My Image

KOOS Knee Survey (Knee Osteoarthritis Outcome Survey)

Today’s Date
 

First Name

Last Name

Date of Birth
 

Date of Surgery
 

What Time Period Are You Reporting?

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.

1. 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?

2. Twisting/pivoting on your knee

3. Straightening knee fully

4. Going up or down stairs

5. 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.

6. Rising from sitting

7. Bending to floor/pick up an object