Knee Quiz

Clinician’s name (or ref) June 13, 2019
Date of completionPatient’s name (or ref)
Please answer the following 12 multiple choice questions.
During the past 4 weeks……
1. How would you describe the pain you usually have in your knee? 7. Could you kneel down and get up again afterwards?
none yes, easily
very mild with little difficulty
mild with moderate difficulty
moderate with extreme difficulty
severe no, impossible
2. Have you had any trouble washing and drying yourself (all over) because of your knee? 8. Are you troubled by pain in your knee at night in bed?
no trouble at all not at all
very little trouble only one or two nights
moderate trouble some nights
extreme difficulty most nights
impossible to do every night
3. Have you had any trouble getting in and out of the car or using public transport because of your knee? (with or without a stick) 9. How much has pain from your knee interfered with your usual work? (including housework)
no trouble at all not at all
very little trouble a little bit
moderate trouble moderately
extreme difficulty greatly
impossible to do totally
4. For how long are you able to walk before the pain in your knee becomes s eve re? (with or without a stick) 10. Have you felt that your knee might suddenly “give away” or let you down?
no pain > 60 min rarely / never
16 – 60 minutes sometimes or just at first
5 – 15 minutes often, not at first
around the house only most of the time
not at all – severe on walking all the time
5. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee? 11. Could you do household shopping on your own?
not at all painful yes, easily
slightly painful with little difficulty
moderately pain with moderate difficulty
very painful with extreme difficulty
unbearable no, impossible
6. Have you been limping when walking, because of your knee? 12. Could you walk down a flight of stairs?
rarely / never yes, easily
sometimes or just at first with little difficulty
often, not just at first with moderate difficulty
most of the time with extreme difficulty
all of the time no, impossible
Knee Quiz Score Is:

 

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Interpreting The Score
score 0 to 19 may indicate severe knee arthritis. it is highly likely that you may well require some form of surgical intervention, contact your family physician for a consult with an orthopaedic surgeon.
score 20 to 29 may indicate moderate to severe knee arthritis. see your family physician for an assessment and x-ray. consider a consult with an orthopaedic surgeon.
score 30 to 39 may indicate mild to moderate knee arthritis. consider seeing your family physician for an assessment and possible x-ray. you may benefit from non-surgical treatment, such as exercise, weight loss, and /or anti-inflammatory medication
score 40 to 48 may indicate satisfactory joint function. may not require any formal treatment.