The Research of Pain and Functional Disability Assessment Scales for Knee Joint Disease

슬관절의 통증과 기능장애의 평가도구에 관한 연구

  • Jung, Chan-Yung (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul) ;
  • Kim, Eun-Jung (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul) ;
  • Hwang, Min-Seop (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul) ;
  • Cho, Hyun-Seok (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul) ;
  • Kim, Kyung-Ho (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul) ;
  • Lee, Seung-Deok (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul) ;
  • Kim, Kap-Sung (Department of Acupuncture & Moxibustion, Graduate School of Oriental Medicine, Dongguk Unive-Seoul)
  • 정찬영 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실) ;
  • 김은정 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실) ;
  • 황민섭 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실) ;
  • 조현석 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실) ;
  • 김경호 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실) ;
  • 이승덕 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실) ;
  • 김갑성 (동국대학교 서울캠퍼스 일반대학원 한의학과 침구학교실)
  • Received : 2010.03.19
  • Accepted : 2010.03.31
  • Published : 2010.04.20


Objectives : The knee pain is the main reason of getting acupuncture treatment. In order to have confidence in the results of a study, it is necessary to establish that questionnaire is both valid and reliable in questionnaire related study. The aim of this study was to review the instruments that are currently in sue for assessing the knee joint. Methods : A literature study was performed to choose appropriate scales for assessment for pain and the function of the knee. Theoretically based scales were selected for review. Therefore, 18 scales for knee and 9 scale for pain were reviewed. the status of scales involved in knee treatment of acupuncture throughout several countries was evaluated. Results & Conclusion : Lysholm Knee Scoring Scale, Cincinnati knee rating system(CKRS) are adequate for ligament injury in knee. International Knee Documentation Committee scoring system(IKDC) may become a publication requirement for journals in view of the international standing of the committee. The available outcome measure for use in osteoarthritis are Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), Lequesne Functional Severity Index(LFI) and Knee Injury and Osteoarthritis Outcome Score(KOOS), and in rheumatoid arthritis are McMaster-Toronto Arthritis patient function preference questionnaire(MACTAR), Quality of Life-Rheumatoid Arthritis Scale(QoL-RA Scale). Visual analog scale(VAS), verbal rating scale(VRS) are commonly used for the standard pain scale. For long term follow-up study The Medical Outcomes Study Short Form-36(SF-36), Arthritis Impact Measurement Scales(AIMS), Health Assessment Questionnaire(HAQ) should be included. Each measurement has its own composition and characteristics. Their validity, reliability, responsiveness and practical characteristics were already evaluated. We found 20 domestic and 28 overseas papers about knee treatment using acupuncture assessed with knee scales.


  1. 대한정형외과학회. 정형외과학(5판). 최신의학사. 1999 : 497.
  2. Cyriax. 정형의학. 영문출판사. 1998 : 3-18.
  3. 류성룡, 안경애, 서병관, 강중원, 이상훈, 이재동, 최도영, 김건식, 이두익, 이윤호. 퇴행성 슬관절염환자 평가 설문도구의 내적 신뢰도, 상관성에 관한 연구. 대한침구학회지. 2005 ; 22(3) : 271-80.
  4. Cougados M, Gueguen A, Nguyen M, Thiesce A, Listrat V, Jacob L. Longitudinal radiologic evaluation of osteoarthritis of the knee. J Rheumatol. 1992 ; 19 : 378-84.
  5. Slevin ML, Plant H, Lunch D, Drinkwater J, Gregory WM. Who should measure quality of life, the doctor or the patient?. Br J Cancer. 1988 ; 57 : 109-12.
  6. Ware JE Jr, Sherbourne CD. The MOS 36-item short form health survey(SF-36) 1 : Conceptual frame-work and item selection. Med Care. 1992 ; 30 : 473-81.
  7. Koran LM. The reliability of clinical methods,data and judgements(first of two parts). N Engl J Med. 1975 ; 293 : 642-6.
  8. Sun Y, Sturumer T, Gunther K, Brenner H. Reliability and validity of clinical outcome measurements of osteoarthritis of the hip and kneea review of the literature. Clin Rheumatol. 1997 ; 16 : 185-18.
  9. 서승석, 정경칠, 김영복. 슬관절 손상에 대한 국문 Knee Injury and Osteoarthritis Outcome Score (KOOS)의 적용을 통한 타당성, 신뢰성 및 반응성 평가. 대한정형외과학회지. 2006 ; 41(3) : 441-53.
  10. 신승우, 김성수. 슬관절 평가법에 관한 고찰. 한방재활의학과학회지. 2002 ; 12(3) : 23-35.
  11. O'Donoghue DH. An analysis of end results of surgical treatment of major injuries to ligaments of the knee. J Bone Joint Surg. 1955 ; 37A : 1-13.
  12. Meenan RF, Gertman PM, Mason JH. Measuring health status in arthritis: the Arthritis Impact Measurement Scales. Arthritis Rheum. 1980 ; 23 : 146-52.
  13. Mason JH, Meenan RF, Anderson JJ. Do self-reported arthritis symptom (RADAR) and health status(AIMS2) data provide duplicative or complementary information? Arthritis Care Res. 1992 Sep ; 5(3) : 163-72.
  14. 황보각. 퇴행성 슬관절염 환자의 한국형 WOMAC과 기능적 보행성취도와의 상관관계 연구. 대구대학교 대학원. 재활과학과 물리치료전공. 박사학위논문. 2004.
  15. 박혜자, 김세현, 배상철. 한국인 질환-특이 및 영역-특이 건강 관련 삶의 질 연구 현황. 대한류마티스학회지. 2002 ; 9(4) : S18-S38.
  16. Meenan RF, Mason JH, Anderson JJ, Guccione AA, Kazis LE. AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum. 1992 ; 35 : 1-10.
  17. 이재호, 신호철, 김철환, 양윤준, 원장원, 조경환, 조비룡, 정화재, 빈성일, 박은숙. 한국형 AIMS2의 타당도와 신뢰도. 가정의학회지. 2003 ; 24 : 19-44.
  18. Guillemin F, Coste J, Pouchot J, Ghezail M, Bregeon C, Sany J. The AIMS2-SF : a short form of the Arthritis Impact Measurement Scales 2. French Quality of Life in Rheumatology Group. Arthritis Rheum. 1997 Jul ; 40(7) : 1267-74.
  19. Ren XS, Kazis L, Meenan RF. Short-form Arthritis Impact Measurement Scales: tests of reliability and validity among patients with osteoarthritis. Arthritis Care Res. 1999 Jun ; 12(3) : 163-71.<163::AID-ART3>3.0.CO;2-Z
  20. Haavardsholm EA, Kvien TK, Uhlig T, Smedstad LM, Guillemin F. A comparison of agreement and sensitivity to change between AIMS2 and a short form of AIMS2(AIMS2-SF) in more than 1,000 rheumatoid arthritis patients. J Rheumatol. 2000 Dec ; 27(12) : 2810-6.
  21. Bae SC, Cook EF, Kim SY. Psychometric evaluation of a Korean Health Assessment Questionnaire for clinical research. J Rheumatol. 1998 ; 25 : 1975-9.
  22. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 ; 23 : 137-45.
  23. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire : a review of its history, issues, progress and documentation. J Rheumatol. 2003 ; 30(1) : 167-78.
  24. 권영대, 강성욱, 장혜정, 이미준, 유창훈, 지남주. 슬관절 치환술의 비용최소화 분석-가정간호서비스를 중심으로. 성균관대학교 의과대학 삼성의료경영연구소. 2005 ; 66-74.
  25. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC : a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 ; 15 : 1833-40.
  26. Bae SC, Lee HS, Yun HR, Kim TH, Yoo DH, Kim SY. Cross-cultural adaptation and validation of Korean Western Ontario and McMaster Universities(WOMAC) and Lequesne osteoarthritis indices for clinical research. Osteoarthritis Cartilage. 2001 ; 9 : 746-50.
  27. 고재근. 한국인 슬관절 질환의 환자에 대한 단순 번역 WOMAC과 한국형 WOMAC의 적용 결과. 석사논문. 2007.
  28. 이승주, 이현주, 우영근. WOMAC-VA3.0의 타당도 및 신뢰도. 한국전문물리치료학회지. 2008 ; 15(2) : 20-9.
  29. 고은경, 이충휘. 한국판 Western Ontario MacMaster WOMAC)의 Rasch 분석. 한국전문물리치료학회지. 2007 ; 14(1) : 82-9.
  30. Wolfe F. Determinants of WOMAC function, pain and stiffness score : Evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia, Rheumatology. 1999 ; 38 : 355-61.
  31. Wolfe F & Kong SX. Research analysis of the Western Ontario MacMaster questionnaire(WOMAC) in 2205 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Ann Rheum Dis. 1999 ; 58(9) : 563-8.
  32. EH Tuzun, L Eker, A Daskapan, M Bayramoglu. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteo Arthritis and Cartilage. 2005 ; 13 : 28-33.
  33. Roos EM, Roos HP, Ekdahl C, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS)-validation of a Swedish version. Scand J Med Sci Sports. 1998 ; 8 : 439-48.
  34. Roos EM, Roos HP, Lohmander LS. WOMAC Osteoarthritis Index-additional dimensions for use in subjects with post-traumatic osteoarthritis of the knee. Western Ontario and MacMaster Universities. Osteoarthritis Cartilage. 1999 ; 7(2) : 216-21
  35. Roos EM, Lohmander LS. The knee injury andOsteoarthritis Outcome Score(KOOS) : from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003 ; 1 : 64.
  36. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score(KOOS)-development of a selfadministered outcome measure. J Orthop Sports Phys Ther. 1998 ; 28 : 88-96.
  37. Lequesne M. Indexes of severity for OA of the hip and knee. Scan J Rheumatol. 1987 ; 65 : 85-9.
  38. Dougados M. Monitoring osteoarthritis progression and therapy. Osteoarthritis Cartilage. 2004 ; 12 : S55-S60.
  39. Caroline B, Richard H O, Fiona L, Melissa M. Referral for Joint Replacement-A management guide for health providers. Final document resulting from consultation. April, 2007.
  40. Dawson J, Fitzpatrick R, Murray D, Carr A.Questionnaire on the perceptions of patients about total knee replacement surgery. J Bone Joint Surg. 1998 ; 80-B : 63-9.
  41. Tugwell P, Bombardier C, Buchanan W, Goldsmith CH, Grace E, Hanna B. The MACTAR Patient Preference Disability Questionnaire : An individualised functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol. 1987 Jun ; 14(3) : 446-51.
  42. Marshall JL, Fetto JF, Botero PM. Knee ligament injuries. A standardized evaluation method. Clin Orthop. 1977 ; 123 : 159-74.
  43. 조우신, 박수성, 김덕현, 정용갑, 백승기, 박천주. HSS 슬관절 평가 지수에 대한 신뢰성. 대한슬관절학회지. 2000 ; 12(1) : 43-7.
  44. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982 ; 10 : 150-4.
  45. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 ; 198 : 43-9.
  46. Hooher J, Bach T, Müunster A, Bouillon B, Tiling T. Does the mode of data collection change results in a subjective knee score? Self-administration versus interview. Am J Sports Med. 1997 ; 25 : 642-7.
  47. Koh SB, Chang SJ, Kang MG, Cha BS, Park JK. Reliability and validity of measurement instrument for health status assessment in occupational worker. Korean J Prev Med. 1997 ; 30 : 251-66.
  48. Irrgang JJ, Ho H, Harner CD. Use of the international knee documentation committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee surg sports traumatol arthrose. 1998 ; 6 : 107.
  49. Insall JN, Dorr LD, Scott RD and Scott WN. Rationale of the knee society clinical rating system. Clin Orthop. 1989 ; 248 : 13.
  50. 임수재, 우승한, 송화용, 이병일. 슬개골 표면치환을 하지 않은 슬관절 인공관절 치환술. 대한슬관절학회지. 2004 ; 16(2) : 94-9.
  51. Noyes FR, Mc Ginniss GH, Mooar LA. Functional disability in the anterior cruciate insufficient knee syndrome. Review of knee rating systems and projected risk factor in determining treatment. Sports Med. 1984 ; 1 : 278-302.
  52. Noyes FR, Barber SD, Mooar LA. A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop. 1989 ; 246 : 238-49.
  53. 오광택, 곽은주, 주은경, 김태환, 이지현, 정원태, 최정윤, 배상철. 한국인 류마티스 질환과 건강 관련 삶의 질. 대한류마티스학회지. 2002 ; 9(4) : S39-S59.
  54. McHorney CA, Ware JE, Raczek AE. The MOS 360item short form health survey(SF-36) : II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical care. 1993 ; 31 : 247-63.
  55. Baumgaertner MR, Cannon WD Jr, Vittori JM, Schmidt ES, Maurer RC. Arthroscopic debridement of the arthritic knee. Clin Orthop Relat Res. 1990 ; 253 : 197-202.
  56. Felson DT, Naimark A, Andersin J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in elderly : the Framingham Study. Arthritis Rheum. 1987 ; 30 : 914-18.
  57. 양동훈, 김건형, 김행범, 최양식, 박영배. 견관절의 임상적 평가도구에 관한 고찰. 대한침구학회지. 2007 ; 24(6) : 123-35.