Knee Health Questionnaire

The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a questionnaire designed to assess short and long-term patient-relevant outcomes following knee injury. The KOOS is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome. KOOS is patient-administered, the format is user-friendly and it takes about 10 minutes.

Name

First Name

Last Name

How often is your knee painful?

Never

Monthly

Weekly

Daily

Always

What degree of pain have you experienced in the last week when: 1. twisting and pivoting on your knee

Straightening your knee fully

Bending Your Knee Fully?

Walking on a flat surface?

Up or down stairs?

At night while in bed?

Sitting or lying?

Standing upright?

Symptoms

How severe is your knee stiffness after first wakening in the morning?

How severe is your knee stiffness after sitting, lying, or resting later in the day?

Do you have swelling in your knee?

Do you feel grinding, hear clicking or any other type of noise when your knee moves?

Does your knee catch or hang up when moving?

Can you straighten your knee fully?

Can you bend your knee fully?

Activities of daily living

Descending steps

Ascending steps

Rising from sitting

Standing

bending to floor to pick up an object

Walking on a flat surface

Getting in and out of vehicles

Going shopping

Putting on socks

Rising from bed

Taking off socks

Lying in bed (turning over)

Getting in and out of bath

Sitting

Getting on/off toilet

Heavy domestic duties

Light domestic duties (cooking, dusting)

Sport & Recreation Questions

What difficulty have you experienced the last week with...?

Squatting

Running

Jumping

Turning on injured knee

Kneeling

Knee Related Quality of Life

How often are you aware of your knee problems?

Have you modified your lifestyle to avoid potentially damaging activities to your knee?

How troubled are you with lack of confidence in your knee?

In general, how much difficulty do you have with your knee?

What is the best day and time for a qualified rehab professional to contact you?