Knee Pain Questionnaire

Knee Pain QuestionnaireDuring the past 4 weeks…circle one answer only1) How would you describe the pain you usually have from your knee? 1) None2) Very mild3) Mild4) Moderate5) Severe2) Have you had any trouble with washing and drying yourself (all over) 1) No trouble at allbecause of your knee?2) Very little trouble3) Moderate trouble4) Extreme difficulty3) Have you had any trouble getting in and out of a car or using publictransportation because of your knee?4) For how long can you walk before the pain from yourknee becomes severe? (with or without a walking aid)5) After a meal (sitting down), how painful has it been for you to standup from a chair because of your knee?5) Impossible to do1) No trouble at all2) Very little trouble3) Moderate trouble4) Extreme difficulty5) Impossible to do1) more than 30 minutes/no pain2) 16 to 30 minutes3) 5 to 15 minutes4) Around the house only5) Not at all/severe immediately1) Not at all painful2) Slightly painful3) Moderately painful4) Very painful5) Unbearable6) Have you been limping when walking, because of your knee? 1) Rarely/never2) Sometimes or just at first3) Often, not just at first4) Most of the time5) All of the time7) Could you kneel/squat down and get up again afterwards? 1) Yes, easily2) With little difficulty3) With moderate difficulty4) With extreme difficulty5) No, impossible8) Have you been troubled by pain from your knee in bed at night? 1) No nights2) Only 1 or 2 nights3) Some nights4) Most nights5) Every night9) How much has pain from your knee interfered with your usual work(including housework)?1) Not at all2) A little bit3) Moderately4) Greatly

10) Have you felt that your knee might suddenly “give way” or let youdown?5) Totally1) Rarely/never2) Sometimes or just at first3) Often, not just at first4) Most of the time5) All of the time11) Could you do household shopping on your own? 1) Yes, easily2) With little difficulty3) With moderate difficulty4) With extreme difficulty5) No, impossible12) Could you walk down a flight of stairs? 1) Yes, easily2) With little difficulty3) With moderate difficulty4) With extreme difficulty5) No, impossibleTotal Score (add all circled answers) = ____________Oxford Hip/Knee ScoringTotal Score12-20 May indicate satisfactory joint function. May not require any formaltreatment.21-30 May indicate mild to moderate arthritis. Consider seeing your familyphysician for an assessment and possible x-ray. You may benefit fromnon-surgical treatment, such as exercise, weight loss, and/or antiinflammatorymedication.31-40 May indicate moderate to severe arthritis. See your family physician foran assessment and x-ray. Consider a consult with an Orthopedic Surgeon.41-60 May indicate severe arthritis. It is highly likely that you may well requiresome form of surgical intervention, contact your family physician for aconsult with an Orthopedic Surgeon.