Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 5/2013

01-05-2013 | Symposium: Special Considerations for TKA in Asian Patients

Development and Validation of a New Evaluation System for Patients With a Floor-based Lifestyle: The Korean Knee Score

Authors: Jin Goo Kim, MD, PhD, Jeong Ku Ha, MD, Seung Beom Han, MD, PhD, Tae Kyun Kim, MD, PhD, Myung Chul Lee, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2013

Login to get access

Abstract

Background

Patients’ perspectives on functioning and health have been increasingly recognized as a crucial aspect of health care, leading to the use of patient-reported instruments for outcome assessment. However, available instruments for total knee arthroplasty do not reflect the floor-based lifestyle with high knee flexion of eastern Asia.

Questions/purposes

We therefore (1) describe a novel patient-generated knee evaluation instrument, the Korean knee score (KKS), to reflect floor-based lifestyles with high knee flexion that included questions regarding health-related quality of life; (2) determined the reliability of the questionnaire; and (3) performed limited validation studies.

Methods

The KKS was developed by a committee of 10 experts from 10 institutes nationwide. The development procedure comprised a development phase for generation of the questionnaire and a testing phase for assessment of measurement properties: reliability, validity, and responsiveness. A total of 634 patients participated in this test survey.

Results

The KKS exhibited an intraclass correlation coefficient of 0.931 and internal consistency (Cronbach’s α = 0.973). The absence of a ceiling or floor effect suggested content validity. The correlation coefficient with Knee Society score (knee score, function score) and Oxford knee score was 0.599, 0.690, and 0.871, respectively, suggesting construct validity. Correlation with concurrent measures of physical function from the SF-36 ranged from 0.549 to 0.719 and those of mental function from 0.407 to 0.428. Responsiveness was evident with a standardized response mean of 0.74.

Conclusions

The KKS is a reliable and responsive instrument for assessing osteoarthritis. The limited validation studies suggest it is an appropriate evaluation instrument for patients with osteoarthritis and a floor-based lifestyle.
Appendix
Available only for authorised users
Literature
1.
go back to reference Alviar MJ, Olver J, Brand C, Tropea J, Hale T, Pirpiris M, Khan F. Do patient-reported outcome measures in hip and knee arthroplasty rehabilitation have robust measurement attributes? A systematic review. J Rehabil Med. 2011;43:572–583.PubMedCrossRef Alviar MJ, Olver J, Brand C, Tropea J, Hale T, Pirpiris M, Khan F. Do patient-reported outcome measures in hip and knee arthroplasty rehabilitation have robust measurement attributes? A systematic review. J Rehabil Med. 2011;43:572–583.PubMedCrossRef
2.
go back to reference Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. 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. 1988;15:1833–1840.PubMed Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. 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. 1988;15:1833–1840.PubMed
3.
go back to reference Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69.PubMedCrossRef Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69.PubMedCrossRef
4.
go back to reference Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–1432.PubMedCrossRef Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–1432.PubMedCrossRef
5.
go back to reference Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, Tompkins C. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96:804–810.PubMed Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, Tompkins C. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96:804–810.PubMed
6.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed
7.
go back to reference Irrgang J, Snyder-Mackler L, Wainner R, Fu F, Harner C. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80:1132–1145.PubMed Irrgang J, Snyder-Mackler L, Wainner R, Fu F, Harner C. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80:1132–1145.PubMed
8.
go back to reference Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD. Development and validation of the international Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29:600–613.PubMed Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD. Development and validation of the international Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29:600–613.PubMed
9.
go back to reference Kirkley A, Griffin S. Development of disease-specific quality of life measurement tools. Arthroscopy. 2003;19:1121–1128.PubMedCrossRef Kirkley A, Griffin S. Development of disease-specific quality of life measurement tools. Arthroscopy. 2003;19:1121–1128.PubMedCrossRef
10.
go back to reference Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32:629–634.PubMedCrossRef Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32:629–634.PubMedCrossRef
11.
go back to reference Koran LM. The reliability of clinical methods, data and judgments (second of two parts). N Engl J Med. 1975;293:695–701.PubMedCrossRef Koran LM. The reliability of clinical methods, data and judgments (second of two parts). N Engl J Med. 1975;293:695–701.PubMedCrossRef
12.
go back to reference Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB. Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am. 2001;83:1856–1864.PubMed Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB. Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am. 2001;83:1856–1864.PubMed
13.
go back to reference Liow RY, Walker K, Wajid MA, Bedi G, Lennox CM. The reliability of the American Knee Society Score. Acta Orthop Scand. 2000;71:603–608.PubMedCrossRef Liow RY, Walker K, Wajid MA, Bedi G, Lennox CM. The reliability of the American Knee Society Score. Acta Orthop Scand. 2000;71:603–608.PubMedCrossRef
14.
go back to reference McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.PubMedCrossRef McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.PubMedCrossRef
15.
go back to reference McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263.PubMedCrossRef McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263.PubMedCrossRef
16.
go back to reference Noyes FR, McGinniss GH, Mooar LA. Functional disability in the anterior cruciate insufficient knee syndrome. Review of knee rating systems and projected risk factors in determining treatment. Sports Med. 1984;1:278–302.PubMedCrossRef Noyes FR, McGinniss GH, Mooar LA. Functional disability in the anterior cruciate insufficient knee syndrome. Review of knee rating systems and projected risk factors in determining treatment. Sports Med. 1984;1:278–302.PubMedCrossRef
17.
go back to reference Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96.PubMed Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96.PubMed
18.
go back to reference Sernert N, Kartus J, Kohler K, Stener S, Larsson J, Eriksson BI, Karlsson J. Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc. 1999;7:160–165.PubMedCrossRef Sernert N, Kartus J, Kohler K, Stener S, Larsson J, Eriksson BI, Karlsson J. Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc. 1999;7:160–165.PubMedCrossRef
19.
go back to reference Sneeuw KC, Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease. J Clin Epidemiol. 2002;55:1130–1143.PubMedCrossRef Sneeuw KC, Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease. J Clin Epidemiol. 2002;55:1130–1143.PubMedCrossRef
20.
go back to reference Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.PubMed Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.PubMed
21.
go back to reference Ueo T, Kihara Y, Ikeda N, Kawai J, Nakamura K, Hirokawa S. Deep flexion-oriented bisurface-type knee joint and its tibial rotation that attributes its high performance of flexion. J Arthroplasty. 2011;26:476–482.PubMedCrossRef Ueo T, Kihara Y, Ikeda N, Kawai J, Nakamura K, Hirokawa S. Deep flexion-oriented bisurface-type knee joint and its tibial rotation that attributes its high performance of flexion. J Arthroplasty. 2011;26:476–482.PubMedCrossRef
Metadata
Title
Development and Validation of a New Evaluation System for Patients With a Floor-based Lifestyle: The Korean Knee Score
Authors
Jin Goo Kim, MD, PhD
Jeong Ku Ha, MD
Seung Beom Han, MD, PhD
Tae Kyun Kim, MD, PhD
Myung Chul Lee, MD, PhD
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 5/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2726-4

Other articles of this Issue 5/2013

Clinical Orthopaedics and Related Research® 5/2013 Go to the issue

Symposium: Special Considerations for TKA in Asian Patients

What Are the Causes of Revision Total Knee Arthroplasty in Japan?