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  • Summary of responses RE: Subjective knee scoring scales

    Thank you everyone who responded to my posting. Below is the original
    posting and a summary of the replies.

    ORIGINAL POSTING

    Hi All,

    Currently I am working with a group of orthopaedic surgeons in Brisbane.
    We are trying to assess which questionnaires are most commonly being used to
    assess pre and post operative function of the knee.

    I have conducted a literature review on the test-retest reliability,
    validity and responsiveness for a number of questionnaires. The results
    suggested that the International Knee Document Committees (IKDC - 2000)
    Subjective Knee Evaluation Form, the Lysholm Knee Rating Scale, the American
    Academy of Orthopaedic Surgeons (AAOS) Knee Rating Scale and the Oxford Knee
    Rating Scale were the most reliable, valid and responsive. It appears that
    these scales provide better coverage in the areas of function, pain,
    swelling, stability and locking.

    In addition, relating to sports function, Marx et al (2000) published an
    article suggesting their new activity rating scale was more valid and
    reliable than the Tegner activity scale.

    I was interested in gathering information on which questionnaires are most
    commonly being used. If anyone is involved in pre and/or postoperative
    assessment could you please let me know which questionnaires you are
    currently using to asses knee function.

    SUMMARY OF REPLIES

    >From the replies it appears that the most widely used questionnaires are the
    IKDC, the Cincinnati, the WOMAC and for TKA the HSS.

    My research has revealed the most reliable, valid and responsive knee scales
    in order to be:
    - The Lysholm knee scoring scale:
    Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with
    special emphasis on use of a scoring scale. American Journal of Sports
    Medicine 10: 150-154, 1982

    - The IKDC subjective knee evaluation form
    Irrgang JJ, Anderson AF, Boland AL et al. Development and valadation of the
    International Knee Document Committee Subjective Knee form. The Americal
    Journal of Sports Medicine. 29(5) 600-619 (2001)

    - The activities of daily living scale of the Knee outcome survey
    Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Hamer CD. Development of a
    patient reported measure of function of the knee. Journal of one and joint
    Surgery (Am). 1998;80 1132-1145

    - The American Academy of Orthopaedic surgeons sports knee rating scale
    American Academy of Orthopaedic Surgeons. Scoring algorithms for the lower
    limb outcomes data collection instrument version 2.0. Rosmont, IL: American
    Academy of Orthopedic Surgeons 1998

    In particular reference to functional activity the best scale was found to
    be The activity Rating scale
    Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. Development and
    evaluation of an activity rating scale for disorders of the knee. American
    Journal of Sports Medicine. 2001: 29(2):213-8

    In particular reference to TKA I found the Oxford scale to be superior.
    Dawson J, Fitzpatrick R, Murray D & Carr A. Questionnaire on the perceptions
    of patients about total knee replacement. Journal of Bone and Joint Surgery.
    80B 63-69 (1998)

    In addition we have done a comprehensive search of medline knee related
    articles for 2002. The results revealed 452 possible matches with 108
    articles using knee questionnaires. Out of the 108:
    - 32 used the Lysholm
    - 17 used the KSS
    - 16 used the IKDC
    - 14 used the Tegner
    - 10 used the HSS
    - 5 used the WOMAC
    - 4 used the Cincinnati
    - 1 used the KOOS, AAOS, Bristol

    Hope this information is helpful

    Regards

    Chris Carty



    RESPONSES

    Dear Chris, For ACL reconstruction, I use the Cincinnati Knee Rating System
    (Noyes F, Barber SD, Mooar LA. A rationale for assessing sports activity
    levels and limitations in knee disorders. Clin Orthop Rel Res 246:238-249,
    1989). For other knee problems, the Lysholm Knee Rating Scale.

    Shaw

    Shaw Bronner PT, MHS, EdM, OCS Director Analysis of Dance and Movement
    (ADAM) Center Long Island University 122 Ashland Place #1A Brooklyn, NY
    11201 718-246-6377 Fax 718-246-6383 E-mail: sbronner@liu.edu
    ------------------------------------------------------------------------

    Our team uses HSS .
    Sandra Martelli

    Dr. Sandra Martelli
    Istituti Ortopedici Rizzoli
    Lab. Biomechanics http://www.ior.it/biomec
    via di Barbiano 1/10 tel. +39 - 051 - 6366.520
    I-40136 BOLOGNA fax +39 - 051 - 583 . 789
    (Italy)
    ------------------------------------------------------------------------

    ISAKOS comitee have done some work on standards and scores . Have you
    checked their web page.
    sandra Martelli

    Dr. Sandra Martelli
    Istituti Ortopedici Rizzoli
    Lab. Biomechanics http://www.ior.it/biomec
    via di Barbiano 1/10 tel. +39 - 051 - 6366.520
    I-40136 BOLOGNA fax +39 - 051 - 583 . 789
    (Italy)
    ------------------------------------------------------------------------

    Chris:
    We are doing research relative to knee function involving pre & post-op
    conditions so are interested in your findings. Have you published your
    literature review- if so where. If not, would you be willing to share it. I
    also would like to obtain, in particular references related to the five knee
    function assessment instruments you found to be most reliable and valid.
    Also, could you provide the full reference for the Marx et al (2000) article
    to which you referred related to sports function. Thank you for you
    willingness to share your findings and information.

    Robert H. Deusinger, PT, PhD Washington University School of Medicine 4444
    Forest Park Blvd./Campus Box 8502 St. Louis, MO 63108 (314) 286-1426 (314)
    286-1410 (FAX) email: deusingerb@msnotes.wustl.edu
    ------------------------------------------------------------------------

    Would you consider the WOMAC a knee questionnaire. It has very good
    responsiveness and its reliability has been studied extensively. The
    McMaster group also developed the patient-specific index and used it at the
    knee. You might also be interested in the lower extremity functional scale.
    I look forward to your summary.

    Eric ----- Original Message ----- From: "chris carty"
    To: Sent: Tuesday, March
    25, 2003 5:41 PM Subject: [BIOMCH-L] Subjective Knee Questionnaires
    ------------------------------------------------------------------------

    For our ACL studies, we use a modified version of the IKDC forms to
    correlate subjective findings with our biomechanical data pre- & post- ACL
    reconstruction. Irrgang et al. (Knee Surg Sports Traum Arthos, 6(2),
    107-114, 1998) provide an adequate description of the forms' applicability.
    The Cincinnati rating system is another one that has been used. However,
    many have compared subjective findings with relatively objective data (ie,
    KT-1000, Cybex, etc.) between ACL patient groups and found similar patterns,
    regardless of the scoring system used. Hopefully, with more dynamic
    biomechanical data from our current motion analysis study on ACL patients,
    we hope to shed more light on the "validity" of the IKDC forms and other
    popular rating systems. Good luck!

    Arnel ---- Arnel Aguinaldo, MA, ATC Biomechanical Engineer Motion Analysis
    Laboratory & Center for Human Performance Children's Hospital San Diego |
    San Diego, CA USA (858) 966-5807 | www.sandiegogaitlab.com

    ------------------------------------------------------------------------

    Hi Chris, one score that is commonly used for pre/post TKR is the knee
    society score (ref: Insall JN, Door MD, Scott RD, et al. Rationale of the
    knee society clinical rating system. Clin Orthop, 1989, 248: 13-14) Cheers
    Erin Mr E Parish, MHSc (Exericse and Sports Science) AIMS Research Research
    Assistant 286 Pacific Highway, Crows Nest, Sydney, Australia, 2065 Phone:
    +61 2 9437 5999 Fax: +61 2 9906 1060 eparish@nsosmc.com.au

    ------------------------------------------------------------------------

    Hello Chris

    The orthopod I am working with in Toronto as a writer/editor has just
    finished sending a paper out on a survey re: the use of common
    patient-centred knee measures for pre/post TKA. A survey of several hundred
    Canadian orth. surgeons has revealed the 4 most popular knee measures
    preferred and used, in order,are:

    1 - WOMAC (Western Ontario and McMaster)
    2 - Knee Society Score
    3 - HSS (Hospital for Special Surgery)
    4 - HSS 2 (Modified HSS)

    I cannot give away too many more details re: the paper as it is being
    reviewed and there are all sorts of confidentiality issues around that
    process as you know.

    Hope this helps.

    Rad Zdero, PhD

    ------------------------------------------------------------------------

    Hi there chris
    Many people around here use the WOMAC- western ontario and macmaster
    university
    arthritis c?

    alison


    Alison McConnell
    Research Engineer
    MOBL- Martin Orthopaedic Biomechanics Laboratory
    St Michael's Hospital - affiliated with the University of Toronto
    30 Bond St, West Annex 1027
    Toronto, Ontario, Canda
    M5B 1W8

    1 416 864-5579 (office)
    1 416 864-5482 (lab)
    1 416 359-1601 (fax)

    ------------------------------------------------------------------------






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