Adjustments in 2011 KSS increase the clinical suitability

Remco N. Dinjens*, Bernd Grimm, Ide C. Heyligers, Rachel Senden

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)


The 2011 KSS is a valid clinical TKA questionnaire, but with a low completion rate (42%). Adjustments, focusing on optimizing scale features, are required to improve its clinical use. The low completion rates, non-optimal scale features, lacking rules or a combination of these factors where addressed, leading to the development of the adjusted 2011 KSS (2011 KSS-A). Four-hundred-ninety-nine primary TKA patients were addressed pre- and postoperative by mail. Clinimetric quality was evaluated. Seventy percent responded and 90% completed the scale. Internal consistency proved excellent with Cronbach's Alpha ≥ 0.79 for all subscales. Strong correlations were found between the Functional Activity subscales and KOOS-PS (r = -0.63 to -0.87). All subscales improved significantly after intervention (r-range 14-33%, effect size 0.50-2.85). Postoperatively, ceiling effects were found in the subscales Symptoms (16%) and Walking & Standing (26%). Adjustments led to a shortened and simplified questionnaire while maintaining its clinimetric quality.

Original languageEnglish
Pages (from-to)43-51
Number of pages9
JournalActa Orthopaedica Belgica
Issue number1
Publication statusPublished - 2016
Externally publishedYes


  • 2011 knee society score
  • Adjustments
  • Functional outcome
  • Patient-reported outcome measure


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