (Cifu et al, 1997). Those subjects who returned to work one year after injury had a significantly higher admission LCFS (mean LCFS=5.6) than those who were unemployed one year after the TBI (mean LCFS=4.9). Similarly, discharge LCFS was significantly higher in subjects who returned to work (mean LCFS=7.2) versus unemployed subjects (mean LCFS=6.7).

In a study of 57 consecutive admissions to an inpatient brain injury program, the effectiveness of a number of rating scales in predicting return to work/school after rehabilitation was examined (Rao and Kilgore, 1992). Admission and discharge LCFS scores correctly predicted 86.8% of the patients who returned to work/school and 63.2% of patients who did not return to work/school. The resultant cost/benefit ratio was 0.18.

Vocational readiness was assessed in 76 subjects with moderate or severe TBI in a multi-disciplinary clinic (Mysiw et al, 1989). Subjects, who were an average of 25 months post-injury, were rated on the LCFS by clinic staff and were evaluated by the physician and placed in one of four categories: return to work; vocational training; supported work; and continued remedial therapy. The LCFS was able to discriminate between those subjects who were the most severely affected and required remedial therapy and each of the other three groups. However, the LCFS could not distinguish between those subjects who were deemed ready to return to work, those who required vocational training, and those who required supported work.


Additional Outcome Studies using the LCFS
The LCFS was one of several outcome measures (including the DRS and FIM) used to examine functional outcomes in older adults with TBI (Cifu et al, 1996). At the time of admission to an inpatient rehabilitation program, older adults (>55 years of age) had a similar mean LCFS ranking (5.17+/-1.15) to younger adults (5.28+/-1.36). While lengths of stay for the older group were significantly longer than the younger group, 89.4+/-68.87 days versus 54.6+/-47.63 days, respectively, the older adults had a significantly lower LCFS rank (6.40+1.26) than the younger adults (7.09+/-0.84). It was concluded that while older persons could demonstrate functional changes, significantly higher costs of change were incurred by this group when compared to younger adults.

Discharge LCFS level was used as the major outcome measure to predict cognitive improvement using admission examination factors obtained during a comprehensive mental status and physical examination (Finch et al, 1997). Forty-six patients who had suffered a TBI and were admitted to an inpatient rehabilitation program were evaluated. LCFS level at discharge was significantly correlated (r=0.47) with the presence of higher cognitive functions at admission (as measured by ability to abstract and backward digit repetition). The correlation between admission and discharge LCFS level was 0.35; while this did not reach statistical significance, it was accounted for by the fact that admission Rancho was also correlated with the presence of higher cognitive functions at admission.


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