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Psychometric properties of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) Spanish version for people with knee osteoarthritis

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To evaluate the validity, reliability, and responsiveness to change of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS) Spanish version questionnaire. This study was based on a questionnaire validation design. A cross-sectional survey of 199 patients with knee osteoarthritis (KOA) and ten healthy controls was studied to evaluate the validity and reliability of KOOS-12. One hundred and sixteen patients were assessed for test-retest reliability, and 38 patients were included for a responsiveness assessment. Structural validity was assessed by the confirmatory factor analysis (CFA). Item response theory-based methods were used to determine the performance of the items. Internal consistency reliability was appropriate for all scales (Cronbach’s alpha = 0.85–0.94). The intra-class correlation coefficient of KOOS-12 scales ranged from 0.60 to 0.71. The CFA and generalized partial credit model showed that KOOS-12 scales presented a good overall model fit. No differential item functioning was found. Convergent validity was demonstrated by strong correlations (Spearman’s rho ≥ 0.70) with KOOS, International Knee Documentation Committee subjective knee evaluation form (IKDC), and Knee Intermittent and Constant Osteoarthritis Pain (ICOAP). Known-groups validity showed that KOOS-12 well discriminated subgroups of patients (radiographic severity and nutritional status). Standardized response means for KOOS-12 scales were ≥ 0.75. Changes in KOOS-12 scales had a moderate to strong correlation (Pearson’s r ≥ 0.40) with the changes in the KOOS, ICOAP, and IKDC scales. The KOOS-12 Spanish version is a valid, reliable, and responsiveness to change questionnaire to measure patients’ opinions about their knee and associated problems in Mexican subjects with KOA.

Key Points

KOOS-12 is a short self-reported measure that assesses patient’s opinions about the difficulties they experience due to problems with their knee and also covers aspects of pain, functional limitations, and knee-related quality of life.

• The Spanish version of KOOS-12 questionnaire is a valid instrument for measuring the patients’ opinions about their knee and associated problems, and is both reliable and responsiveness to change.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



Conceptualization and design: Gabriel Horta-Baas; Rodrigo Vargas-Mena; Erik Alejandre; Ingris Peláez-Ballestas; María del Socorro Romero-Figueroa; and Gloria Queipo.

Provision of study materials or patients: Gabriel Horta-Baas; Rodrigo Vargas-Mena; and Erik Alejandre.

Analysis: Gabriel Horta-Baas; Ingris Peláez-Ballestas; María del Socorro Romero-Figueroa; and Gloria Queipo.

Data interpretation: Gabriel Horta-Baas; Rodrigo Vargas-Mena; Erik Alejandre; Ingris Peláez-Ballestas; María del Socorro Romero-Figueroa; and Gloria Queipo.

Manuscript writing: Gabriel Horta-Baas.

Manuscript review final approval: Gabriel Horta-Baas; Rodrigo Vargas-Mena; Erik Alejandre; Ingris Peláez-Ballestas; María del Socorro Romero-Figueroa; and Gloria Queipo.

Corresponding author

Correspondence to Gabriel Horta-Baas.

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The authors declare that there is no conflict of interest regarding the publication of this paper.

Ethics approval and consent to participate

The research ethics committee of the Instituto Mexicano del Seguro Social approved this study. Informed consent was obtained from all individual participants included in the study.

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Horta-Baas, G., Vargas-Mena, R., Alejandre, E. et al. Psychometric properties of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) Spanish version for people with knee osteoarthritis. Clin Rheumatol 40, 1547–1558 (2021).

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