Validation of the KOOS, JR: A Short-form Knee Arthroplasty Outcomes Survey

Abstract

Background Medicare is rapidly moving toward using patient-reported outcome measures (PROMs) for outcomes assessment and justification of orthopaedic and other procedures. Numerous measures have been developed to study knee osteoarthritis (OA); however, many of these surveys are long, disruptive to clinic flow, and result in incomplete data capture and/or low followup rates. The Knee injury and Osteoarthritis Outcome (KOOS) physical function short-form (KOOS-PS), while shorter, ignores pain, which is a primary concern of patients with advanced knee OA. Questions/purposes Our objective was to derive and validate a short-form survey focused on the patient with end-stage knee OA undergoing TKA.Methods Using our hospital's knee replacement registry, we retrospectively identified 2291 patients with knee OA who underwent primary unilateral TKA and had completed preoperative and 2-year postoperative PROMs. We assessed 30 items from the 42-item KOOS that were quantitatively most difficult for patients to perform before TKA and qualitatively most relevant to patients with endstage knee OA. Rasch analysis identified the KOOS, JR, a seven-item instrument, representing a single dimension, which we define as ''knee health'' because it reflects aspects of pain, symptom severity, and activities of daily living (ADL) including movements or activities that are directly relevant and difficult for patients with advanced knee OA. We assessed the internal consistency, external One or more of the authors (SL, PDF) has received funding from the Agency for Healthcare Research and Quality (Rockville, MD, USA). One of the authors certifies that he (MBC), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,00 from Intellijoint (Waterloo, ON, Canada), an amount of USD 10,000 to USD 100,000 from Smith & Nephew (London, UK), an amount of USD 10,000 to USD 100,00 from Exactech (Gainesville, FL, USA), an amount of USD 10,000 to USD 100,00 from Link (Hamburg, Germany), and an amount of USD 10,000 to USD 100,000 from Acelity (San Antonio, TX, USA). One of the authors certifies that he (DEP) or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Stryker-Mako (Fort Lauderdale, FL, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Evaluating instrument responsiveness in joint function: The HOOS JR, the KOOS JR, and the PROMIS PF CAT

“…The HOOS JR is scored on a 0–100 scale with higher numbers indicating higher function. The KOOS consists of 42 questions but the shortened KOOS JR used by our study improves respondent burden with just seven questions in the domains of function and pain (see supplemental Appendix S3) . The KOOS JR is an accepted CMS metric for the Comprehensive Care for Joint Replacement Model, is scored on a 1–100 scale with higher numbers indicating higher levels of function.…”

“…Though more than 75 PRO measures assess physical function, the knee injury and osteoarthritis outcome score (KOOS) and hip and disability osteoarthritis score (HOOS) provide joint specific information and are now widely used assessments in joint replacement care . The HOOS and KOOS have recently been developed in short forms (HOOS JR and the KOOS JR) that ease respondent burden and are recognized in joint replacement registries as well as by CMS as approved PROs with sound psychometric properties . As the benefits of differing instruments are considered, understanding the responsiveness of an instrument, or in other words, the ability of an instrument to detect change over time can assist clinicians in selecting appropriate PRO measures to enhance the quality of care.…”

A Crosswalk Between UCLA and Lower Extremity Activity Scales

“…Finally, patients for this study were recruited from a high-volume specialized orthopaedic hospital and may not be representative of the population of patients undergoing THA and TKA in the United States. However, prior research has shown that patients in our registries are generally similar to those in the nationally representative Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement and Quality Improvement (FORCE-TJR) registry [14,15].…”

Value-based Healthcare: Person-centered Measurement: Focusing on the Three C's

“…While numerous validated PRO instruments can paint a detailed picture of a patient's pain and function, many of these are cumbersome to administer and still more cumbersome to complete as a patient. We suggest using smaller question sets such as the HOOS, Jr. [4] and the KOOS, Jr. [3] at more frequent intervals, reserving the longer tools for the pre-operative visit and at specified postoperative intervals (such as 2, 5, and 10 years after surgery). Using multiple measurement tools provides a path toward validating or improving upon the current measurement sets.…”