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The primary aim of this study was to develop a patient-reported Activity & Participation Questionnaire (the OKS-APQ) to supplement the Oxford knee score, in order to assess higher levels of activity and participation. The generation of items for the questionnaire involved interviews with 26 patients. Psychometric analysis (exploratory and confirmatory factor analysis and Rasch analysis) guided the reduction of items and the generation of a scale within a prospective study of 122 relatively young patients (mean age 61.5 years (42 to 71)) prior to knee replacement. A total of 99, completed pre-operative and six month post-operative assessments (new items, OKS, Short-Form 36 and American Knee Society Score). The eight-item OKS-APQ scale is unidimensional, reliable (Cronbach's alpha 0.85; intraclass correlation coefficient (ICC) 0.79; or 0.92 when one outlier was excluded), valid (r > 0.5 with related scales) and responsive (effect size 4.16). We recommend that it is used with the OKS with adults of all ages when further detail regarding the levels of activity and participation of a patient is required.

Original publication




Journal article


Bone Joint J

Publication Date





332 - 338


Knee arthroplasty, Knee osteoarthritis, Oxford knee score, Patient-reported outcome measure, Activities of Daily Living, Adult, Aged, Disability Evaluation, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Osteoarthritis, Knee, Psychometrics, Reproducibility of Results, Surveys and Questionnaires