Patient-reported outcome measure
Knee Outcome Survey Calculator
Knee Outcome Survey — Activities of Daily Living Scale and Sports Activity Scale
The Knee Outcome Survey is a patient-reported measure of knee function with two scales — a 14-item Activities of Daily Living Scale and an 11-item Sports Activity Scale — each item scored 5 to 0 and expressed as a percentage of the maximum, so that 100% means no symptoms and no functional limitation.
What the Knee Outcome Survey score means
Knee Outcome Survey totals run from 0 to 100, where a higher score is better. No severity bands are shown because no cut-offs have been published that we can verify — read the total against the source studies and your own protocol, as described below.
How the score is calculated
Stated in full so the calculation can be independently checked, and reproduced by hand if needed.
Every item has six response columns, scored 5 for the first (no symptom, or not difficult) down to 0 for the last (the symptom prevents all activity, or the patient is unable to do the activity). The Activities of Daily Living Scale has 14 items — six symptoms (pain, stiffness, swelling, giving way, weakness and limping) and eight activities (walking, going up stairs, going down stairs, standing, kneeling, squatting, sitting with the knee bent and rising from a chair) — so the maximum is 70. Its score is the item total divided by 70 and multiplied by 100. The Sports Activity Scale has 11 items — seven symptoms and four activities (running straight ahead, jumping and landing, stopping and starting quickly, and cutting and pivoting) — so the maximum is 55, and its score is the item total divided by 55 and multiplied by 100. A higher percentage means better function. The original form also asks for a 0 to 100 global rating of current knee function and two overall ratings of function and activity level; these are not part of either scale score.
Missing data
No missing-data rule has been published for either scale, so a score is shown only when every item of that scale is answered. A prorated score is not comparable with published figures.
Instrument profile
- Developer
- James J. Irrgang, Lynn Snyder-Mackler, Robert S. Wainner, Freddie H. Fu and Christopher D. Harner
- Institution
- University of Pittsburgh, United States
- First published
- 1998
- Custodian
- No active custodian known to us
- Items
- 25
- Response format
- Six response columns per item, scored 5 to 0
- Score range
- 0 to 100
- Direction
- Higher score = better
- Recall period
- The last 1 to 2 days
- Completion time
- About 5 minutes
- Age range
- Adults
- Regions
- Knee
- Conditions
- ACL injury, Meniscal injury, Knee osteoarthritis, Knee ligament injury
- Procedures
- ACL reconstruction, Meniscectomy, Meniscal repair, Total knee arthroplasty, Knee rehabilitation
- Languages
- English
- Validity
- Developed and tested in patients with a range of knee disorders, including ligament and meniscal injury, patellofemoral pain and osteoarthritis. It is widely used after ACL injury and reconstruction.
- Responsiveness
- Used to follow recovery of knee function after injury and surgery. No minimal clinically important difference is shown here because we could not verify a published value.
- Ceiling effect
- Likely in active patients late in recovery, which is why the separate Sports Activity Scale exists.
When to use the Knee Outcome Survey
Well suited to
- Following knee function in rehabilitation after ACL injury, meniscal injury or knee surgery, where the Knee Outcome Survey is the form the comparison literature used.
- Pairing a daily living score with a sports score in a patient whose daily function has recovered but whose sport has not.
Limitations and poor fits
- Choosing a primary outcome for a new study where a knee-specific measure with published thresholds, such as the KOOS or IKDC, would let results be interpreted more easily.
- Comparing with a series that used a 16-item or otherwise altered form of the daily living scale.
- Judging whether an individual patient has improved meaningfully: no minimal clinically important difference is shown here.
Knee Outcome Survey compared with other instruments
Instruments measuring a related construct, with the practical difference between them.
| Instrument | Items | Range | What it adds |
|---|---|---|---|
| KOOS | 42 | 0–100 | The KOOS is a 42-item patient-reported questionnaire that scores knee function as five separate subscales — Symptoms, Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life — each from 0 (extreme problems) to 100 (no problems). |
| IKDC | 18 | 0–100 | The IKDC Subjective Knee Evaluation Form is an 18-item patient-reported questionnaire covering knee symptoms, sports and daily activity and current knee function, whose raw total is transformed to a 0 to 100 score where 100 means no symptoms and no activity limitation — it requires permission from the AOSSM, so the items are not reproduced here. |
| Lysholm | 8 | 0–100 | The Lysholm Knee Scoring Scale is an eight-domain questionnaire that rates knee symptoms and function — limp, support, locking, instability, pain, swelling, stair climbing and squatting — on a 0 to 100 scale, where 95 and above is graded excellent, 84 to 94 good, 65 to 83 fair, and below 65 poor. |
| Marx | 4 | 0–16 | The Marx Activity Rating Scale measures how frequently a patient runs, cuts, decelerates and pivots in their healthiest state over the past year, scoring each on a 0 to 4 frequency scale for a total of 0 to 16, where a higher score means a more demanding activity level. |
| Tegner | 1 | 0–10 | The Tegner Activity Scale is a single-item ordinal ladder that grades a patient's work and sport activity from 0 (sick leave or disability pension because of knee problems) to 10 (national or international elite competitive sport), and is normally recorded twice — the pre-injury level and the current level — so that the drop between them can be reported. |
Copyright and permitted use
Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.
The survey is circulated freely in clinics and used throughout the knee literature, and we know of no licensing programme. We have not asked the developers for written permission, so we cannot say it is free of copyright; if a rights holder objects, the item wording will be removed and the page reduced to a profile.
References
- Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. Journal of Bone and Joint Surgery (American volume). 1998.doi:10.2106/00004623-199808000-00006PMID 9730122
Editorial status
Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.