Analysis of the Quality of Life Domain in Knee Injury an Osteoarthritis Outcome Score as an Expansion of Western Ontario and McMaster Universities Osteoarthritis Index for Evaluating Knee Osteoarthritis Therapy Outcomes
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Published:
Dec 24, 2025
Keywords:
knee osteoarthritis, KOOS, WOMAC, quality of life, USD TENS
Main Article Content
Abstract
Introduction : Knee osteoarthritis is a degenerative joint disease causing pain and functional limitation, with rising prevalence globally and in Indonesia. Outcomes are commonly assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which evaluates pain, stiffness, and function, but excludes quality of life (QOL). Rehabilitation medicine emphasizes not only symptom relief but also recovery and life quality. The Knee Injury and Osteoarthritis Outcome Score (KOOS) adds a QOL domain for more comprehensive evaluation.
Method: A pre-post observational study was conducted on 24 knee osteoarthritis patients receiving ultrasound diathermy and transcutaneous electrical nerve stimulation (USD TENS). KOOS scores for pain, activities of daily living (ADL), and QOL were recorded before and after intervention. Paired t-tests or Wilcoxon tests analyzed score changes, while Pearson or Spearman tests assessed correlations between ?QOL and ?pain, ?ADL, and ?WOMAC.
Result: KOOS scores improved significantly after therapy (pre = 58.96; post = 33.29; p < 0.001), including QOL (p = 0.002), pain (pre = 52.50; post = 30.63; p = 0.000), and ADL (pre = 58.13; post = 37.92; p = 0.000). However, QOL changes were not significantly correlated with ?pain (r = 0.399; p = 0.053), ?ADL (? = 0.306; p = 0.146), or ?WOMAC (? = 0.356; p = 0.088).
Conclusion: The QOL domain in KOOS reflects a distinct dimension not captured by WOMAC. KOOS thus offers a more holistic and patient-centered evaluation of therapeutic outcomes, highlighting the importance of including QOL in rehabilitation medicine.
Keywords: knee osteoarthritis, KOOS, WOMAC, quality of life, USD TENS
Method: A pre-post observational study was conducted on 24 knee osteoarthritis patients receiving ultrasound diathermy and transcutaneous electrical nerve stimulation (USD TENS). KOOS scores for pain, activities of daily living (ADL), and QOL were recorded before and after intervention. Paired t-tests or Wilcoxon tests analyzed score changes, while Pearson or Spearman tests assessed correlations between ?QOL and ?pain, ?ADL, and ?WOMAC.
Result: KOOS scores improved significantly after therapy (pre = 58.96; post = 33.29; p < 0.001), including QOL (p = 0.002), pain (pre = 52.50; post = 30.63; p = 0.000), and ADL (pre = 58.13; post = 37.92; p = 0.000). However, QOL changes were not significantly correlated with ?pain (r = 0.399; p = 0.053), ?ADL (? = 0.306; p = 0.146), or ?WOMAC (? = 0.356; p = 0.088).
Conclusion: The QOL domain in KOOS reflects a distinct dimension not captured by WOMAC. KOOS thus offers a more holistic and patient-centered evaluation of therapeutic outcomes, highlighting the importance of including QOL in rehabilitation medicine.
Keywords: knee osteoarthritis, KOOS, WOMAC, quality of life, USD TENS
Article Details
How to Cite
Hidayatulloh, A., & Oka Narasara, G. G. (2025). Analysis of the Quality of Life Domain in Knee Injury an Osteoarthritis Outcome Score as an Expansion of Western Ontario and McMaster Universities Osteoarthritis Index for Evaluating Knee Osteoarthritis Therapy Outcomes. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 183 - 188. https://doi.org/10.36803/indojpmr.v14i2.506
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Original Article
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References
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7. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis Cartilage. 2016;24(8):1317-29. doi:10.1016/j.joca.2016.03.010.
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9. World Health Organization. Rehabilitation in health systems. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
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11. Yildiz SK, Özkan FÜ, Akta? ?, ?ilte AD, Kaysin MY, Badur NB. The effectiveness of ultrasound treatment for the management of knee osteoarthritis: a randomized, placebo-controlled, double-blind study. Turk J Med Sci. 2015;45(6):1187-93. doi:10.3906/sag-1408-81.
12. Lee Y, Lee SH, Lim SM, Baek SH, Ha IH. Mental health and quality of life of patients with osteoarthritis pain: The sixth Korea National Health and Nutrition Examination Survey (2013–2015). PLoS One. 2020;15(11):e0242077. doi:10.1371/journal.pone.0242077.
13. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi:10.1186/1477-7525-1-64.
14. Lyman S, Lee YY, Franklin PD, Li W, Mayman DJ, Padgett DE. Validation of the KOOS, JR: A short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res. 2016;474(6):1461-71. doi:10.1007/s11999-016-4719-1.
15. Shalhoub M, Anaya M, Deek S, Skaik R, El?Hassan H, Abu?Heija M, et al. The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC Musculoskelet Disord. 2022;23:248. doi:10.1186/s12891-022-05207-x.
16. Mezey GA, Paulik E, Máté Z. Effect of osteoarthritis and its surgical treatment on patients’ quality of life: a longitudinal study. BMC Musculoskelet Disord. 2023;24:537. doi:10.1186/s12891-023-06662-w.
17. Roos EM. 30 years with the Knee injury and Osteoarthritis Outcome Score (KOOS). Osteoarthritis Cartilage. 2024;32(4):421-9. doi:10.1016/j.joca.2024.01.003.
18. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. J Clin Epidemiol. 1998;51(11):1171–8. doi:10.1016/S0895-4356(98)00109-7.
19. Watson T. Ultrasound in contemporary physiotherapy practice. Ultrasonics. 2008;48(4):321–9.doi:10.1016/j.ultras.2008.02.004.
20. Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Soltani-Moghaddas SH, Moradi A, Mazloumi SM. “The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne algofunctional index (LFI) in patients with knee osteoarthritis: translation and validation of the Persian versions.” Arch Bone Jt Surg. 2015.
21. Paradowski PT, Englund M, Roos EM. “Validity and reliability of the Swedish version of the KOOS for patients with knee injury.” Health Qual Life Outcomes. 2006.
? Keduanya menunjukkan WOMAC bisa dipetik dari KOOS.
2. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59. doi:10.1016/S0140-6736(19)30417-9.
3. Butarbutar JCP, Basuki P, Sungono V, Riantho A, Fidiasrianto K. Burden of osteoarthritis in Indonesia: A Global Burden of Disease (GBD) study 2019. Narra J. 2024;4(2):e884. doi:10.52225/narra.v4i2.884.
4. Bellamy N. WOMAC Osteoarthritis Index User Guide. Version 3.1. Brisbane: Nicholas Bellamy; 2021 [cited 2025 Aug 12]. Available from: https://www.womac.com/womac/womac_userguide.php
5. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Care Res. 2001;45(5):453-61. doi:10.1002/1529-0131(200110)45:5<453::AID-ART365>3.0.CO;2-W.
6. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi:10.1186/1477-7525-1-64.
7. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis Cartilage. 2016;24(8):1317-29. doi:10.1016/j.joca.2016.03.010.
8. Kim GW. Patient-reported outcome measure of knee function: Knee injury and Osteoarthritis Outcome Score (KOOS). Ann Rehabil Med. 2023;47(6):441-3. doi:10.5535/arm.230009.
9. World Health Organization. Rehabilitation in health systems. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
10. Sharma A, Kumar S, Singh S, Gupta R, Mehta A, Kaur P, et al. Home care program and exercise prescription for improving quality of life in geriatric population with knee osteoarthritis: A systematic review and meta-analysis. J Bodyw Mov Ther. 2024;40:1645-56. doi:10.1016/j.jbmt.2024.05.014.
11. Yildiz SK, Özkan FÜ, Akta? ?, ?ilte AD, Kaysin MY, Badur NB. The effectiveness of ultrasound treatment for the management of knee osteoarthritis: a randomized, placebo-controlled, double-blind study. Turk J Med Sci. 2015;45(6):1187-93. doi:10.3906/sag-1408-81.
12. Lee Y, Lee SH, Lim SM, Baek SH, Ha IH. Mental health and quality of life of patients with osteoarthritis pain: The sixth Korea National Health and Nutrition Examination Survey (2013–2015). PLoS One. 2020;15(11):e0242077. doi:10.1371/journal.pone.0242077.
13. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi:10.1186/1477-7525-1-64.
14. Lyman S, Lee YY, Franklin PD, Li W, Mayman DJ, Padgett DE. Validation of the KOOS, JR: A short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res. 2016;474(6):1461-71. doi:10.1007/s11999-016-4719-1.
15. Shalhoub M, Anaya M, Deek S, Skaik R, El?Hassan H, Abu?Heija M, et al. The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC Musculoskelet Disord. 2022;23:248. doi:10.1186/s12891-022-05207-x.
16. Mezey GA, Paulik E, Máté Z. Effect of osteoarthritis and its surgical treatment on patients’ quality of life: a longitudinal study. BMC Musculoskelet Disord. 2023;24:537. doi:10.1186/s12891-023-06662-w.
17. Roos EM. 30 years with the Knee injury and Osteoarthritis Outcome Score (KOOS). Osteoarthritis Cartilage. 2024;32(4):421-9. doi:10.1016/j.joca.2024.01.003.
18. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. J Clin Epidemiol. 1998;51(11):1171–8. doi:10.1016/S0895-4356(98)00109-7.
19. Watson T. Ultrasound in contemporary physiotherapy practice. Ultrasonics. 2008;48(4):321–9.doi:10.1016/j.ultras.2008.02.004.
20. Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Soltani-Moghaddas SH, Moradi A, Mazloumi SM. “The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne algofunctional index (LFI) in patients with knee osteoarthritis: translation and validation of the Persian versions.” Arch Bone Jt Surg. 2015.
21. Paradowski PT, Englund M, Roos EM. “Validity and reliability of the Swedish version of the KOOS for patients with knee injury.” Health Qual Life Outcomes. 2006.
? Keduanya menunjukkan WOMAC bisa dipetik dari KOOS.