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	Subject of the scale: Hip - knee

Knee injury and Osteoarthritis Outcome Score (KOOS)		Download / Print : PDF

This is a Swedish self-assessment questionnaire published in 1998 (Roos et al. 1998) which evaluates the patient's opinion about his knee and the associated problems.

The KOOS assesses the consequences of the knee injury in both the short and the long term, and the consequences of gonarthrosis.

It contains 42 items divided into five sub-sub-scales:
KOOS Pain, KOOS Symptoms, Function in daily living (KOOS ADL), Sport (KOOS Sport) and Knee related quality of life (KOOS QOL). The total scores can vary from 0 to 100.

> Access to the scale is free.

Criteria	Psychometric properties		References
Validity	Face validity		[3]
	Content validity		[3]
	Criterion validity	Concurrent validity
		Predictive validity
	Construct validity	Convergent validity	[5]
		Divergent validity
		Discriminant validity (sensitivity and distinctiveness)
Reliability	Intra-rater reliability		[5]
	Inter-rater reliability
	Test-retest		[2]
Internal consistency (alpha)			[2] [5]
Responsiveness			[6]

General comment on reliability:

The construct validity has been assessed in a manner open to dispute, since it was only compared to the SF36 [1].
The advantage of this scale is that it is a self-assessment questionnaire.
However its slightly complicated method of calculation, the absence of assurance of a correct construct validity, and the absence of comparison with the scales traditionally used could be criticised.

Reference update:

To notify us of a missing reference, please use: contact@scale-library.com

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Olivier UCAY :

References: Inaugural references: [1] Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. août 1998;28(2):88 96 Psychometric references: [2] Roos EM, Toksvig-Larsen S: Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 2003, 1:17 [3] Collins, N. J., D. Misra, et al. (2011). "Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS)." Arthritis care & research 63 Suppl 11: S208-228. [4] Tanner, S. M., K. N. Dainty, et al. (2007). "Knee-specific quality-of-life instruments: which ones measure symptoms and disabilities most important to patients?" Am J Sports Med 35(9): 1450-1458. [5] Salavati, M., B. Akhbari, et al. (2011). "Knee injury and Osteoarthritis Outcome Score (KOOS); reliability and validity in competitive athletes after anterior cruciate ligament reconstruction." Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 19(4): 406-410 [6] Collins, N. J. and E. M. Roos (2012). "Patient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a "good" measure." Clinics in geriatric medicine 28(3): 367-394. [8] Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. oct 2001;29(5):600 13. [9] Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC, et al. Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. oct 2006;34(10):1567 73 [10] Roos, E. M. and S. Toksvig-Larsen (2003). "Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement." Health Qual Life Outcomes 1(1): 1

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< Back	Subject of the scale: Hip - knee

Lysholm Score and Tegner Activity Scale		Download / Print : PDF

The Lysholm score [1] comprises eight items. Its total of 100 points are divided as follows: limp five points, walking support five points, squatting five points, stair climbing ten points, swelling ten points, locking and catching of the knee 15 points, stability 25 points, pain 25 points.

The result is considered as very good and good for a total score between 84 and 100 points, average between 65 and 83 points, and poor below 65 points.

It was created initially to monitor ligamentoplasty of the ACL, then was used in monitoring other knee conditions (chondropathy [27], meniscus syndrome [12]).

The Tegner activity-level scale [1] is a scale of physical sports and professional activities: from 0 (sick leave or disability pension because of knee problems) to 10 (competitive sports soccer, football, rugby (national elite)).

The scale was initially developed to measure activity following knee injuries, and was validated for monitoring ACL ruptures in ligamentoplasty [2].

> Access to the scale is free.

Criteria	Psychometric properties		References
Validity	Face validity		[3] [4] [6]
	Content validity		[3] [4]
	Criterion validity	Concurrent validity	[3] [4]
		Predictive validity	[5] [6]
	Construct validity	Convergent validity	[5] [6]
		Divergent validity	[5] [6]
		Discriminant validity (sensitivity and distinctiveness)
Reliability	Intra-rater reliability		[1] [3] [4] [6]
	Inter-rater reliability		[1] [3] [4] [6]
	Test-retest		[1] [3] [4] [6]
Internal consistency (alpha)			[3] [4] [6]
Responsiveness			[3] [4]

General comment on reliability:

The Lysholm and Tegner scores have shown acceptable test-retest reliability (ICC = 0.9 and 0.8 respectively), floor and ceiling effects, criterion validity, construct validity and sensitivity to change (minimal change detectable of 8.9 for Lysholm and 1 for Tegner).
The Lysholm is correlated with the IKDC (r = .8) and the SF 12 (r = .4) and the Tegner is correlated with the SF 12 (r = .2).
There are ceiling effects that are too high (> 30 %) in the Lysholm score for the limp, instability, support and locking items.

Reference update:

To notify us of a missing reference, please use: contact@scale-library.com

Knee injury and Osteoarthritis Outcome Score (KOOS)

Subjective International Knee Documentation Committee (IKDC) scores

SF36

SF 12

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Olivier UCAY :

Inaugural references:

[1] Tegner,Y., Lysholm,J. Rating systems in the evaluation of knee ligament injuries. Clin. Orthop., 1985, 198, 43-49

[2] Tegner Y, Lysholm J, Odensten M, Gillquist J. Evaluation of cruciate ligament injuries. Acta Orthop Scand 1988;59(3):336-

Psychometric references:

[3] Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. mai 2009;37(5):890?7.

[4] Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 2006;88:698705.

[5] Briggs KK, Steadman JR, Hay CJ, Hines S. Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 2009;37(5):898901.

[6] Paxton EW, Fithian DC, Stome ML, Silva P. The reliability and validity of knee specific and general health instruments in assessing acute patella dislocation outcomes. Am J Sports Med 2003;31(4):48792.

[7] Chaory K, Poiraudeau S. [Rating scores for ACL ligamentoplasty]. Ann Réadapt Médecine Phys Rev Sci Société Fr Rééduc Fonct Réadapt Médecine Phys. août 2004;47(6):309?16.