Koos, Jr. Knee Survey
This survey asks for your view about your knee. This information will help us keep track of how you feel about your knee and how well you are able to do your usual activities. Answer every question by choosing the most appropriate option.
Name
*
First Name
Last Name
Stiffness: The following question concerns the amount of joint stiffness you have experienced during the last week in your knee. Stiffness is a sensation of restriction or slowness in the ease with which you move your knee joint.
*
Rows
None
Mild
Moderate
Severe
Extreme
How severe is your knee stiffness after first wakening in the morning?
Pain: What amount of knee pain have you experienced the last week during the following activities?
*
Rows
None
Mild
Moderate
Severe
Extreme
Twisting/pivoting on your knee
Straightening knee fully
Going up or down stairs
Standing upright
Function, Daily Living: The following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your knee.
*
Rows
None
Mild
Moderate
Severe
Extreme
Rising from sitting
Bending to floor/pick up an object
Final Score
Date
*
-
Month
-
Day
Year
Date
Signature
*
Scoring Instructions
Raw Score
Interval Score
0
100.00
1
91.975
2
84.600
3
79.914
4
76.332
5
73.342
6
70.704
7
68.284
8
65.994
9
63.776
10
61.583
11
59.381
12
57.140
13
54.840
14
52.465
15
50.012
16
47.487
17
44.905
18
42.281
19
39.625
20
36.931
21
34.174
22
31.307
23
28.251
24
24.875
25
20.941
26
15.939
27
8.291
28
0.000
Submit
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