COSMIN database

Patient-assessed health instruments for the knee: a structured review

Garratt, A. M., Brealey, S., Gillespie, W. J., and Team, Damask Trial
OBJECTIVES: To identify patient-assessed health instruments specific to the knee and review evidence for reliability, validity and responsiveness.

METHODS: Instruments were identified through systematic searches of the literature. Information relating to instrument content, patient population, reliability, validity and responsiveness was extracted from published papers.

RESULTS: The 16 instruments that met the inclusion criteria varied in length from 4 to 42 items. The majority form a single index; six produce a profile of scores. Eight have been evaluated in patients with a variety of knee problems. All instruments have satisfactory internal or test-retest reliability. However, there is limited empirical support for the health domains of six instruments. Patients informed the development of items within just five instruments. Few authors gave explicit consideration to the size of expected relationships in tests of construct validity. Eleven instruments have evidence for responsiveness to changes in health. The minimally important difference was not determined for any of the instruments.

CONCLUSIONS: In the absence of comparative evidence, the large number of patient-assessed instruments for knee problems makes instrument selection difficult. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Pain Scale and Oxford Knee Score have good evidence for reliability, content validity and construct validity. The KOOS and Oxford instruments also have evidence for responsiveness. The instruments have not been evaluated for all knee problems, and instrument appropriateness, including content relevance, must be assessed before application. The comparative evaluation of instruments is recommended.
Rheumatology (Oxford)
1462-0324 (Print)
Publication year:
Symptom status:
Physical state
Functional status:
Physical functioning
General health perceptions / HRQoL:
Health-related quality of life
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
6 - Clinical rating scales
AKPS - Anterior Knee Pain Scale [alias: KPS - Kujala Patellofemoral Score Questionnaire]   
ARS - Activity Rating Scale
CKRS - Cincinnati Knee Rating System
EKFS - Edinburgh Knee Function Scale
IKDC Subjective Knee Form - International Knee Documentation Committee Subjective Knee Form
Knee Pain Scale
Knee Severity Index
Knee Vas
KOOS - Knee injury and Osteoarthritis Outcome Score   
KOS-AoDL - Knee Outcome Survey- Activities of Daily Living Scale
LEAP - Lower Extremity Activity Profile
Lysholm (Knee) Score   
OKS - Oxford Knee Score   
QoL-ACL - Quality of Life Outcome Measure for Anterior Cruciate Ligament Deficiency
Sports Knee Rating Scale