KOOS RESULT

Date: [Date]
Patient: [Name or ID, age]
Version: [Full 42-item KOOS, KOOS-12, or KOOS JR; official form and language]
How it was completed: [Paper in clinic, online before the visit, or tablet in the waiting room]

KNEE
Side scored: [Left or right; the knee the patient was asked to answer about]
Diagnosis: [Osteoarthritis, ligament or meniscus injury, cartilage lesion, or other]
Surgery: [Procedure and date, or none]
Visit: [Pre-treatment baseline, or weeks or months since surgery or injury]

SUBSCALE SCORES
Pain: [0 to 100; items answered out of 9]
Symptoms: [0 to 100; items answered out of 7]
Activities of daily living: [0 to 100; items answered out of 17]
Sport and recreation: [0 to 100; items answered out of 5, or not scored and why]
Knee-related quality of life: [0 to 100; items answered out of 4]
Short-form score: [KOOS-12 summary or KOOS JR interval score, if that version was used]

CHANGE FROM BASELINE
Baseline scores: [Date and all five subscale scores]
Change per subscale: [Points gained or lost on each; 8 to 10 points or more is a meaningful change]
Previous result: [Date and scores at the last review]

INTERPRETATION
Profile: [Which subscales are near normal and which lag behind]
What the patient reports: [The activities and worries behind the lowest subscale, in their words]
Exam and imaging: [Range of motion, effusion, quadriceps strength, stability, X-ray]
Impression: [What the scores add to the diagnosis and the expected course]

PLAN
Treatment: [Exercise therapy, weight management, injection, bracing, surgery, or rehab phase]
Work, sport, and activity: [What the patient can do now, and the tests needed before more]
Repeat KOOS: [Date or interval, with the same version]

Clinician: [Name, credentials]