Abstract
Background: The Knee Injury and Osteoarthritis Outcome Score (KOOS) scale is used to assess patient perspectives on knee health. However, the structural validity of the KOOS has not been sufficiently tested; therefore, our objective was to assess the KOOS in a large, multi-site database of patient responses who were receiving care for knee pathology. Methods: A cross-sectional study was conducted using the Surgical Outcome System (SOS) database. A confirmatory factor analysis (CFA) was conducted to assess the proposed five-factor KOOS using a priori cut-off values. Because model fit indices were not met, a subsequent exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting four-factor structure (i.e., KOOS SF-12) was then assessed using CFA and subjected to multigroup invariance testing. Results: The original KOOS model did not meet rigorous CFA fit recommendations. The KOOS SF-12 did meet model fit recommendations and passed all invariance testing between intervention procedure, sex, and age groups. Conclusion: The KOOS failed to meet model fit recommendations. The KOOS SF-12 met model fit recommendations, maintained a multi-factorial structure, and was invariant across all tested groups. The KOOS did not demonstrate sound structural validity. A refined KOOS SF-12 model that met recommended model fit indices and invariance testing criteria was identified. Our findings provide initial support for a multidimensional KOOS structure (i.e., KOOS SF-12) that is a more psychometrically sound instrument for measuring patient-reported knee health.