KOOS-JR
Knee Injury and Osteoarthritis Outcome Score
Name
*
First Name
Last Name
Email
*
example@example.com
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Please Select
Male
Female
Non-binary
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
If you are completing this form regarding a different date, enter it here (Month, Day, Year)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Enter your current height (in or cm)
Enter your current weight (lbs or kg)
Please indicate which knee this survey is about:
*
Left
Right
VAS: Overall, how bad is your pain (0=no pain, 100 =maximum imaginable pain)
*
Stiffness
*
Rows
None
Mild
Moderate
Severe
Extreme
1. How severe is your knee stiffness after first waking in the morning?
Pain - What amount of knee pain have you experienced in the LAST WEEK during the following activities?
*
Rows
None
Mild
Moderate
Severe
Extreme
2. Twisting / pivoting your knee
3. Straightening knee fully
4. Going up or down stairs
5. Standing upright
Function, daily living - Thinking about the LAST WEEK: The following questions concern your physical function. By this we mean your ability to move around and to look after yourself.
*
Rows
None
Mild
Moderate
Severe
Extreme
6. Rising from sitting
7. Bending to floor / pick up an object
Overall KOOS-Jr Score (0-28)
Submit
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