Item selection for 12-item short forms of the knee injury and Osteoarthritis Outcome Score (KOOS-12) and hip disability and Osteoarthritis Outcome Score (HOOS-12)

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Epidemiology | Health Services Research | Musculoskeletal Diseases | Orthopedics


OBJECTIVE: To develop 12-item short forms (KOOS-12, Hip disability and Osteoarthritis Outcome Score (HOOS)-12) of the 42-item Knee injury and Osteoarthritis Outcome Score (KOOS) and 40-item HOOS that represent the full-length instruments sufficiently to provide joint-specific pain, function and quality of life (QOL) domain and summary joint impact scores. This paper describes KOOS-12 and HOOS-12 item selection. Subsequent papers will examine KOOS-12 and HOOS-12 reliability, validity and responsiveness.

DESIGN: Items were selected based on qualitative information from patients, clinicians and KOOS/HOOS translators and analysis of data from 1,395 knee osteoarthritis (OA) and 1,281 hip OA patients from the FORCE-TJR cohort who completed KOOS or HOOS before and after total joint replacement (TJR). Item response theory models and computerized adaptive test (CAT) simulations were used to identify items that best measured patients' levels of pain and function pre- and post-TJR. KOOS-12/HOOS-12 items were selected based on content, coverage of a wide measurement range, high item information, item usage in computerized adaptive testing (CAT) simulations, scale-level properties (reliability, validity, responsiveness), and qualitative information.

RESULTS: KOOS-12 and HOOS-12 each included a pain frequency item and three items measuring pain during increasingly difficult activities (sitting/lying, walking, up/down stairs); function items about standing, rising from sitting, getting in/out of a car, and twisting/pivoting (KOOS-12) or walking on an uneven surface (HOOS-12); and the original 4-item QOL scale.

CONCLUSIONS: This study demonstrated the benefits of examining patient-reported outcome measures using modern psychometric methods, to create short forms with diverse content that provide domain-specific and summary joint impact scores.


HOOS, Item response theory, KOOS, Osteoarthritis, Patient reported outcome measures, Psychometrics

DOI of Published Version



Osteoarthritis Cartilage. 2018 Dec 26. pii: S1063-4584(18)31585-1. doi: 10.1016/j.joca.2018.11.011. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Osteoarthritis and cartilage

PubMed ID


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Link to Article in PubMed