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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2019

01-02-2019 | KNEE

Determination of normal KOOS and WOMAC values in a healthy population

Authors: Vincent Marot, Jérôme Murgier, Alessandro Carrozzo, Nicolas Reina, Edoardo Monaco, Philippe Chiron, Emilie Berard, Etienne Cavaignac

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2019

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Abstract

Purpose

The KOOS questionnaire is used to assess the symptoms and function of patients with traumatic or degenerative knee pathology. The WOMAC score has been validated mainly in the context of knee osteoarthritis. The distribution of these scores in a non-diseased population is not known. The hypothesis was that KOOS and WOMAC scores were influenced by patients’ age, sex, and BMI. The primary objective of this study was to describe, for the first time, the distribution of KOOS and WOMAC scores in a healthy population based on age, sex, and BMI.

Methods

This was a pilot (innovative), cross-sectional, international, multicenter, descriptive study. Persons accompanying patients to our clinic were invited to participate in this study by filling out the KOOS questionnaire. These data were also used to calculate the WOMAC score. The study was designed according to guidelines on pilot studies and planned to enroll a minimum of 30 subjects in each age, gender, and BMI group. Expected KOOS and WOMAC scores by age, gender, and BMI were determined using a linear regression model.

Results

Seven hundred and fourteen subjects were included: 305 men (42.7%) and 409 women (57.3%). For the KOOS score, as age increases, there was a decrease in the “ADL” (p = 0.0001) and “sport” (p = 0.0001) items and an increase in the “symptoms” (p = 0.0025) and “QOL” items (p = 0.0001). Women had lower scores (p < 0.05) than men on all the KOOS items, except “QOL”. For the WOMAC, the “pain”, “stiffness”, and “function” items varied significantly based on age (p = 0.0203) and sex (p = 0.0121). The “stiffness” item varied significantly based on age (p = 0.0005) and sex (p = 0.0477). The “function” item varied significantly based on age (p = 0.0001) and sex (p = 0.0256). The expected value for the KOOS and WOMAC scores in a healthy population without any knee ailments were determined.

Conclusions

The KOOS and WOMAC scores vary significantly based on age, sex, and BMI in a healthy population. This study also provides KOOS and WOMAC values in a population without any knee issue. These scores can be used, in a daily practice, as a reference to assess functional outcomes after a surgical procedure.

Level of evidence

IV.
Appendix
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Literature
1.
Ageberg E, Forssblad M, Herbertsson P, Roos EM (2010) Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish knee ligament register. Am J Sports Med 38:1334–1342CrossRefPubMed
2.
Baldwin JN, McKay MJ, Simic M, Hiller CE, Moloney N, Nightingale EJ, Burns J, 1000 Norms Project Consortium (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. Osteoarthr Cartil 25:1282–1290CrossRefPubMed
3.
Bekkers JEJ, de Windt TS, Raijmakers NJH, Dhert WJA, Saris DBF (2009) Validation of the Knee injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil 17:1434–1439CrossRefPubMed
4.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840PubMed
5.
Bremner-Smith AT, Ewings P, Weale AE (2004) Knee scores in a “normal” elderly population. Knee 11:279–282CrossRefPubMed
6.
Cameron KL, Thompson BS, Peck KY, Owens BD, Marshall SW, Svoboda SJ (2013) Normative values for the KOOS and WOMAC in a young athletic population: history of knee ligament injury is associated with lower scores. Am J Sports Med 41:582–589CrossRefPubMed
7.
Davies GM, Watson DJ, Bellamy N (1999) Comparison of the responsiveness and relative effect size of the western Ontario and McMaster Universities Osteoarthritis Index and the short-form Medical Outcomes Study Survey in a randomized, clinical trial of osteoarthritis patients. Arthritis Care Res Off J Arthritis Health Prof Assoc 12:172–179CrossRef
8.
Demirdjian AM, Petrie SG, Guanche CA, Thomas KA (1998) The outcomes of two knee scoring questionnaires in a normal population. Am J Sports Med 26:46–51CrossRefPubMed
9.
Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N (2000) Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol 27:2635–2641PubMed
10.
Escobar A, Quintana JM, Bilbao A, Azkárate J, Güenaga JI (2002) Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Western Ontario and McMaster Universities Osteoarthritis Index. Clin Rheumatol 21:466–471CrossRefPubMed
11.
Faschingbauer M, Kasparek M, Schadler P, Trubrich A, Urlaub S, Boettner F (2017) Predictive values of WOMAC, KOOS, and SF-12 score for knee arthroplasty: data from the OAI. Knee Surg Sports Traumatol Arthrosc 25:3333–3339CrossRefPubMed
12.
Fillingim RB (2000) Sex, gender, and pain: women and men really are different. Curr Rev Pain 4:24–30CrossRefPubMed
13.
Garratt AM, Brealey S, Gillespie WJ, DAMASK Trial Team (2004) Patient-assessed health instruments for the knee: a structured review. Rheumatology 43:1414–1423CrossRefPubMed
14.
Hambly K, Griva K (2008) IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? Am J Sports Med 36:1695–1704CrossRefPubMed
15.
Hambly K, Griva K (2010) IKDC or KOOS: which one captures symptoms and disabilities most important to patients who have undergone initial anterior cruciate ligament reconstruction? Am J Sports Med 38:1395–1404CrossRefPubMed
16.
Kluczynski MA, Marzo JM, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Zhou Z, Zhao J, Bisson LJ (2017) The effect of body mass index on clinical outcomes in patients without radiographic evidence of degenerative joint disease after arthroscopic partial meniscectomy. Arthroscopy 33:2054.e10–2063.e10
17.
Lancaster GA, Dodd S, Williamson PR (2004) Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract 10:307–312CrossRefPubMed
18.
McLean JM, Brumby-Rendell O, Lisle R, Brazier J, Dunn K, Gill T, Hill CL, Mandziak D, Leith J (2018) Asymptomatic population reference values for three knee patient-reported outcomes measures: evaluation of an electronic data collection system and implications for future international, multi-centre cohort studies. Arch Orthop Trauma Surg 138:611–621CrossRefPubMed
19.
Monticone M, Ferrante S, Salvaderi S, Rocca B, Totti V, Foti C, Roi GS (2012) Development of the Italian version of the Knee injury and Osteoarthritis Outcome Score for patients with knee injuries: cross-cultural adaptation, dimensionality, reliability, and validity. Osteoarthr Cartil 20:330–335CrossRefPubMed
20.
Oishi K, Tsuda E, Yamamoto Y, Maeda S, Sasaki E, Chiba D, Takahashi I, Nakaji S, Ishibashi Y (2016) The Knee injury and Osteoarthritis Outcome Score reflects the severity of knee osteoarthritis better than the revised Knee Society Score in a general Japanese population. Knee 23:35–42CrossRefPubMed
21.
Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson J-N, Roos EM, Guillemin F, Maillefert JF (2008) Cross-cultural adaptation and validation of the French version of the Knee injury and Osteoarthritis Outcome Score (KOOS) in knee osteoarthritis patients. Osteoarthr Cartil 16:423–428CrossRefPubMed
22.
Paradowski PT, Bergman S, Sundén-Lundius A, Lohmander LS, Roos EM (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord 7:38CrossRefPubMedPubMedCentral
23.
Rodriguez-Merchan EC (2012) Review article: risk factors of infection following total knee arthroplasty. J Orthop Surg 20:236–238CrossRef
24.
Rolfson O, Malchau H (2015) The use of patient-reported outcomes after routine arthroplasty: beyond the whys and ifs. Bone Jt J 97-B:578–581CrossRef
25.
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64CrossRefPubMedPubMedCentral
26.
Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation of a Swedish version. Scand J Med Sci Sports 8:439–448CrossRefPubMed
27.
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefPubMed
28.
Roos EM, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17CrossRefPubMedPubMedCentral
29.
Roos H, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693CrossRefPubMed
30.
Salavati M, Mazaheri M, Negahban H, Sohani SM, Ebrahimian MR, Ebrahimi I, Kazemnejad A, Salavati M (2008) Validation of a Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthr Cartil 16:1178–1182CrossRefPubMed
31.
Soininen JV, Paavolainen PO, Gronblad MA, Kaapa EH (2008) Validation study of a Finnish version of the Western Ontario and McMasters University osteoarthritis index. Hip Int J 18:108–111CrossRef
32.
Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, Theiler R (1996) Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index. Z Rheumatol 55:40–49PubMed
33.
Tamura LS, Cazzo E, Chaim EA, Piedade SR (2017) Influence of morbid obesity on physical capacity, knee-related symptoms and overall quality of life: a cross-sectional study. Rev Assoc Medica Bras 1992 63:142–147
34.
Tanner SM, Dainty KN, Marx RG, Kirkley A (2007) Knee-specific quality-of-life instruments: which ones measure symptoms and disabilities most important to patients? Am J Sports Med 35:1450–1458CrossRefPubMed
35.
Wigler I, Neumann L, Yaron M (1999) Validation study of a Hebrew version of WOMAC in patients with osteoarthritis of the knee. Clin Rheumatol 18:402–405CrossRefPubMed
36.
Williamson T, Sikka R, Tompkins M, Nelson BJ (2016) Use of the Knee Injury and Osteoarthritis Outcome Score in a healthy United States population. Am J Sports Med 44:440–446CrossRefPubMed
37.
Wright JG, Young NL (1997) A comparison of different indices of responsiveness. J Clin Epidemiol 50:239–246CrossRefPubMed
Metadata
Title
Determination of normal KOOS and WOMAC values in a healthy population
Authors
Vincent Marot
Jérôme Murgier
Alessandro Carrozzo
Nicolas Reina
Edoardo Monaco
Philippe Chiron
Emilie Berard
Etienne Cavaignac
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5153-6

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