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Knee Injury and Osteoarthritis Outcome Score for Children

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Purpose

●    The Knee Injury and Osteoarthritis Outcome Score for Children (KOOS-Child) is a 48-item instrument designed to assess the patient’s opinion about their knee after a knee injury that can result in post-traumatic osteoarthritis. 
●    The KOOS-Child 2.1, updated in October of 2015 consists of 39 items.

Link to Instrument

Instrument Details

Acronym KOOS-Child

Area of Assessment

Activities of Daily Living
Pain
Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

http://www.koos.nu/

Key Descriptions

  • 39 items (KOOS-Child 2.1); 48 items (KOOS-Child 1.0)
  • 5 subscales: pain, symptoms, activities of daily living, function in sports and play, and knee-related quality of life
  • Each question gets a score of 0-4
  • A normalized score is calculated for each subscale: 0 indicating extreme symptoms and 100 indicating no symptoms
  • Maximum score = 100 per subscale

Number of Items

39 items (KOOS-Child 2.1); 48 items (KOOS-Child 1.0)

Equipment Required

  • Pen
  • Paper
  • Access to Questionnaire

Time to Administer

10-20 minutes

Required Training

No Training

Required Training Description

No training is required. The KOOS-Child is self-explanatory and can be administered in the waiting room or used as a mailed survey.

Age Ranges

Child

6 - 12

years

Adolescent

13 - 17

years

Instrument Reviewers

Alyssa Varsalona, SPT, CSCS

Le’Shaunda Jones, SPT

Kurtis Kepfer, SPT

Melisa Smith, PT, DPT

Jennifer Wiley, PT, DHS, DPT

Body Part

Lower Extremity

ICF Domain

Body Function
Activity

Measurement Domain

General Health

Considerations

  • The KOOS-Child is available in several languages. It has been validated in Danish, English, Finnish, Greek, Norwegian, Persion, Spanish, and Swedish. All versions are available on the KOOS Website (http://www.koos.nu).
  • An adult version (KOOS) is also available

Pediatric Disorders

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Standard Error of Measurement (SEM)

Children with Knee Disorders: (Ortqvist, 2013; n=115; mean age = 13.0 (1.9) years)

  • SEM for pain subscale (n=72): 5.69
  • SEM for symptoms subscale (n=72): 8.14
  • SEM for ADL subscale (n=72): 5.28
  • SEM for sports/play subscale (n=70): 8.02
  • SEM for QoL subscale (n=70): 7.59

 

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

  • SEM for symptoms subscale (n=59): 10.2
  • SEM for pain subscale (n=59):  9.9
  • SEM for ADL subscale (n=59):  8.9
  • SEM for sports/play subscale (n=59):  16.9
  • SEM for QoL subscale: (n=59): 10.5

Minimal Detectable Change (MDC)

Children with Knee Disorders: (Ortqvist, 2013; n=115; mean age = 13.0 (1.9) years)

  • MDC for individuals on pain subscale: 15.78
  • MDC for individuals on symptoms subscale: 22.56
  • MDC for individuals on ADL subscale: 14.64
  • MDC for individuals on sports/play subscale: 22.22
  • MDC for individuals on QOL subscale: 21.03
     
  • MDC for group on pain subscale: 1.86
  • MDC for group on symptoms subscale: 2.66
  • MDC for group on ADL subscale: 1.73
  • MDC for group on sports/play subscale: 2.66
  • MDC for group on QOL subscale: 2.51

 

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

  • MDC for symptoms subscale: 28.4
  • MDC for pain subscale: 27.3
  • MDC for ADL subscale: 24.7
  • MDC for sport/play subscale: 46.9
  • MDC for QoL subscale: 29.2

Normative Data

Healthy Individuals Aged 8-17: (Baldwin, 2013; n=84)

 

 

 

 

 

Mean

Standard Dev.

Median

Min;Max

N

Pain

 

Male

 

Female

 

 

95.7

 

92.2

 

 

10.7

 

14.0

 

 

100

 

100

 

 

44;100

 

28;100

 

 

84

 

82

Symptoms

 

Male

 

Female

 

 

 

95.8

 

93.1

 

 

8.3

 

11.4

 

 

100

 

100

 

 

57;100

 

43;100

 

 

84

 

82

ADL

 

Male

 

Female

 

 

99.1

 

96.4

 

 

3.4

 

7.6

 

 

100

 

100

 

 

75;100

 

52;100

 

 

84

 

82

Sport/play

 

Male

 

Female

 

 

97.8

 

93.2

 

 

5.8

 

13.7

 

 

100

 

100

 

 

71;100

 

43;100

 

 

84

 

82

QoL

 

Male

 

Female

 

 

97.3

 

94.4

 

 

7.2

 

13.7

 

 

100

 

100

 

 

54;100

 

13;100

 

 

84

 

82

Test/Retest Reliability

Children with Knee Disorders: (Ortqvist, 2013; n=115; mean age = 13.0 (1.9) years)

  • Excellent for pain subscale (ICC=0.87)
  • Excellent for ADL subscale (ICC=0.85)
  • Excellent for sports/play subscale (ICC=0.91)
  • Excellent for QoL subscale (ICC=0.85)
  • Adequate for symptoms subscale (ICC=0.78)

 

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

  • Excellent for symptoms subscale (ICC=0.9)
  • Excellent for pain subscale (ICC=0.9)
  • Excellent for ADL subscale (ICC=0.9)
  • Excellent for sports/play subscale (ICC=0.8)
  • Excellent for QoL subscale (ICC=0.9)

Interrater/Intrarater Reliability

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

  • Excellent Reliability: ICC 0.8–0.9

Internal Consistency

Greek KOOS-Child: (Moutzouri et al, 2020; n =59; mean age: 11 ± 1.8 years)

  • Excellent:  Alpha > 0.8

Subscale

Alpha

Pain

0.92

Symptoms

0.81

ADL

0.96

Sport-play

0.94

QoL

0.93

 

 

French KOOS-Child: (Rioux Trottier et al, 2018; n = 99)

Subscale

Alpha-control

Alpha knee pain

Symptoms

0.572; missing =1

0.622; missing =5

Pain

0.943; missing =0

0.873; missing =6

ADL

0.856; missing =0

0.948; missing =7

Sports

0.898; missing =0

0.906; missing =11

Quality of life

0.547; missing=0

0.739; missing =2

Total score

0.953; missing=1

0.959; missing =19

Construct Validity

Greek KOOS-Child: (Moutzouri et al, 2020; n =59; mean age: 11 ± 1.8 years)

 

KIDSCREEN Subscales

KOOS-Child Subscales

Physical activities/health

General Feeling

Parents/Free Time

Friends

School

Pain

0.6

0.5

-

-

0.4

Symptoms

0.7

0.3

-

-

0.5

ADL

0.5

0.4

0.4

0.3

0.3

Sport-play

0.5

0.4

-

0.4

0.3

QoL

0.5

0.6

0.5

0.4

0.4

 

 

Kid-KINDL Subscales

KOOS-Child Subscales

Physical Health

General Feeling

Self

Family

Friends

School

Hospital/Disease

Pain

0.5

0.5

-

-

-

-

0.3 (ns)

Symptoms

0.6

0.5

-

-

-

-

0.4

ADL

0.6

0.5

-

-

-

-

-

Sport-play

0.6

0.4

-0.6 (ns)

-

-

-

-

QoL

0.6

0.6

0.1 (ns)

0.2 (ns)

0.6 (ns)

0.3

0.3 (ns)

ns: not significant (p>0.05)

 

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

 

KOOS Symptoms

KOOS Pain

KOOS ADL

KOOS Sport/play

KOOS QoL

Pedi-IKDC

0.69

0.84

0.83

0.80

0.76

Lysholm

0.70

0.71

0.66

0.56

0.57

NRS Pain

-0.44

-0.71

-0.62

-0.54

-0.52

EQ_5D

0.42

0.52

0.50

0.45

0.53

 

 

French KOOS-Child: (Rioux Trottier et al, 2018; n = 99; mean age =?)

  • Poor correlation between KOOS-Child subscales and CHAQ grip subscales (pain = -0.023; symptom = 0.110; ADL = -0.102; sport/play = -0.091; QoL = 0.132)
  • Excellent correlation between KOOS-Child pain subscale and CHAQ pain subscale (-0.792)
  • Excellent correlation between KOOS-Child sport/play subscale and CHAQ run and play subscale (-0.809)
  • Excellent correlation between KOOS-Child ADL subscale and CHAQ walking subscale (-0.782)
  • Adequate correlation between KOOS-Child symptoms subscale and VAS (-0.507)
  •  Excellent correlation between KOOS-Child pain, ADL, sport/play and QoL subscales and VAS (pain = -0.601; ADL = -0.646; sport/play = -0.604; QoL = -0.622)
  • Excellent correlation between KOOS-Child QoL subscale and Eq-5D-Y usual activities subscale (-0.788)

Content Validity

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

Relevant items/total items (%)

Orthopaedic surgeons

(n = 18)

Patients

(n = 18)

Symptoms

6/7 (86%)

7/7(100%)

Pain

7/8 (88%)

7/8 (88%)

ADL

7/11(64%)

9/11(82%)

Sport/play

7/7(100%)

7/7(100%)

QOL

(83%)

6/6(100%)

Floor/Ceiling Effects

French KOOS-Child: (Rioux Trottier et al, 2018; n = 99; mean age =?)

  • Symptoms: floor effect = 0; ceiling effect = 13.4%
  • Pain: floor effect = 0; ceiling effect = 18.6%
  • ADL: floor effect = 1; ceiling effect = 21.2%
  • Sport/play: floor effect = 7.7; ceiling effect = 20.9%
    QoL: floor effect = 0; ceiling effect = 10.1%

 

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

  • Ceiling effects were found in the KOOS-Child ADL, as 24.8% of the patients had the maximal score of > 95.
  • Floor effects were found in the KOOS-Child sport/play subscale, as 17.8% of the patients had the minimal score of < 5.

 

Greek KOOS-Child: (Moutzouri et al, 2020; n =59; mean age: 11 ± 1.8 years)

  • Pain: floor effect = N/A; ceiling effect = 22.0%
  • Symptoms: floor effect = N/A; ceiling effect = 27.4%
  • ADL: floor effect = N/A; ceiling effect = 39.8%
  • Sport/Play: floor effect = N/A; ceiling effect = 15.1%
  • QoL: floor effect = N/A; ceiling effect = 15.1%

Responsiveness

Greek KOOS-Child: (Moutzouri et al, 2020; n =59; mean age: 11 ± 1.8 years)

  • Moderate effect size for pain, symptom, and QoL subscales at 2 weeks
  • Small effect size for ADL and sport/play subscales

KOOS-Child Subscale

Effect Sizes (baseline to 3 months)

Pain

1.1

Symptoms

0.6

ADL

0.8

Sport/play

1.2

QoL

1.4

 

Children with Stable Knee Conditions: (Van der Velden, 2019; n=100; mean age = 15.0)

ES

Symptoms

Pain

ADL

Sport/Play

QoL

No Change

0.29

0.27

0.13

0.28

-0.07

Improvement

0.84

1.26

0.83

1.57

1.24

Worsening

-0.44

-0.43

-0.75

-1.23

-0.83

Bibliography

Baldwin, J. N., McKay, M. J., et al. (2017). Self-reported knee pain and disability among healthy individuals: Reference data and factors associated with the knee injury and osteoarthritis outcome score (KOOS) and KOOS-child. Osteoarthritis and Cartilage, 25(8), 1282-1290. https://doi.org/10.1016/j.joca.2017.03.007

Moutzouri, M., Tsoumpos, P., et al. (2020). “Greek KOOS-child: A valid, disease specific, diagnostically accurate and responsive PROM in children with knee-related pathology”. Knee Surgery, Sports Traumatology, Arthroscopy, , 1. https://doi.org/10.1007/s00167-020-06237-5

Örtqvist, M., Iversen, M. D., et al. (2014). Psychometric properties of the knee injury and osteoarthritis outcome score for children (KOOS-child) in children with knee disorders. British Journal of Sports Medicine, 48(19), 1437-1446. https://doi.org/10.1136/bjsports-2013-093164

Rioux Trottier, E., Beauséjour, M., et al. (2018). Validation of the french version of the KOOS-child questionnaire. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 27(7), 2361-2367. https://doi.org/10.1007/s00167-018-5302-y

Van der Velden, C. A., van der Steen, M. C., et al. (2019). Pedi-IKDC or KOOS-child: Which questionnaire should be used in children with knee disorders? BMC Musculoskeletal Disorders, 20(1) https://www.narcis.nl/publication/RecordID/oai:pure.tue.nl:publications%2F1a71cac7-aa34-4188-8e67-944918799245

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