title: Development of an Encompassing Questionnaire for Evaluating the Outcomes Following Total Knee Arthroplasty.
abstract: BACKGROUND
  There are many standardized scales and questionnaires used to evaluate TKA patients; however, individually they do not always assess patients adequately. Consequently, many are used in combinations to provide a thorough evaluation. However, this leads to redundancy, confusion, and an excessive patient time-burden. Therefore, the purpose of this study was to develop a usable combined knee questionnaire that combines questions in a non-redundant manner. Specifically, we aimed to: 1) create a combined knee questionnaire that encompasses questions from multiple systems, while eliminating redundancy; 2) correlate the new system with the existing validated questionnaires; and 3) determine the length of time it takes to administer this new questionnaire.
  
  
  METHODS
  In a previous study, it was determined that the six most commonly cited validated systems to assess the knee were the: Knee Society Score (KSS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Functional Scale (LEFS), Activity Rating Scale (ARS), and Short-Form-36 (SF-36). Therefore, we ensured that the new questionnaire encompassed all elements of these systems. After development of the combined questionnaire, we co-administered it to 20 subjects alongside the above validated questionnaires. We then transposed the corresponding answers from the combined questionnaire to each selected validated system to perform an intra-class correlation analysis. In addition, we recorded the length of time it took to administer the new questionnaire and compared it to the time it took to administer the individual validated questionnaires.
  
  
  RESULTS
  Intra-class correlation analysis demonstrated statistically significant positive correlations between the KSS, WOMAC, KOOS, LEFS, ARS, SF-36, and the corresponding questions in the combined questionnaire. The mean length of time it took to administer the combined questionnaire (mean, 10.1 minutes, range, 6.6 to 12.6 minutes) was significantly shorter than the time it took to administer the selected validated questionnaires (mean, 21.3 minutes, range, 17.3 to 24.1 minutes).
  
  
  CONCLUSIONS
  We have proposed an all-encompassing combined knee questionnaire that eliminates redundancy and inefficiency during the evaluation of TKA patients. It is a reliable, time-efficient system that can be utilized to fill out the most commonly used questionnaires for assessing TKA. Standardization and uniform use of this questionnaire may simplify future patient assessment following TKA.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Melbin
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Chukwuweike U
authors.initials: CU
authors.lastname: Gwam
authors.affiliation: Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland.
authors.forename: Julio J
authors.initials: JJ
authors.lastname: Jauregui
authors.affiliation: Department of Orthopaedic Surgery, University of Mississippi, Jackson, Mississippi.
authors.forename: Randa K
authors.initials: RK
authors.lastname: Elmallah
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, Florida.
authors.forename: Martin
authors.initials: M
authors.lastname: Roche
authors.affiliation: Hip, Knee, and Shoulder Surgery, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome