About 2.1 million Australians are estimated to have osteoarthritis (OA), much of which affects the knee.
Patients often believe that OA leads to a progressive deterioration and “wearing out” of their joint – joint replacement surgery being just a matter of time. This belief can limit engagement in non-surgical treatments – why would a patient bother when they believe they are headed for the operating table anyway? Might as well get it over with!
In conditions like OA, that take a protracted course, it can be hard to measure progress. OA causes many symptoms – pain, swelling, weakness, instability, catching and deformity among them. Identifying what symptoms are actually limiting your patient is the first step to addressing them and KOOS can help you do this nicely. By monitoring your patient’s OA symptoms over time using KOOS, you will be able to demonstrate deterioration or improvement, the results of your interventions, and encourage your patient on their journey. Discussing the results and regular follow-up measures also show them you care about what is bothering them and not just their diagnosis. It’s also helpful to show patients how they compare to others.
Knee injury and Osteoarthritis Outcome Score (KOOS) can be used in patients who have knee OA or a knee injury that can result in OA e.g. ACL and meniscal injuries.
The KOOS is a widely used PROM in knee OA or conditions that can lead to OA (such as ligament or meniscal injury). It contains sub-scales covering important symptom domains with each question having 5 response options. A normalised score out of 100 is calculated for each sub-scale. (The scoring and calculations are complicated and tedious using a pen and paper method, and even using the KOOS.nu excel file still requires a lot of your time). A KOOS sub-scale score of 0 indicates severe symptoms, 100 no symptoms. KOOS is not designed to be used as an aggregated score, however this is commonly used to get an overall feel for a patient’s disability and to guide decisions around timing for surgery. In practice, this aggregate score can show patients they are not “bad enough” for surgery and encourage compliance with non-operative treatments.
- ADL – function in daily living
- Function in Sport and Recreation
- Symptoms – other
- Quality of Life – related to the knee
KOOS short form (a 7 question physical function survey) has been included in the knee set chosen by the International Consortium for Health Outcome Measures (ICHOM). KOOS also contains all the items forming the WOMAC (another commonly used PROM for knee OA) plus others that make it useful for acute knee injury as well. This makes KOOS a great tool for clinicians and researchers alike.
We love KOOS because it gives us lots of useful information about our OA patients and can track them over the entire course of their disease. The questionnaire is quite long however, and we didn’t like scoring the paper surveys – so we made MyScoreIt! Given the purpose of MyScoreIt is to engage patients, we have taken some liberties with the graph presentation, and measure an aggregated or overall score as well. We hope this makes sense to patients and that clinicians will enjoy using it!