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Patient-reported outcome measures for the knee.
Dean Wang1, Morgan H Jones, Mahmoud M Khair
1Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. wangd@ccf.org
The Journal of Knee Surgery
|February 19, 2011
Summary
This systematic review evaluated patient-reported outcome measures for knee conditions. While many knee instruments show good reliability and validity, no single score fits all knee disorders, necessitating condition-specific selection.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Biostatistics
Background:
- Growing number of knee instruments and rating scales for patient-reported outcomes over the past two decades.
- Limited evaluation of these instruments for reliability, validity, and responsiveness.
- Need for psychometric evidence to guide selection of appropriate patient-reported outcome measures (PROMs).
Purpose of the Study:
- To systematically review the psychometric evidence of knee-specific patient-reported outcome measures.
- To identify the most suitable outcome scores for various specific knee conditions.
Main Methods:
- Conducted a literature search for studies on the development and evaluation of knee instruments.
- Identified 24 unique knee-specific instruments.
- Assessed psychometric properties including reliability (internal consistency, test-retest), validity (face, content, construct), and responsiveness.
Main Results:
- Most identified instruments demonstrated satisfactory internal consistency (alpha > 0.82) and test-retest reliability (ICC > 0.80).
- Face/content validity was typically addressed during item development; construct validity was assessed via hypothesis testing or correlations.
- Many instruments showed large effect sizes and standardized response means (> 0.80) for responsiveness in disease-specific populations.
Conclusions:
- Recommended specific instruments for various knee conditions: Cincinnati Knee Rating System, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score for ACL injuries; Kujala Anterior Knee Pain Scale for anterior knee pain; International Knee Documentation Committee (IKDC) Subjective Knee Form, KOOS, Lysholm for chondral defects; Western Ontario Meniscal Evaluation Tool (WOMET) for meniscal injuries; KOOS for osteoarthritis (OA).
- No single instrument is universally applicable across all knee disorders and patient groups.
- Clinicians and researchers must consider the specific patient population when selecting a knee outcome measure; a diagnostic algorithm approach may offer a solution for universal applicability.
