Hi there

You can download a spreadsheet direct from the KOOS site, which has all the formulas already plugged in, you just need to enter the score. See the attached link.

The KOOS site www.koos.nu also has guides on scoring and how to use the subscales. It's the best place to go for info on this.

Good luck!

David

http://www.koos.nu/KOOS2012.xls

Dear Sir David, Thank you so much. it is really helpful.It contains many rows it means many patients data can be entered in same file and score will be obtained at the end? please just clarify one thing, while entering data Symptom subclass comes first but at the end where score is obtained pain subclass  score comes first? I hope there will be no effect of this on accuracy of my data scoring. Thanks again sir

Yes, you can put many patients in the one spreadsheet and it will calculate each row separately.

I'm not sure why they have the pain subclass first in the scoring. Maybe they see that as most important? Since you have identified this you will need to make sure you keep it in mind when reporting.

Hope it goes well

david

Dear Sir David,

Many thanks. Its of great help. God bless.tc

Dear Kanwal

I sending a manuscript

Amelia

Dear Madam Amelia, Thanks for manuscript.

Just to ask for your opinion, i am using KOOS not to access any post treatment effect but to access quality of life of primary knee osteoarthritis patients and their pain score. what is your opinion about the use of KOOS for this purpose? thanks 

Kanwal

The Knee injury and Osteoarthritis Outcome Score (KOOS) is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life.  I think  is possible to use KOOS.

Dr. Kanval, I agree entirely with Dr. Amelia Markes and Dr. Schmidt. KOOS is a good tool for your work tasks.

thnx Dr Panayat Tanchev

We have evaluated the outcomes measures proposed by the American physical Therapy Association and compiled information about each for use in our clinic and to educate our therapists on their use, strengths and weaknesses. Below you will find the information on the KOOS:

KNEE INJURY AND OSTEOARTHRITIS

OUTCOME SCORE (KOOS)

KOOS

We use the Knee injury and Osteoarthritis Outcome Score (KOOS), English version LK1.0, questionnaire. It is three pages long and scoring and other information from Collins NJ, D Misra, DT Felson, KM Crossley, EM Roos. Measures of Knee Function. Arthritis Care & Research. 63(S11): S208–S228, 2011; and the KOOS User's Guide 2003 are presented below.

Purpose of the Knee injury and Osteoarthritis Outcome Score is: to measure patients’ opinions about their knee and associated problems over short- and long-term follow-up (1 week to decades). (pg. S213)

Intended populations/conditions. Young and middle-aged people with posttraumatic osteoarthritis (OA), as well as those with injuries that may lead to posttraumatic OA (e.g., anterior cruciate ligament [ACL], meniscal, or chondral injury) (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. 28:88–96, 1998.). (pg. S213)

Version. The original KOOS remains unchanged.

KOOS includes WOMAC Osteoarthritis Index LK 3.0 [Bellamy N, WW Buchanan, CH Goldsmith, J Campbell, LW Stitt: Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 15:1833-40, 1988.] in its complete and original format (with permission), and WOMAC scores can be calculated. WOMAC is valid for elderly subjects with knee OA.

KOOS Manual scoring sheet

Instructions:

Assign the following scores to the boxes:

None o             Mild o        Moderate o         Severe o          Extreme o

0                         1                      2                      3                      4

Missing data. If a mark is placed outside a box, the closest box is chosen. If two boxes are marked, that which indicated the more severe problems is chosen. Missing data are treated as such; one or two missing values are substituted with the average value for that subscale. If more than two items are omitted, the response is considered invalid and no subscale score is calculated.

Sum the total score of each subscale and divide by the possible maximum score for the scale. Traditionally in orthopedics, 100 indicates no problems and 0 indicates extreme problems.

The normalized score is transformed to meet this standard. Please use the formulas provided for each subscale!

1. PAIN: 100 – [(Total score P1-P9 x 100)/36] = 100 – (∑ P1 – P9 x 100/36) = ______

2. SYMPTOMS:100 – [(Total score S1-S7 x 100)/28] = 100 – (∑ S1 – S7 x 100/28) = ______

3. ADL: 100 – [(Total score A1-A17 x 100)/68] = 100 – (∑ A1 – A17 x 100/68) = ______

4. SPORT&REC: 100 – [(Total score SP1-SP5 x 100)/20] = 100 – (∑ SP1 – SP5 x 100/20) = ______

5.QOL: 100 – [(Total score Q1-Q4 x 100)/16] = 100 – (∑ Q1 – Q4 x 100/16) = ______

 WOMAC: How to score from the KOOS

Assign scores from 0 to 4 to the boxes as shown above. To get original WOMAC scores sum the item scores for each subscale. If you prefer percentage scores in accordance with the KOOS, use the formula provided below to convert the original WOMAC scores.

Transformed scale = 100 – [(actual raw score x 100)/Possible raw score range]

WOMAC subscores              Original score =                                   Possible                                                                                              sum of the following items                     raw score range

Pain                                          P2-P6                                                  20

Stiffness                                    S6-S7                                                    8

Function                                   A1-A17                                               68

Ability to detect change. The KOOS appears to be responsive to change in patients with a variety of conditions that have been treated with nonsurgical and surgical interventions. In patients who have undergone partial meniscectomy, 3 months previously, large effect sizes are seen on all but the ADL subscale. Large effect sizes are seen in all subscales 6 months after ACL reconstruction. Three years following autologous chondrocyte implantation or microfracture, large effect sizes are seen for the pain, sport/recreation, and QOL subscales, and moderate effects on the symptoms and ADL subscales. In those with knee OA who have undergone physical therapy treatment, large effect sizes are seen at 4 weeks on the pain, symptoms, and ADL subscales, while the sport/recreation and QOL subscales show moderate effects. Large effect sizes are consistently reported on all subscales 3–12 months after TKR. The minimum clinically important difference (MCID) and patient-acceptable symptom state (PASS) have not been calculated in any patient population. (pg. S214 – S215).

According to the KOOS website as of 7/22/2014 (www.koos.nu): The Minimal Detectable Changes in patients with knee injury were for Pain 6-6.1, for Symptoms 5-8.5, for ADL 7-8, for Sport/Rec 5.8-12, and for QOL 7-7.2. The Minimal Detectable Changes in patients with knee OA were for Pain 13.4, for Symptoms 15.5, for ADL 15.4, for Sport/Rec 19.6, and for QOL 21.1 (3).

The Minimal Important Change (MIC) is currently suggested to be 8-10. However, the current understanding is that MIC is dependent on factors such as patient group, intervention and time to follow-up. Thus most likely there is no such thing as one MIC value for an instrument. Research is ongoing, please refer to FAQ for more complete information.

Strengths. The KOOS has undergone a substantial amount of psychometric testing, largely among populations for whom the scale was intended. Establishment of the KOOS as a reliable and valid measure across multiple languages highlights its usefulness as a patient-reported measure of knee function for people with knee OA and various combinations of ACL, meniscal, and cartilage injury. The use of individual scores for each subscale, rather than an aggregate score, enhances clinical interpretation and in research acknowledges the impact of different interventions on different dimensions (e.g., exercise therapy is likely to have more impact on ADL and sport/recreation, while pharmacology may impact more on pain and symptoms) and ensures content validity in groups of different ages and functional activity levels (pg. S215).

Caveats and cautions. The KOOS has not been validated for interview administration, meaning that it may not be appropriate for patients who are unable to read or write, or where telephone follow-up is necessary. Rasch analysis suggests that only the subscales that are not based on the WOMAC exhibit unidimensionality in patients who have undergone ACL reconstruction. When administering the KOOS in older or less physically active individuals, higher level components of the ADL and sport/recreation subscales may not be applicable, and could result in missing data. It may be appropriate to leave out the sport/recreation subscale in those with more advanced disease or disability; however, doing so omits the ability to measure improvements seen in these more demanding functions following treatment. The MCID is lacking from psychometric evaluation (pg. S215).

Clinical usability. The KOOS is freely available online. Administration and scoring burden are minimal. Clinicians should bear in mind that the sport/recreation subscale may not be applicable for less physically active patients, and may not have adequate test–retest reliability in individuals with knee injuries. (pg. S215).

Research usability. The KOOS fulfills desired criteria for research outcomes, demonstrating adequate reliability for use in groups and validity when used in those with knee injuries and knee OA. The inclusion of the 3 WOMAC subscales facilitates comparison of findings with studies that have utilized the WOMAC as a primary measure. The lack of reported MCID in any knee condition is a weakness. (pg. S215).

How to obtain. The KOOS and associated documentation are freely available at www.koos.nu (pg. S213).

Dear Fred Victor

thanks for your answer. I have got this sheet and calculate it via excel sheet. When I was presenting my work someone asked me why 100 indicates no problem while 0 indicates extreme problem as normally 0 indicate no problem. Can you add something on this?

There appears to have been a movement in physical therapy to reverse the scoring of functional PRO measures, like the KOOS, and have 0 be no problems and 100 be worst possible result. There are mathematical procedures to reverse the scoring to the traditional 0 is worst, 100 is best scoring. Since each section of the KOOS is independent one example is sufficient: under the scoring of the KOOS 0 = no problem, 4 = extreme difficulty, for the PAIN subsection if you subtract the sum of the 9 PAIN questions multiplied by 100 and divided by 36 (maximum score for the PAIN subsection) from 100 the resultant score will reverse the scoring so that it is a score of function based on 100 being best and 0 being worst. For example: the patient scored 36 on the PAIN subscale (extreme PAIN on all 9 questions) traditionally this would be registered as a score of 0 for PAIN, the worst possible score. Using the formula: 100 - [(36 x 100)/36] = 100 - [3600/36] = 100 - 100 = 0, you have converted the score to the more traditional type of score for outcomes in orthopaedics.

A number of the current PRO measures require this reverse scoring to produce a more "logical" outcome score. There is, to my knowledge, no published rationale for using the 100 is bad, 0 is good scoring used in some of the more recent outcomes measures, but most reviews and analyses of the measures include formulae to produce "reversed" results that comply with traditional 100 is good, 0 is bad scoring. The only thing you must always do is acknowledge your use of score reversing measures that allow "translation" of the results into the more traditional scoring methodology and interpretation. 

As you have already seen, if you report things as 100 is good, 0 is bad people intuitively grasp the information, it is only when you use the 0 is good and 100 is bad that questions arise.

Dear Harding,

Thanks. But i am finding any reference to know that why 0 indicate extreme problem while 100 indicates no problem in orthopedic opposite to instruments in rheumatology? I have seen during data collection 0 indicate no problem and 4 indicate extreme problem but i want to know the reason why we reverse the scores?

In my experience, which is primarily in orthopaedics and exercise science, 100 is usually good and 0 is bad, the reason is probably because in sports higher scores are considered better. In rheumatology, no symptoms are better than many symptoms, so in reality it is probably just a case of how one views the world. Is the cup half empty or half full? I do know from my study of PRO measures in orthopaedics most are scored with higher scores being evidence of better function and lower scores being evidence of poorer function.  With measures developed more recently the scoring is reversed to be similar to what you describe in rheumatology. With the newer measures, most, if not all, give procedures to reverse the scoring to compare it among various PRO measures. The why, probably comes down to how the people in the profession view the world as I related above; because in making decisions based on mainly subjective measures you are free to choose your own measurement system and scaling. 

I would recommend the official homepage for the KOOS score: http://www.koos.nu/kooslanguage.html

"100 indicating no symptoms and 0 indicating extreme symptoms"

I recommended the manucript  about Koos validation