Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties

Collins, N. J., Prinsen, C. A. C., Christensen, R., Bartels, E. M., Terwee, C. B. and Roos, E. M. (2016) Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis and Cartilage, 24 8: 1317-1329. doi:10.1016/j.joca.2016.03.010

Author Collins, N. J.
Prinsen, C. A. C.
Christensen, R.
Bartels, E. M.
Terwee, C. B.
Roos, E. M.
Title Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties
Journal name Osteoarthritis and Cartilage   Check publisher's open access policy
ISSN 1522-9653
Publication date 2016-08
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.joca.2016.03.010
Open Access Status Not Open Access
Volume 24
Issue 8
Start page 1317
End page 1329
Total pages 13
Place of publication London, United Kingdom
Publisher Elsevier
Collection year 2017
Language eng
Formatted abstract
Objective: To conduct a systematic review and meta-analysis to synthesize evidence regarding measurement properties of the Knee injury and Osteoarthritis Outcome Score (KOOS).

Design: A comprehensive literature search identified 37 eligible papers evaluating KOOS measurement properties in participants with knee injuries and/or osteoarthritis (OA). Methodological quality was evaluated using the COSMIN checklist. Where possible, meta-analysis of extracted data was conducted for all studies and stratified by age and knee condition; otherwise narrative synthesis was performed.

Results: KOOS has adequate internal consistency, test-retest reliability and construct validity in young and old adults with knee injuries and/or OA. The ADL subscale has better content validity for older patients and Sport/Rec for younger patients with knee injuries, while the Pain subscale is more relevant for painful knee conditions. The five-factor structure of the original KOOS is unclear. There is some evidence that the KOOS subscales demonstrate sufficient unidimensionality, but this requires confirmation. Although measurement error requires further evaluation, the minimal detectable change for KOOS subscales ranges from 14.3 to 19.6 for younger individuals, and ≥20 for older individuals. Evidence of responsiveness comes from larger effect sizes following surgical (especially total knee replacement) than non-surgical interventions.

Conclusions: KOOS demonstrates adequate content validity, internal consistency, test-retest reliability, construct validity and responsiveness for age- and condition-relevant subscales. Structural validity, cross-cultural validity and measurement error require further evaluation, as well as construct validity of KOOS Physical function Short form. Suggested order of subscales for different knee conditions can be applied in hierarchical testing of endpoints in clinical trials.

Systematic review registration: PROSPERO (CRD42011001603).
Keyword Knee injury
Knee osteoarthritis
Measurement properties
Patient-reported outcome measures
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
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