Garratt A M, Brealey S, Gillespie W J
Department of Public Health, University of Oxford, UK.
Rheumatology (Oxford). 2004 Nov;43(11):1414-23. doi: 10.1093/rheumatology/keh362. Epub 2004 Aug 17.
To identify patient-assessed health instruments specific to the knee and review evidence for reliability, validity and responsiveness.
Instruments were identified through systematic searches of the literature. Information relating to instrument content, patient population, reliability, validity and responsiveness was extracted from published papers.
The 16 instruments that met the inclusion criteria varied in length from 4 to 42 items. The majority form a single index; six produce a profile of scores. Eight have been evaluated in patients with a variety of knee problems. All instruments have satisfactory internal or test-retest reliability. However, there is limited empirical support for the health domains of six instruments. Patients informed the development of items within just five instruments. Few authors gave explicit consideration to the size of expected relationships in tests of construct validity. Eleven instruments have evidence for responsiveness to changes in health. The minimally important difference was not determined for any of the instruments.
In the absence of comparative evidence, the large number of patient-assessed instruments for knee problems makes instrument selection difficult. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Pain Scale and Oxford Knee Score have good evidence for reliability, content validity and construct validity. The KOOS and Oxford instruments also have evidence for responsiveness. The instruments have not been evaluated for all knee problems, and instrument appropriateness, including content relevance, must be assessed before application. The comparative evaluation of instruments is recommended.
识别患者自评的膝关节特异性健康评估工具，并综述其信度、效度和反应度的证据。
通过系统检索文献来识别评估工具。从已发表的论文中提取与评估工具内容、患者群体、信度、效度和反应度相关的信息。
符合纳入标准的16种评估工具的条目数从4条到42条不等。大多数形成单一指数；6种生成分数概况。8种已在患有各种膝关节问题的患者中进行了评估。所有评估工具都具有令人满意的内部信度或重测信度。然而，6种评估工具的健康领域的实证支持有限。只有5种评估工具的条目开发有患者参与。在结构效度测试中，很少有作者明确考虑预期关系的大小。11种评估工具具有对健康变化的反应度证据。没有任何一种评估工具确定了最小重要差异。
在缺乏比较证据的情况下，大量患者自评的膝关节问题评估工具使得工具选择变得困难。膝关节损伤和骨关节炎疗效评分（KOOS）、膝关节疼痛量表和牛津膝关节评分在信度、内容效度和结构效度方面有充分的证据。KOOS和牛津评估工具也有反应度的证据。这些评估工具尚未针对所有膝关节问题进行评估，在应用前必须评估工具的适用性，包括内容相关性。建议对评估工具进行比较评价。
