Oxford Knee Score: Difference between revisions
m (After performing a literature review I found that not all the latest info is included on this page. I added info under the headings 'method of use' and 'scoring' and added new references I used including the links to the related articles. I also found a few grammar mistakes in the previous editor's work and corrected those and tried to make a sentence flow better.) |
No edit summary |
||
Line 8: | Line 8: | ||
</div> | </div> | ||
== Objective == | == Objective == | ||
The Oxford Knee Score (OKS) was developed in 1998 and validated to measure pain and function after total knee replacement<ref name=":1">Dawson J, Fitzpatrick R, Murray D, Carr A. [https://pdfs.semanticscholar.org/d5b2/584be94a90dc00a89272955bd7ef10e131bd.pdf Questionnaire on the perceptions of patients about total knee replacement surgery]. J. Bone Joint Surg 1998; 80-B:63-69. Accessed 15 January 2020.</ref>. | The Oxford Knee Score (OKS) was developed in 1998 and validated to measure pain and function after [[Total Knee Arthroplasty|total knee replacement]]<ref name=":1">Dawson J, Fitzpatrick R, Murray D, Carr A. [https://pdfs.semanticscholar.org/d5b2/584be94a90dc00a89272955bd7ef10e131bd.pdf Questionnaire on the perceptions of patients about total knee replacement surgery]. J. Bone Joint Surg 1998; 80-B:63-69. Accessed 15 January 2020.</ref>. | ||
== Intended Population == | == Intended Population == | ||
The OKS was originally developed and validated for use with individuals undergoing knee arthroplasty but has also been used to measure outcomes in pharmacological treatments, | The OKS was originally developed and validated for use with individuals undergoing knee arthroplasty but has also been used to measure outcomes in pharmacological treatments, post [[Osteotomy|osteotomies]], following rehabilitation or with fractures<ref>Murray D, Rogers K, Pandit H, Beard D, Carr A, Dawson, J. [https://www.researchgate.net/publication/6054260_The_use_of_the_Oxford_Hip_and_Knee_Scores The use of the Oxford Hip and Knee Scores]. The Journal of Bone and Joint Surgery. 2007. 89; 8: 1010-4. Accessed 2 December 2019.</ref>. It is a primary outcome measure of choice for national audits of knee replacements<ref>Browne J, Lewsey L, Van Der Muelen J, Black N. Report to the Department of Health. London, UK: London School of Hygiene & Tropical Medicine; 2007. Patient Reported Outcome Measures (PROMS) in Elective Surgery.</ref>. It has also been used to predict revisions six months after a replacement<ref>Rothwell A, Hooper G, Hobbs A, Frampton C. [https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.92B3.22913 An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry]. J Bone Joint Surg Br. 2010 Mar;92(3):413-8. Accessed 15 January 2020.</ref>. | ||
== Method of Use == | == Method of Use == | ||
The OKS is a patient reported outcome measure that consists of 12 questions about an individual's level of function, [[ADLs|activities of daily living]] and how they have been affected by pain over the preceding four weeks. | The OKS is a patient reported outcome measure that consists of 12 questions about an individual's level of function, [[ADLs|activities of daily living]] and how they have been affected by pain over the preceding four weeks<ref name=":0" />. | ||
The questionnaire can be completed by the patient individually on paper or digitally<ref name=":3">Makaram N, Lee T, Macdonald D, Clement ND. [https://www.sciencedirect.com/science/article/abs/pii/S0968016020302829 The verbal Oxford Knee Score is not clinically different from the written score when assessed before or after total knee arthroplasty.] The Knee. 2020 Oct 1;27(5):1396-405.</ref>. A recent study suggests that there is no clinical difference collecting the data verbally before and after a total knee arthroplasty<ref name=":3" />. This may be useful for patients who cannot complete otherwise and the test can be | The questionnaire can be completed by the patient individually on paper or digitally<ref name=":3">Makaram N, Lee T, Macdonald D, Clement ND. [https://www.sciencedirect.com/science/article/abs/pii/S0968016020302829 The verbal Oxford Knee Score is not clinically different from the written score when assessed before or after total knee arthroplasty.] The Knee. 2020 Oct 1;27(5):1396-405.</ref>. A recent study suggests that there is no clinical difference collecting the data verbally compared to written, both before and after a total knee arthroplasty<ref name=":3" />. This may be useful for patients who cannot complete otherwise and the test can be administered telephonically as an alternative<ref name=":3" />. | ||
=== Questions === | === Questions === | ||
The patient is first asked to date | The patient is first asked to date the questionnaire and confirm which knee is affected. If both knees are involved, a questionnaire is done for each leg<ref name=":0" />. | ||
{| class="wikitable" | {| class="wikitable" | ||
|+From Dawson et al 1998<ref name=":1" /> and Oxford University Innovation<ref name=":0" /> | |+From Dawson et al 1998<ref name=":1" /> and Oxford University Innovation<ref name=":0" /> | ||
Line 158: | Line 158: | ||
=== Scoring === | === Scoring === | ||
When the OKS was originally developed, it was designed to be as simple as possible | When the OKS was originally developed, it was designed to be as simple as possible for ease of use. The original scoring system was a 1-5 where one represented the best outcome<ref name=":0">Oxford University Innovation. The Oxford Knee Score (OKS). 2016. Accessed online from https://innovation.ox.ac.uk/outcome-measures/oxford-knee-score-oks/ on 15 January 2020.</ref>. However, clinicians found this confusing in practice and adaptations began to appear so the original authors developed a new scoring system from 0-4 where four is the best outcome and total scores range from 0 (poorest function) to 48 (maximal function)<ref name=":0" />. | ||
If there are more than two missing answers, it is recommended that the overall score should not be calculated. In the event one or two questions are unanswered, it is recommended that clinicians calculate a mean score from the patient's other answer. If a question has more than one answer, the worst response i.e. smallest number is used for calculations<ref name=":0" />. | If there are more than two missing answers, it is recommended that the overall score should not be calculated. In the event one or two questions are unanswered, it is recommended that clinicians calculate a mean score from the patient's other answer. If a question has more than one answer, the worst response i.e. smallest number is used for calculations<ref name=":0" />. | ||
''Mikkelsen et al.''<ref name=":4">Mikkelsen M, Gao A, Ingelsrud LH, Beard D, Troelsen A, Price A. [https://pubmed.ncbi.nlm.nih.gov/33301905/ Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements.] Journal of Clinical Epidemiology. 2021 Apr 1;132:18-25.</ref> | ''Mikkelsen et al.''<ref name=":4">Mikkelsen M, Gao A, Ingelsrud LH, Beard D, Troelsen A, Price A. [https://pubmed.ncbi.nlm.nih.gov/33301905/ Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements.] Journal of Clinical Epidemiology. 2021 Apr 1;132:18-25.</ref> recently created a clinical meaningful classification of the change scores (ΔOKS). The results suggest that four categories can be distinguished when comparing the ΔOKS: | ||
1. much better (≥16) | |||
2. a little better (7-15) | |||
3. about the same (1-6) | |||
4. much worse (≤0) <ref name=":4" /> | |||
=== Equipment === | === Equipment === | ||
Pen and paper or [http://www.orthopaedicscore.com/scorepages/oxford_knee_score.html online calculator]. | Pen and paper or [http://www.orthopaedicscore.com/scorepages/oxford_knee_score.html online calculator]. | ||
== | == Resources == | ||
Original article by [https://pdfs.semanticscholar.org/d5b2/584be94a90dc00a89272955bd7ef10e131bd.pdf Dawson et al 1998]. | Original article by [https://pdfs.semanticscholar.org/d5b2/584be94a90dc00a89272955bd7ef10e131bd.pdf Dawson et al 1998]. | ||
Line 184: | Line 192: | ||
=== Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span> === | === Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span> === | ||
Research<ref>Robb C, McBryde C, Caddy S, Thomas A, Pynser P. [https://publishing.rcseng.ac.uk/doi/pdf/10.1308/bull.2013.95.4.1 Oxford scores as a triage tool for lower limb arthroplasty lead to discrimination and health inequalities]. Ann R Coll Surg Engl (Suppl) 2013; 95. Accessed 15 January 2020.</ref> suggests that the OKS should not be used to decide whether or not an individual should have surgery because it can be biased in regards to gender, older age and to individuals reporting worse symptoms in order to meet criteria for surgery. Instead, the individual's pain symptoms should be | Research<ref>Robb C, McBryde C, Caddy S, Thomas A, Pynser P. [https://publishing.rcseng.ac.uk/doi/pdf/10.1308/bull.2013.95.4.1 Oxford scores as a triage tool for lower limb arthroplasty lead to discrimination and health inequalities]. Ann R Coll Surg Engl (Suppl) 2013; 95. Accessed 15 January 2020.</ref> suggests that the OKS should not be used to decide whether or not an individual should have surgery because it can be biased in regards to gender, older age and to individuals reporting worse symptoms in order to meet criteria for surgery. Instead, the individual's pain symptoms should be considered. | ||
The OKS is available in multiple [https://innovation.ox.ac.uk/wp-content/uploads/2014/09/OKS_language-list_Jan2020.pdf languages]. | The OKS is available in multiple [https://innovation.ox.ac.uk/wp-content/uploads/2014/09/OKS_language-list_Jan2020.pdf languages]. |
Revision as of 00:02, 20 November 2021
Original Editor - Your name will be added here if you created the original content for this page.
Top Contributors - Lauren Lopez, Gunilla Buitendag and Aminat Abolade
Objective[edit | edit source]
The Oxford Knee Score (OKS) was developed in 1998 and validated to measure pain and function after total knee replacement[1].
Intended Population[edit | edit source]
The OKS was originally developed and validated for use with individuals undergoing knee arthroplasty but has also been used to measure outcomes in pharmacological treatments, post osteotomies, following rehabilitation or with fractures[2]. It is a primary outcome measure of choice for national audits of knee replacements[3]. It has also been used to predict revisions six months after a replacement[4].
Method of Use[edit | edit source]
The OKS is a patient reported outcome measure that consists of 12 questions about an individual's level of function, activities of daily living and how they have been affected by pain over the preceding four weeks[5].
The questionnaire can be completed by the patient individually on paper or digitally[6]. A recent study suggests that there is no clinical difference collecting the data verbally compared to written, both before and after a total knee arthroplasty[6]. This may be useful for patients who cannot complete otherwise and the test can be administered telephonically as an alternative[6].
Questions[edit | edit source]
The patient is first asked to date the questionnaire and confirm which knee is affected. If both knees are involved, a questionnaire is done for each leg[5].
Questions | Scoring |
---|---|
|
None
Very mild Mild Moderate Severe |
2. Have you had any trouble with washing and drying yourself (all over) because of your knee? | No trouble
Very little trouble Moderate trouble Extreme difficulty Impossible to do |
3. Have you had any trouble getting in and out of a car or using public transport because of your knee? (whichever you tend to use) | No trouble
Very little trouble Moderate trouble Extreme difficulty Impossible to do |
4. For how long have you been able to walk before the pain from your knee becomes severe (with or without a stick) | No pain/more than 30 minutes
16 to 30 minutes 5 to 15 minutes Around the house only Not at all/pain severe when walking |
5. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee? | Not at all painful
Slightly painful Moderately painful Very painful Unbearable |
6. Have you been limping when walking, because of your knee? | Rarely/ never
Sometimes, or just at first Often,not just at first Most of the time All of the time |
7. Could you kneel down and get up again afterwards? | Yes, easily
With little difficulty With moderate difficulty With extreme difficulty No, impossible |
8. Have you been troubled by pain from your knee in bed at night? | No nights
Only 1 or 2 nights Some nights Most nights Every night |
9. How much has pain from your knee interfered with your usual work (including housework)? | Not at all
A little bit Moderately Greatly Totally |
10. Have you felt that your knee might suddenly “give way” or let you down? | Rarely/ never
Sometimes, or just at first Often, not just at first Most of the time All of the time |
11. Could you do the household shopping on your own? | Yes, easily
With little difficulty With moderate difficulty With extreme difficulty No, impossible |
12. Could you walk down a flight of stairs? | Yes, easily
With little difficulty With moderate difficulty With extreme difficulty No, impossible |
Scoring[edit | edit source]
When the OKS was originally developed, it was designed to be as simple as possible for ease of use. The original scoring system was a 1-5 where one represented the best outcome[5]. However, clinicians found this confusing in practice and adaptations began to appear so the original authors developed a new scoring system from 0-4 where four is the best outcome and total scores range from 0 (poorest function) to 48 (maximal function)[5].
If there are more than two missing answers, it is recommended that the overall score should not be calculated. In the event one or two questions are unanswered, it is recommended that clinicians calculate a mean score from the patient's other answer. If a question has more than one answer, the worst response i.e. smallest number is used for calculations[5].
Mikkelsen et al.[7] recently created a clinical meaningful classification of the change scores (ΔOKS). The results suggest that four categories can be distinguished when comparing the ΔOKS:
1. much better (≥16)
2. a little better (7-15)
3. about the same (1-6)
4. much worse (≤0) [7]
Equipment[edit | edit source]
Pen and paper or online calculator.
Resources[edit | edit source]
Original article by Dawson et al 1998.
Useful information on background and use of The Oxford Knee Score by Oxford University Innovation.
Evidence[edit | edit source]
Reliability[edit | edit source]
The OKS has demonstrated strong test-retest reliability in its original testing[1]. A 2016 systematic review of 23 studies found good evidence of its reproducibility[8].
Validity[edit | edit source]
OKS shows significant correlation with similar measures (American Knee Society Score, SF-36, Health Assessment Questionnaire), particularly the pain and physical function domains[1]. A 2016 systematic review (23 studies) found good evidence for its internal consistency and construct validity[8].
Responsiveness[edit | edit source]
Research suggests the OKS is responsive to change post operatively [1][8] and a change of four or more points represents "real" change for an individual while a change of seven or more points represents "clinically relevant"[9].
Miscellaneous[edit | edit source]
Research[10] suggests that the OKS should not be used to decide whether or not an individual should have surgery because it can be biased in regards to gender, older age and to individuals reporting worse symptoms in order to meet criteria for surgery. Instead, the individual's pain symptoms should be considered.
The OKS is available in multiple languages.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement surgery. J. Bone Joint Surg 1998; 80-B:63-69. Accessed 15 January 2020.
- ↑ Murray D, Rogers K, Pandit H, Beard D, Carr A, Dawson, J. The use of the Oxford Hip and Knee Scores. The Journal of Bone and Joint Surgery. 2007. 89; 8: 1010-4. Accessed 2 December 2019.
- ↑ Browne J, Lewsey L, Van Der Muelen J, Black N. Report to the Department of Health. London, UK: London School of Hygiene & Tropical Medicine; 2007. Patient Reported Outcome Measures (PROMS) in Elective Surgery.
- ↑ Rothwell A, Hooper G, Hobbs A, Frampton C. An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Joint Surg Br. 2010 Mar;92(3):413-8. Accessed 15 January 2020.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Oxford University Innovation. The Oxford Knee Score (OKS). 2016. Accessed online from https://innovation.ox.ac.uk/outcome-measures/oxford-knee-score-oks/ on 15 January 2020.
- ↑ 6.0 6.1 6.2 Makaram N, Lee T, Macdonald D, Clement ND. The verbal Oxford Knee Score is not clinically different from the written score when assessed before or after total knee arthroplasty. The Knee. 2020 Oct 1;27(5):1396-405.
- ↑ 7.0 7.1 Mikkelsen M, Gao A, Ingelsrud LH, Beard D, Troelsen A, Price A. Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements. Journal of Clinical Epidemiology. 2021 Apr 1;132:18-25.
- ↑ 8.0 8.1 8.2 Harris K, Dawson J, Gibbons E, Lim C, Beard D, Fitzpatrick R, Price A. Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty. Patient Relat Outcome Meas. 2016; 7: 101–108. Published online 2016 Jul 25. doi: 10.2147/PROM.S97774. Accessed 15 January 2020.
- ↑ Beard D, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, Price AJ. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2015 Jan;68(1):73-9. doi: 10.1016/j.jclinepi.2014.08.009. Epub 2014 Oct 31. Accessed 15 January 2020.
- ↑ Robb C, McBryde C, Caddy S, Thomas A, Pynser P. Oxford scores as a triage tool for lower limb arthroplasty lead to discrimination and health inequalities. Ann R Coll Surg Engl (Suppl) 2013; 95. Accessed 15 January 2020.