COSMIN database

Evaluation of outcome measures for use in clinical practice for adults with musculoskeletal conditions of the knee: A systematic review

Howe, T. E., Dawson, L. J., Syme, G., Duncan, L., and Reid, J.
BACKGROUND: This systematic review reported on the clinimetric properties of outcome measures for use in clinical practice for adults with musculoskeletal conditions of the knee.

METHODS: A systematic search was performed in Medline, EMBASE, Cinahl and AMED to identify studies examining the clinimetric properties of outcome measures for adults undergoing conservative treatment of ligament injuries, meniscal lesions, patellofemoral pain and osteoarthritis of the knee. Outcomes measures taking less than 20 min to administer and requiring minimal equipment and space were included. Pairs of authors used a checklist to record the characteristics of the outcome measures, their reported clinimetric properties and the demographics of the study populations. The OMERACT filters of 'truth' and 'discrimination' were applied to the data for each outcome measure by an expert panel.

RESULTS: Forty-seven studies were included evaluating 37 outcome measures. Ten outcome measures had adequate supporting evidence for 'truth' and 'discrimination': AAOS, AKPS, goniometer measurement, IKDC, KOOS, LEFS, Lysholm, Tegner, WOMAC and WOMET. However none of the outcome measures had been comprehensively tested across all clinimetric properties.

CONCLUSION: Despite the widespread use of some outcome measures in clinical practice and primary research, data on the clinimetric properties were available for only 37 and of these only 10 had adequate supporting evidence for use in this population. However, before a core set of outcome measures can be recommended use in clinical practice, for adults with musculoskeletal conditions of the knee, consensus should be obtained on 'feasibility' in terms of burden on the clinician and the participant
Publication year:
Biological and physiological variables:
Biological and physiological variables
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
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
AAOS Hip and Knee Questionnaire - American Academy of Orthopedic Surgeons Hip and Knee Questionnaire
AKPS - Anterior Knee Pain Scale [alias: KPS - Kujala Patellofemoral Score Questionnaire]   
ALF - Aggregated Locomotor Function
AQoL - Assessment of Quality of Life
CKRS - Cincinnati Knee Rating System
EKFS - Edinburgh Knee Function Scale
EQ-5D - EuroQoL-5 Dimensions   
FIQ - Funtional Index Questionnaire
Goniometry / Goniometer   
HAP - Human Activity Profile
HSS - Hospital for Special Surgery
ICOAP - Intermittent and Constant OsteoArthritis Pain   
IKDC Subjective Knee Form - International Knee Documentation Committee Subjective Knee Form
Indices of severity (algo-functional indices) for OA of the Knee
J-MAP - Joint-Specific Multidimensional Assessment of Pain
KneST - Knee Pain Screening Tool
KOOS - Knee injury and Osteoarthritis Outcome Score   
KOS-AoDL - Knee Outcome Survey- Activities of Daily Living Scale
KQoL-26 - Knee Quality of Life 26-item
KSS - Kneescore of the Knee Society / Knee Society Score
LEFS - Lower Extremity Function Scale
Level walking
Lysholm (Knee) Score   
OKS - Oxford Knee Score   
Patellofemoral Pain Syndrome Impairment Tests
PSFS - Patient-Specific Functional Scale   
PSS - Patellofemoral Pain Syndrome (PFPS) Severity Scale
QoL-ACL - Quality of Life Outcome Measure for Anterior Cruciate Ligament Deficiency
Self paced walk
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SRQ - Self-Report Questionnaire
SW - Stair Walk
Tegner Score   
TUG - Timed Up and Go test   
VAS - Visual Analogue Scale   
WOMAC - Western Ontario and McMaster Universities Osteoarthritis Index (Also I-WOMAC - Individualized WOMAC)   
WOMET - Western Ontario Meniscal Evaluation Tool